During a clinical trial comparing bolus 5FU alone to bolus 5FU with oxaliplatin, some patients in both arms of the trial developed severe diarrhea and signs of injury to the walls of their colons.  Diarrhea and dehydration required hospitalization, and x-rays or scopes revealed damage to the bowel itself. 

The clinical trial NSABP C-07 compared weekly bolus injections of 5FU modified with leucovorin (Roswell Park regimen or FL) to the same treatment with oxaliplatin added (FLOX).  Patients were receiving chemotherapy after surgery for stage II or III colon cancer.

Bowel wall injury was characterized by:

• hospitalization for severe diarrhea and dehydration
• bowel wall thickening or ulceration shown in x-rays or endoscopy

There were 1857 patients in the trial.  Of those

• 79 (4.3 percent) developed bowel wall injury syndrome
• 38 (35.4%) in the 5FU/L only arm
• 51 (64.6%) in the FLOX arm with oxaliplatin
• 30 patients developed a serious bowel infection (enteric sepsis) with severe diarrhea and low white cell counts:  22 in the FLOX arm and 8 among those treated with FL only.

This severe gastrointestinal toxicity usually occurred in the third or fourth week during the first treatment cycle.  Patients were hospitalized and treated with fluids, medication to manage diarrhea, and antibiotics.

There were 5 deaths ((0.3%) during the trial due to bowel toxicity.  Two were related to infection (enteric sepsis) and three to both enteric sepsis and bowel wall injury.

Dr. J. Phillip Kuebler, MD and his colleagues warned,

Patients treated with adjuvant FL should be closely monitored for diarrhea and aggressively managed, especially if oxaliplatin has been added to the regimen.

Previously, overall results of the clinical trial were published in the Journal of Clinical Oncology showing a significant improvement in disease-free survival both three and four years after treatment when oxaliplatin (FLOX) was added to the bolus 5FU and leucovorin regimen (FL).  At three years, disease-free survival was 71.8 percent for FL and 76.1% for FLOX.  After four years, it was 67.0 percent for FL and 73.2 percent for FLOX. 

Bolus treatments are short injections into a vein.  5FU is also administered by continuous infusion, pumped more slowly into the vein over a two day period.  With oxaliplatin, this treatment for colorectal cancer is called FOLFOX.

SOURCE:  Kuebler et al, Cancer, Volume 110, Issue 9, November 2007.

An Italian study has found that CT-Colonography (virtual colonoscopy) can effectively be used to screen patients at higher risk for colorectal cancer.  Reported at the Eighth Annual Symposium on Virtual Colonoscopy in Boston, the IMPACT study was over 90 percent sensitive in finding adenomas larger than 1 centimeter.

Unlike previous virtual colonoscopy studies that included only patients at average risk for colorectal cancer, the IMPACT trial focused on patients with higher risk because of a previous adenoma or whose family member had an adenoma or colorectal cancer diagnosed between the ages of 40 and 65.

203 polyps and 42 colorectal cancers were found in the 934 individuals who were screened.

CT-colonography found 90.7 percent of adenomas at least 10 millimeters in size and 90.4 percent of those at least 6 millimeters.

The test accurately diagnosed polyps or no polyps in 89 percent of all patients in the trial.

Researchers led by principal investigator Dr. Daniele Regge and Dr. Andrea Laghi, who reported  results at the symposium, said that,

The results suggest CTC could be introduced as an alternative for surveillance of patients with an increased personal risk or a family history of colorectal cancer

SOURCE:  Diagnostic Imaging Online, October 15, 2007.

November is set aside to honor and celebrate the day-to-day efforts of the many family members who care for their loved ones who are disabled or ill. 

This year family caregivers are being encouraged to speak up as advocates for their needs and the needs of the people they care for and for policies that ease the caregiving burden.

In addition they are reminded to:

• Believe in yourself.
• Protect your health
• Reach out for help.
• Speak up for your rights.

The world is moved not only by the mighty shoves of the heroes, but also by the aggregate of the tiny pushes of each honest worker.  Helen Keller

Cancer Risk Reduction:  A Report from the President’s Cancer Panel

A discussion of the recently released report of the President’s Cancer Panel will be featured during the October 31st Understanding the NCI Teleconference.  Speakers will address cancer risk related to physical activity, obesity, nutrition, tobacco use, and second-hand smoke.

Advocates will be able to ask questions about the report and learn about the current series of President’s Cancer Panel meetings.

The teleconference will feature

• Dr. Margaret Kripke, Member of the President’s Cancer Panel
• Dr. Dwayne Proctor, Senior Program Officer at the Robert Wood Johnson Foundation
• Matt Myers, President of the Campaign for Tobacco-Free Kids

The teleconference is scheduled

• October 31, 2007
• 1:00 PM to 2 PM (Eastern time)
• USA Toll-Free:  1-800-857-6584
• Passcode PCP
• Toll-Free Playback: 1- 888-568-0891 until November 30, 2007

The Understanding the NCI Teleconferences are sponsored by the National Cancer Institute Office of Advocacy Relations.

More information about the President’s Cancer Panel and Promoting Healthy Lifestyles, the 2006-2007 report are available.

The Senate passed the Labor HHS Appropriations bill, which includes funding for the National Institutes of Health (NIH), by a vote of 75 – 19. President Bush has already threatened to veto the $606 billion Appropriations bill.

The NIH would receive an additional $1 billion dollars above the Fiscal Year 2007 budget. Under the President’s proposal the agency would have been cut by $289 million.

The bill will now go to conference where the House and the Senate will work out a compromise. They hope to send the compromised bill to the President by early November.

This will be the first of the 12 Appropriations bills sent to the White House.