After surgery to remove rectal cancer, there is a danger that the cancer will return locally within the rectum at the surgical site or have local recurrence. 

The TME trial randomized rectal cancer patients to receive or not receive radiation treatment before surgery.  During surgery, total mesorectal excision (TME) surgery removed the tumor, section of rectum, and fatty tissue outside of the rectum in a single piece.

After a median follow-up of six years, patients with rectal cancer who had radiotherapy before their surgery had a significantly decreased risk of local recurrence but there was no difference in overall survival.

Almost 1,900 patients were treated during the trial.  5.6 percent of those who received pre-surgical radiotherapy had cancer return locally compared to 10.9 percent of patients who didn’t have radiation.

However, there was no difference in overall survival.  After five years, 64.2 percent of the radiotherapy group and 63.5 percent of the surgery-only group were alive.

Koen Peeters and the team from the Dutch Colorectal Cancer Group concluded,

With increasing follow-up, there is a persisting overall effect of preoperative short-term radiotherapy on local control in patients with clinically resectable rectal cancer. However, there is no effect on overall survival. Since survival is mainly determined by distant metastases, efforts should be directed towards preventing systemic disease.

SOURCE: Peeters et al, Annals of Surgery, Volume 245, Number 5, November 2007.

Last week Congress passed the Labor HHS Appropriations bill. This bill will provide an additional $899 million, a 3.1 percent increase, for the National Institutes of Health (NIH). Of this $899 million, $128 million will be allocated to the National Cancer Institute (NCI).

President Bush has threatened to veto this spending bill. He has proposed a $480 million cut to NIH. The veto could come as early as today and then it will be sent back to Congress for an override vote sometime between Tuesday and Friday of this week before they leave for Thanksgiving Recess.

I urge you to contact your Member of Congress and ask them to override the President’s veto!

Adventrx Pharmaceuticals will no longer be enrolling patients for a Phase III clinical trial of CoFactor® for the first-line treatment of colorectal cancer that has spread.

The trial’s Data Safety Monitoring Committee recommended ending the trial based on slow enrollment of participants.  The DSMC did not find safety problems in the trial, but were concerned that patient accrual was too slow to justify continuing the study. 

The clinical trial was comparing CoFactor as a modifier for 5-fluorouracil plus Avastin® to a standard 5FU modified by leucovorin with Avastin treatment.  The study, which began in May 2006, was seeking 1,200 patients.

In addition, analysis of an earlier phase II trial that also compared CoFactor to leucovorin as a modifier of 5FU showed no significant difference in either safety or effectiveness.  Survival results from that trial should be available sometime in 2009.

CoFactor is also known as ANX-510.

Parents who live more than ten years after a diagnosis of cancer improve the chances that a child will also survive the same cancer.  On the other hand, poor survival in a parent predicts poorer survival for children.

According to a study of cancer outcomes of over 3 million families in Sweden, if a parent died within 10 years after diagnosis, children with the same cancer had an increased risk of also dying compared to those children whose parents had lived longer than 10 years. 

Children of parents with colorectal cancer had a 44 percent greater risk of dying of their cancer if their parents did not survive ten years. 

Dr. Linda Lindstrom and her colleagues at the Karolinska Institutet in Stockholm wrote,

Our findings suggest that cancer-specific survival in parents predicts survival from the same cancer in their children. Consequently, data on survival in a parent might have the potential to guide treatment decisions and genetic counselling. Finally, molecular studies to highlight the genetic determinants of cancer survival are now warranted.

An article about the study is available from Reuters.

SOURCE:  Lindstrom et al, Lancet Oncology, Volume 8, Issue 11, November 2007.

The American College of Obstetricians and Gynecologists (ACOG) has published new guidelines for colorectal screening for women.  The new guidelines recommend that colonoscopy be the only method used for screening.

ACOG is the first and only group of primary care physicians recommending colonoscopy as the preferred method of colorectal cancer screening.

Previously, ACOG recommended that women over 50 be screened with one of several methods without one method being preferred over the others.

In making their recommendations ACOG noted

• Colonoscopy allows the direct visualization of the entire length of the colon.
• Pre-cancerous polyps can be removed during the procedure.
• Colonoscopy provides access  to right-sided lesions—the main type of advanced colorectal cancer occurring in women—which may be missed by other screening methods.

Carol L. Brown, MD, the immediate past chair of the ACOG Committee on Gynecologic Practice, pointed out that while colonoscopy was the preferred test for colorectal cancer screening, it was important to discuss other options with women so that they would be screened by some test.  She said

Our message today is that colonoscopy is the gold standard when it comes to colorectal cancer screening. While we want ob-gyns to encourage this method, they should still discuss the advantages and limitations of the other screening options with their patients.  

The bottom line is we want women to get tested by whichever method they are most likely to accept and follow through with.”

The ACOG guidelines call for African Americans — both men and women — to be screened earlier at age 45 instead of 50.

SOURCE: American College of Obstetricians and Gynecologists, News Release, October 26, 2007.