New Year’s Resolution: Get Screened for Colorectal Cancer

New Year’s Resolutions

• If you will be 50 this year, plan with your doctor to begin a regular colorectal cancer screening program.
• If you are older than 50 and haven’t been screened, make an appointment for screening today.
• Learn the symptoms of colon and rectal cancer, and if you have one, get a colonoscopy — no matter how young you are.

Help make sure every American has access to colorectal cancer screening.  Go to CoverYourButt.Org and learn how.

Have a Happy and Health New Year!

Posted by Kate Murphy on December 31st, 2007
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Given before surgery for liver mets, Avastin reduces tumors and protects the liver

Added to FOLFOX chemotherapy, Avastin® (bevacizumab) reduced active colorectal cancer that had spread to the liver and also protected the liver from chemo damage before surgery.

A research team at MD Anderson Cancer Center in Texas studied liver tumors from colorectal cancer patients removed during surgery and also changes in non-cancerous liver tissue.  They compared liver pathology from patients who received oxaliplatin and 5FU (FOLFOX) alone to those who were treated with Avastin along with FOLFOX.

Tumor viability was defined as the percentage of remaining active cancer compared to overall tumor area.

When Avastin was added to FOLFOX chemotherapy,

• There was significantly less tumor viability — 32.9 percent compared to 45.3 percent.
• More patients had less than 25 percent remaining viable tumor cells  — 45 percent versus 23 percent.
• However, there was no difference in the percentage of patients whose tumors responded completely, resulting in no cancer cells present.  About 11 percent of patients in both groups had a complete pathologic response to treatment before surgery.

In addition, Avastin protected the liver from chemotherapy damage.  Changes in small blood vessels in the liver known as hepatic sinusoidal dilation occurred less often and was less severe:

• Any grade:  27.4 percent versus 53.5 percent in those who did not receive Avastin.
• Moderate or severe:  8.1 percent compared to 27.9 percent.

Speaking for the research team, Dario Riberio MD wrote,

In patients treated with 5FU/OX chemotherapy, bevacizumab improves the pathologic response, as demonstrated by a reduction of the degree of tumor viability, and reduces the incidence and severity of hepatic injury. This retrospective study provides additional evidence supporting the use of bevacizumab in combination with 5FU/OX for colorectal liver metastases.

SOURCE:  Riberio et al, Cancer, Volume 110, Issue 12, December 2007.

Disclosure: C3 has accepted funding for projects and educational programs from Genentech in the form of unrestricted educational grants. C3 has ultimate authority over website content.

Posted by Kate Murphy on December 28th, 2007
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Removing both liver and lung mets from colorectal cancer can lead to long-term survival

Colorectal cancer patients who had surgery to remove tumors in both lungs and liver had a good chance of being alive five years later.

Surgeons in a single hospital in Seoul, South Korea reviewed cases where patients had lung and liver tumors removed between 1995 and 2004.  They found 32 colorectal cancer patients who’d had operations at both sites.

After five years more than sixty percent of patients who’d had surgery were still alive. The average time before any cancer returned was 44 months.  None died during or after surgery.

Won-Suk Lee and colleagues concluded,

An aggressive surgical treatment of selected colorectal cancer patients with lung and liver metastases resulted in prolonged survival. The 5-year survival rate of 60.8% with no perioperative mortality was observed in our study.

SOURCE:  Lee et al. Journal of Gastroenterology and Hepatology, published early online, December 16, 2007.

Posted by Kate Murphy on December 28th, 2007
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Minocycline reduced acne-like rash symptoms from Erbitux treatment

Antibiotic minocycline reduced facial rash and itching when given to patients with colorectal cancer from the beginning of their treatment with Erbitux® (cetuximab).  Erbitux causes an unsightly and uncomfortable skin rash in almost all patients, although its presence and intensity is related to successful response to treatment.

Dermatologists at Memorial Sloan Kettering Cancer Center in New York randomly assigned 48 patients to receive either daily oral minocycline or a placebo as soon as they began treatment with Erbitux.  They also tested applying tazarotene ointment to one side of the face only.

After four weeks of treatment, patients receiving minocycline had

• Less moderate to severe rash:  20 percent of minocycline group versus 42 percent of placebo.
• Less moderate to severe itching:  20 percent versus 50 percent.
• To stop treatment due to severe rash:  no minocycline patients compared to four in the placebo arm

No benefit was seen with tazarotene applied to the skin, and one third of patients had to stop using it because of severe irritation.

After 8 weeks, there were few differences between the treated and placebo groups.

Minocycline belongs to the tetracycline family of antibiotics and has been used to treat acne and other skin infections.

Alon Scope and team concluded,

Prophylaxis with oral minocycline may be useful in decreasing the severity of the acneiform rash during the first month of cetuximab treatment. Topical tazarotene is not recommended for management of cetuximab-related rash.

SOURCE: Scope et al. Journal of Clinical Oncology,Volume 25, Number 34, December 1, 2007.

Posted by Kate Murphy on December 27th, 2007
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Bowel prep before colon surgery . . . can we drop it?

Traditionally, patients who were facing colon surgery also faced a difficult process of cleaning the bowel completely with strong laxatives.  However, researchers report in The Lancet that this may not be necessary.

To study whether or not restricted diets and colon cleansing  (mechanical bowel preparation) was necessary to prevent leaking where the colon was rejoined (anastomosis), surgeons at thirteen hospitals in the Netherlands randomly assigned 1,400 patients due to have elective colorectal surgery to either

• A liquid diet and cleansing laxatives of either polyethylene glycol or sodium phosphate.
• A normal diet the day before surgery and no laxatives.

There was no significant difference in the rate of anastomotic leaking — 4.8 percent in those who had mechanical bowel preparation versus 5.4 percent who did not.  When there was leaking, there were more abscesses in those patients without bowel preparation:  2 versus 17 without preparation.

There were no differences in other infections, the risk of the surgical wound opening, or mortality.

Caroline ME Contant MD and her colleagues wrote,

We advise that mechanical bowel preparation before elective colorectal surgery can safely be abandoned.

Similar results were found in another, smaller randomized trial of mechanical bowel preparation reported in the Archives of Surgery in 2005.  After that study, Edward Ram MD and his colleagues at Campus Golda in Israel concluded,

Our results suggest that no advantage is gained by preoperative MBP in elective colorectal surgery.

Dr. Ram pointed out that

Mechanical bowel preparation may cause discomfort to the patient, prolonged hospitalization, and water and electrolyte imbalance. It was assumed that with the improvement in surgical technique together with the use of more effective prophylactic antibiotics, it was possible that MBP would no longer be necessary.

However, in cases where colonoscopy during surgery might be necessary, bowel cleansing is important.  In situations where a large tumor might cause a bowel obstruction, mechanical bowel preparation may even be dangerous.

SOURCES Contant et al, The Lancet, Volume 370, Number 9605, December 22, 2007.

Ram et al, Archives of Surgery, Volume 140, Number 3, March 2005.

An additional detailed article about the Ram study is on Medscape, March 22, 2005.

Posted by Kate Murphy on December 26th, 2007
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