Call on Congress is almost here so register by February 1st and make sure your voice is heard on Capitol Hill!

This is your chance to meet fellow colorectal cancer advocates, develop the skills you need to be a better advocate back home, and learn what Congress’ role is in fighting this terrible disease.

Most important, you’ll conclude your visit by putting what you learn into practice on Capitol Hill in meetings with your Members of Congress and/or their staff that we will schedule for you.

Time is running out so register today!

Gilda’s Club South Jersey is sponsoring an evening lecture by Dr. Gordon Callender, colorectal surgeon.  Dr. Callender will talk about colorectal cancer diagnosis, treatment options, and recent advances.

There will be a chance to ask questions in the Club’s comfortable and supportive setting. 

He completed his fellowship in colon and rectal  surgery at St. Luke’s Roosevelt Hospital in New York City and is now practicing with Salartash Surgical Associates in southern New Jersey.

• Ask The Doctor about Colorectal Cancer
• Gilda’s Club South Jersey
• Wednesday, February 6th
• 6:00 pm to 7:30 pm
• Call 609-926-2699 to register

Gilda’s Club of Southern New Jersey is located at 300 Shore Road just 400 feet south of the intersection with Central Avenue in Linwood, NJ

Contact Program Director Erin McAllister for more information. Registration is required.

FROM 2008 ORLANDO GI SYMPOSIUM

Not all patients treated with Vectibix® (panitumumab) will respond to it.  In a randomized clinical that compared colorectal cancer treatment with Vectibix alone to the best supportive cancer care, only about ten percent had tumors shrink. All patients in the study had previously gotten worse on standard treatments. In this trial, Vectibix was given alone or as monotherapy.

In an attempt to figure out which patients  were most likely to benefit from Vectibix, researchers measured tumor DNA for a mutation in the KRAS gene. They studied the differences in both treatment outcomes and patient-reported cancer symptoms and quality of life between those patients with mutated KRAS genes and those with normal or wild type KRAS.

About 43 percent of patients had a mutation in the KRAS gene.

Comparing patients with mutated KRAS with wild type KRAS, they found:

Impact on progression-free survival

• Wild type KRAS: Median time before cancer began to progress for patients on Vectibix was 12.3 weeks compared to 7.3 weeks for best supportive care.
• Mutated KRAS: Median progression-free survival was not different between the two groups (7.4 weeks for those on Vectibix and 7.3 weeks for those receiving supportive care.)

Impact on response to treatment

• All patients: 10 percent in group that received Vectibix  had tumors shrink somewhat (partial response) compared to no partial responses in the best supportive care arm.
• Wild type KRAS: 17 percent partial responses with Vectibix compared to none in supportive care.
• Mutant KRAS: No partial responses in either the Vectibix group or the group that received best supportive care.

Impact on stable disease

• All patients: 25 percent had their cancer remain stable during the trial while on Vectibix compared to 10 percent on supportive care.
• Wild type KRAS: 34 percent had stable disease on Vectibix compared to 10 percent on best supportive care.
• Mutant KRAS: 12 percent had stable disease on Vectibix compared to 8 percent not receiving the drug.

Impact on quality of life

• Wild type KRAS: Scores of patient-reported outcomes on quality of life were better for patients receiving Vectibix and their cancer symptoms improved somewhat during treatment.
• Mutant KRAS: There was no difference in quality of life between the two groups and cancer symptoms and quality of life got worse during treatment.

Overall, the researchers felt that there was no benefit to treating patients with mutated KRAS with Vectibix in this particular setting — when they had gotten worse on all previous standard treatments and when Vectibix was used alone.

There is other research underway to study response to Vectibix earlier in metastatic colorectal cancer treatment and in combination with chemotherapy including the impact of KRAS mutations on that response.

Vectibix is approved by the FDA to treat patients with colon or rectal cancer who had progressed on all other therapies.

R.G. Amado, MD and colleagues concluded in a 2008 GI Symposium abstract that

Panitimumab efficacy in CRC is confined to patients with tumors lacking KRAS mutations. Wild type KRAS patient receiving panitumumab had better colorectal cancer symptoms vs best supportive care patients.

In his presentation, Dr. Amado also pointed out:

KRAS genotyping of tumors should be strongly considered in patients with metastatic colorectal cancer being treated with panitumumab monotherapy.

Disclosure: Fight Colorectal Cancer has accepted funding for projects and educational programs from Amgen in the form of unrestricted educational grants. Fight CRC has ultimate authority over website content.

FROM 2008 ORLANDO GI SYMPOSIUM

A new test for a protein found in the blood of patients with colorectal cancer or with advanced polyps may provide a simple way to identify the disease earlier.

Scientists at Johns Hopkins University and the University of Pittsburgh measured levels of colon cancer-specific antigen-2 (CCSA-2) in blood from patients who had undergone colonoscopy.  Patients had either normal colonoscopies, hyperplastic and non-advanced adenomas, advanced adenomas, or colorectal cancer.  Another group of control blood samples were also included.

They found a level of CCSA-2 that was present in over ninety percent of patients with colorectal cancer or an advanced adenoma (a polyp in the colon with high potential to develop into colon cancer).

Only about 20 percent of people without cancer or advanced polyps had the marker in their blood making the test unlikely to find many false positives.

Diagnosing colorectal cancer in its earliest stages would mean more cures and less difficult treatment for patients.  Since the CCSA-2 test also finds advanced polyps before they become cancerous, it might have the ability to prevent the disease entirely.  More sensitive than current stool tests and less invasive than colonoscopy, it might be able to screen for those people who need colonoscopy exams.

The researchers point out that the test needs further validation before it can be proven effective for colorectal cancer screening.

Robert Getzenberg and his team reported to the 2008 GI Symposium in Orlando that,

Although further validation studies are required, our initial study demonstrates that CCSA-2 is a potential serum-based marker for colon cancer detections with high sensitivity and specificity.

SOURCE: R. H. Getzenberg, Initial evaluation of colon cancer-specific antigen-2 (CCSA-2) as a serum marker for colorectal cancer, 2008 Gastrointestinal Symposium, Abstract Number 276.

FROM 2008 ORLANDO GI SYMPOSIUM

Patients without insurance are twice as  likely to be diagnosed with advanced colon or rectal cancer than those with either Medicare or private insurance.   Patients whose treatment is covered by Medicaid have a fifty percent larger risk of having an advanced cancer (stage III or IV).

Being diagnosed at stage III, where cancer has spread to nearby lymph nodes, or stage IV, where cancer is found in distant organs, greatly decreases the chances that the patient will survive.

Researchers with the American Cancer Society studied nearly half a million patients diagnosed with colon or rectal cancer between 1998 and 2004, whose cases were entered in the National Cancer Data Base. The NCDB includes about 75% of all US cancer patients.

The majority of patients (61.0 percent) were 65 or older and covered by Medicare, another 32.4 percent had private insurance.  Two percent were uninsured and 2.5 percent were covered by Medicaid.  Another 2.2 percent had Medicare, but were younger than 65.

The scientists calculated the odds that patients without insurance, covered by Medicaid, or covered by Medicare would be diagnosed with later stage cancer compared to those with private insurance.

More likely to be diagnosed with stage II rather than stage I disease:

• Uninsured patients: 90 percent more likely or almost twice the risk.
• Medicaid-covered: 40 percent more likely or about half again the risk.
• Medicare:  no difference for either those 65 and older or those under 65.

More likely to be diagnosed with stage III or IV versus stage I

• Uninsured patients:  100 percent more likely or twice the risk.
• Medicaid patients: fifty percent more likely
• Medicare:  no significant difference

The research team also found other factors that were associated with advanced stage at diagnosis including:

• Black or Hispanic race
• Females
• Older age
• Treatment in non-teaching hospitals or hospitals that did not do research
• Residence in zip codes with lower incomes and lower educational levels

Michael T. Halpern, MD, PhD, and his colleagues at Health Services Research at the American Cancer Society in Atlanta concluded,

Uninsured and Medicaid patients with colorectal cancer have increased likelihoods of more advanced disease at diagnosis compared to patients with private insurance.  Improved screening and access to other medical care among these underserved populations may reduce this substantial disparity.

SOURCE:  Halpern et al, Association between insurance status and stage at diagnosis for patients with colorectal cancer, 2008 Gastrointestinal Cancers Symposium, abstract number 275.