It looks like the hold placed on The Genetic Information Non-Discrimination Act (GINA) by Senator Tom Coburn (R-OK) will be lifted and the Senate will vote on the legislation either tonight or tomorrow.

The Genetic Information Non-Discrimination Act (GINA) makes it illegal for health insurers to deny coverage or charge a higher rate or premium to an otherwise healthy individual found to have a potential genetic condition or genetic predisposition towards a disease or disorder. GINA also makes it illegal for employers to use an employee’s genetic information when making hiring, firing, placement, or promotion decisions.

Please click here to see if your Senators support the legislation.

If not…Get on the phone and urge them to vote in favor of the bill.

Click here to find your Senator’s office number..

Chemoradiation is the standard primary treatment for cancer of the anal canal.  Current standard treatment combines radiotherapy with 5FU (fluorouracil) and mitomycin.

Studying the possibility of a better treatment, gastrointestinal researchers compared the standard treatment with mitomycin and radiotherapy to a new regimen that combined 5FU with cisplatin and radiotherapy in a randomized clinical trial.  The goal was to find out which treatment was most effective in preventing the cancer from returning within 5 years (disease-free survival).

• Overall, the standard treatment outperformed the new experimental therapy.
• Five year disease-free survival was 60 percent for mitomycin-based treatment compared to 54 percent for cisplatin-based therapy.
• Overall survival at five years was 75 percent for mitomycin, 70 percent for cisplatin.
• 25 percent of the mitomycin group had their cancer come back in the anal canal (local recurrence) compared to 33 percent of the cisplatin group.
• 15 percent of mitomycin patients had cancer spread to distant organs (metastasis) compared to 19 percent of the cisplatin patients.
• 10 percent of mitomycin patients needed a colostomy compared to 19 percent of those receiving cisplatin-based treatment.

However, mitomycin caused more severe drops in blood counts.

Courtesy of JAMA

Led by Jaffer A. Ajani, MD, the research team concluded,

In this population of patients with anal canal carcinoma, cisplatin-based therapy failed to improve disease-free-survival compared with mitomycin-based therapy, but cisplatin-based therapy resulted in a significantly worse colostomy rate. These findings do not support the use of cisplatin in place of mitomycin in combination with fluorouracil and radiotherapy in the treatment of anal canal carcinoma.

The Journal of the American Medical Association includes information for patients describing anal cancer risks, diagnosis, and treatment in the same issue.

SOURCE:  Ajani et al. Journal of the American Medical Association, Volume 299, Number 15, April 23, 2008.

This is National Minority Cancer Awareness Week — time set aside to consider the additional burden that cancer places on minorities in this country.

African Americans are more likely to be diagnosed with colon or rectal cancer, have their cancer found at a later stage, and die of it.  While colorectal cancer incidence and death rates have been decreasing over the past years for white Americans, they have remained flat for both African American men and African American women.

African Americans have less access to life-saving colorectal cancer screening and fewer are screened.

On April 8, 1987, the U. S. House of Representatives Joint Resolution 119 designated the third week in April as “National Minority Cancer Awareness Week.” In the Congressional Record, the resolution was intended to draw attention to:

An unfortunate, but extremely important fact about cancer. While cancer affects men and women of every age, race, ethnic background and economic class, the disease has a disproportionately severe impact on minorities and the economically disadvantaged.

Although African Americans are more likely to be low-income and uninsured, these factors are not the only reasons for increased risk.  Even with insurance, rates of diagnosis and death are higher than average.

The American College of Gastroenterology recommends that African Americans begin screening earlier at age 45 and that they use colonoscopy as a screening method because of their higher incidence of right-sided polyps and cancers.

To ensure that every American, no matter what ethnicity, income, age, or insurance status, has coverage for colorectal cancer screening, join the Cover Your Butt Campaign.

Patients whose colorectal cancer has already gotten worse on initial FOLFOX therapy do better when Erbitux® (cetuximab) is added to Camptosar® (irinotecan) during their second-line treatment.

The ERBITUX Plus Irinotecan for Metastatic Colorectal Cancer (EPIC) study randomly assigned 1,300 patients with colorectal cancer who had to stop their initial FOLFOX treatment when their cancer got worse or side effects became intolerable to:

• Camptosar (irinotecan) alone
• Camptosar plus Erbitux (cetuximab)

While the study did not meet its primary objective — increasing overall survival in the combination arm, both response rates and rates of progression-free survival were higher in the Erbitux/Camptosar arm. 

Since almost half of patients in the non-Erbitux arm of the trial eventually received some form of Erbitux treatment, it is possible that these subsequent therapies impacted overall survival results.

Comparison of the two arms revealed:

• Overall survival: 10.7 months for the combination, 10 months for irinotecan alone.
• Progression-free survival: 4.0 months for combination, 2.6 months for irinotecan.
• Response rate: 16.4 percent for cetuximab and irinotecan, 4.2 percent for irinotecan alone.

In addition, quality of life measures, including overall health status and physical, emotional, and cognitive functioning were better in the group treated with both Erbitux and Camptosar.

Led by Alberto F. Sobrero MD, the research team concluded,

Cetuximab and irinotecan improved progression-free survival and response rate, and resulted in better quality of life, versus irinotecan alone. Overall survival was similar between study groups, possibly influenced by the large number of patients in the irinotecan arm who received cetuximab and irinotecan post study.

SOURCE: Sobrero et al. Journal of Clinical Oncology, published online ahead of print Apr 7 2008.

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

Men who have had radiation for rectal cancer have a reduced risk for later prostate cancer.  After treatment they had 72 percent less prostate cancer than other men of similar ages and race.

Researchers at Massachusetts General Hospital in Boston studied three groups of men, comparing their rates of prostate cancer to what would be expected in a similar male population:

• 1,574 men with local or regional rectal cancer who were treated with both radiation and sphincter-sparing surgery.
• 3,114 men with rectal cancer who had surgery but no radiation
• 24.578 men with local or regional colon cancer who did not receive radiation.

Among the 1,574 men who had both surgery and radiation, there were 20 who eventually developed prostate cancer — far fewer than would have been expected.  The ratio of actually observed cases of prostate cancer to that which would have been expected (O/E) was 0.28 or a 72 percent reduced occurrence.

However, there was little difference between the actual number of subsequent prostate cancers and those which would have been expected in either the men who had rectal cancer but no radiation or men who had colon cancer.  O/E for rectal cancer was .94 and for colon cancer 1.09.

Average age of the group of men with rectal cancer who were treated with radiation was 64 and their median survival time after treatment was 76 months or more than 6 years.

The research team was led by Karen E. Hoffman, MD, MHSc at Harvard Medical School and the Department of Radiation Oncology at Massachusetts General Hospital.

SOURCE: Hoffman et al, Cancer, Volume 112, Number 4, February 2008.