German surgeons reviewed all patients in a Berlin hospital who had a second surgery to remove colon or rectal cancer that had spread to their livers (hepatectomy).  Of 811 patients who had liver resection, 94 had an additional surgery when cancer recurred again in their livers.

Researchers found that surgical complications were similar to those in initial resections.

In addition, outcomes were good.  Nearly 25 percent were still alive after ten years. 38 percent survived 5 years and 89 percent of patients lived at least one year after the surgery.

A. Thelen and colleagues from the Charité Universitaetsmedizin Berlin concluded:

Repeat hepatectomy is a safe and effective treatment for recurrent liver metastases from colorectal cancer. Perioperative risk and long-term survival were similar when compared to the results obtained during the initial resection. Achieving a curative resection is the most relevant prognostic factor for a favourable prognosis after repeat liver resection.

SOURCE: Thelen et. al., European Journal of Surgical Oncology, Volume 33, Issue 3, April 2007, Pages 324-328.

Schering-Plough has made their polyethylene glycol (PEG) laxative Miralax® available over-the-counter in the same strength as the original prescription version.  Taken once a day, Miralax works by drawing water into the bowel.

A 2005 review of medical literature found good evidence to support the use of PEG laxatives to relieve constipation, assigning a Grade A. The only other agent with a Grade A rating, tegaserod or Zelnorm® has recently been removed from the market.  Grade B or moderate evidence was found for psyllium, and lactulose.  The reviewers found very little data on the use of commonly used laxatives including milk of magnesia, senna, bisacodyl, and stool softeners.

Writing in the American Journal of Gastroenterology, Ramkumar and Rao concluded,

There is good evidence to support the use of PEG, tegaserod, lactulose, and psyllium. Surprisingly, there is a paucity of trials for many commonly used agents. These aspects should be considered when designing trials comparing new agents with traditional therapies because their use may not be well validated.

Cancer patients often face constipation from chemotherapy and from the need for opiates to treat pain.

Women who used aspirin on a regular basis had a reduced risk of death from cardiovascular disease and cancer according to data from the Nurse’s Health Study.  Deaths from colorectal cancer were reduced by 28 percent.

The Nurse’s Health Study has followed nearly 80,000 women over 24 years.  During that time nearly 10,000 women have died.  Overall deaths were 25 percent lower among women who reported regular aspirin use.  Aspirin had a larger impact on cardiovascular deaths, reducing them by 38 percent, than on cancer which had a 12 percent reduction. 

In addition, cardiovascular mortality reduction was seen sooner, after five years of aspirin use compared to ten years for cancer.

Writing in the March 26, 2007 Archives of Internal Medicine, Andrew T. Chan, MD, MPH and his colleagues concluded,

In women, low to moderate doses of aspirin are associated with significantly lower risk of all-cause mortality, particularly in older women and those with cardiac risk factors. A significant benefit is evident within 5 years for cardiovascular disease, whereas a modest benefit for cancer is not apparent until after 10 years of use.

However, it is important to realize that regular aspirin use has risks as well as benefits.  The US Preventive Services Task Force recommends against the routine use of aspirin and other non-steroidal anti-inflammatory drugs to prevent colorectal cancer.

An additional article about the study appears on the Cancer Consultants website.

SOURCE:  Chan et. al., Archives of Internal Medicine, Vol. 167, No. 6, pp. 562-572, March 26, 2007.

Elizabeth Lamphere taught me to think.  She taught me to consider evidence, to work through problems — scientific and otherwise.  She’s a big reason why I write about medical science today.

She died on March 27, 2007 at the age of 90.

She was an extraordinary teacher, organizing extracurricular science projects for her students — including me.  Many nights she was in the high school lab until nearly ten o’clock giving us a chance to learn science hands-on.  She was tough, never allowing us to cut corners, demanding excellence.

I left high school fully expecting that I would be a scientist of some sort.  My life turned out quite differently, but her training in problem-solving, hard work, and curiosity stayed with me my whole life.

I mourn her passing and celebrate her inspiring life.

I know that she would be pleased that the American Association for Cancer Research is hosting 300 Los Angeles area high school students at their annual meeting.  After presentations about cancer research, each student will be matched with scientist mentor to visit scientific displays of research results.

While Erbitux® (cetuximab) can shrink tumors and increase the time before cancer gets worse for some patients whose colon cancer has spread, not all people respond to it.  French scientists have found that patients with a KRAS mutation in their tumor were very unlikely to show any tumor shrinkage when they are treated with Erbitux.  In addition, the time before their disease progressed was significantly shorter.

KRAS is a gene that signals proteins to encourage cell growth.  Mutations in KRAS are associated with some, but not all, colorectal cancers.

Studying 59 patients who were treated with cetuximab and chemotherapy, the researchers found that 22 had a KRAS mutation in their tumor.  None of these KRAS-positive patients responded to treatment.  On the other hand, all 12 patients who did respond did not have KRAS identified.

Time to disease progression for those with KRAS was 3 months compared to 5.5 months for patients without the mutation.

Patients studied were being treated with cetuximab and chemotherapy after progressing on standard chemotherapy.

Dr. Frederic Di Fiore led the group of researchers in Rouen in analyzing the tumors and patient outcomes. 

SOURCE:  Di Fiore et.al. British Journal of Cancer, advance online publication, 20 March 2007.