Colorectal cancer patients and survivors who sit less and exercise more actually live longer, according to a carefully designed study published in a recent Journal of Clinical Oncology .

Researchers found that cancer survivors who got exercise equaling about 150 minutes per week of moderate to vigorous walking had a 28% lower risk of death from any cause than those who did less than 60 minutes per week of walking.

And no matter their job, people who spent 6 or more hours a day of their leisure time sitting (reading, watching TV, computer-anything) had 36% higher risk of death from any cause, than people who sat 3 hours or less per day during leisure time.

Perhaps most striking, those who reported leisure-time sitting of more than 6 hours after they were diagnosed with colorectal cancer had a 62% higher risk of dying from colorectal cancer.

This was the first-ever study of the association between leisure-time sitting and death rates, but also one of the first-ever prospective, long-term studies of exercise and survival “that was beautifully designed and analyzed” according to University of Oxford professor Dr. David Kerr.

Using a national study of 184,000 people who filled out questionnaires at the beginning of a 16-year study, researchers focused on 2293 people who developed either localized or regional—but not metastatic—colon or rectal cancer during that time. (The average time of survival after their diagnosis was almost 7 years.) They compared the participants’ reported exercise and sitting times both before and after diagnosis with death from colorectal cancer or any other cause.

The study authors wrote, “Our results add to mounting evidence that physicians should consider counseling colorectal cancer survivors to adopt a physically active lifestyle …150 minutes per week of moderate intensity activity, such as walking, and to avoid prolonged sitting.”

So shut down your computer, and go out for a walk!

SOURCES: “Associations of Recreational Physical Activity and Leisure Time Spent Sitting With Colorectal Cancer Survival,” March 1 2013 Journal of Clinical Oncology (JCO 31:876-885); Medline abstract [http://Medscape.com/medline/abstract/23341510); “Get Off Your Bottom,” David Kerr, April 19 2013 Medscape .

Recent studies show some promise in understanding chemo-caused neuropathy, and perhaps in using a common medicine to ease the worst symptoms in some people.

Study shows neuropathy relief for some using antidepressant

 A well-designed clinical study has provided the first evidence that the antidepressant Cymbalta® (duloxetine) can provide some patients with significant relief from peripheral neuropathy caused by chemotherapy.

From 20 to 40 percent of cancer patients given neurotoxic chemotherapy–taxanes, platinum-based including Eloxatin® (oxaliplatin), vinca alkaloids, bortezomib–will develop painful peripheral neuropathy (numbness, tingling, burning in hands or feet). If the pain is severe, colorectal cancer patients often have to reduce the dose or stop taking Eloxatin. Even then, this painful condition can persist for months, even years, after chemotherapy is stopped.

Previous studies have found that Cymbalta eases the neuropathy pain caused by diabetes, but this is the first comprehensive trial testing whether Cymbalta could ease neuropathy from chemotherapy. As reported in the April 3, 2013 JAMA (Journal of the American Medical Association), the trial enrolled 220 patients at 8 different cancer centers across the U.S. who still had significant neuropathy (at least 4 on a pain scale of 10) at least 3 months after chemotherapy. (Over half, 129 patients, had taken Eloxatin, mostly for colorectal cancer.) In this randomized, double-blind (neither patients nor clinicians know who’s getting the test drug), crossover trial, one-half the group received Cymbalta for 5 weeks while the others took a placebo, and then the groups switched treatments.

Of those taking Cymbalta, 59% reported at least moderately decreased pain (minimum 1 point on the 10-point scale)—usually within the first week. Among those taking a placebo first, 38% reported decreased relief. Interestingly, Cymbalta-associated pain relief was significant only in feet, not hand, symptoms. Also, 11% of people taking Cymbalta had to stop due to side effects—mostly severe fatigue.

Experts theorize that the antidepressant might help because it reduces the neurotransmitters serotonin and noradrenaline, which deliver pain messages to the brain. The study authors pointed out limitations in this first study: relatively small numbers, the effects measured by patient self-report, and the study only followed patients for 5 weeks on Cymbalta.

However, “This is not just about improving quality of life by decreasing pain, but potentially it’s helping patients live longer because they can get their full chemotherapy treatment,” noted lead author Ellen M. Lavoie Smith, Ph.D., APRN, AOCN, of the University of Michigan Comprehensive Cancer Center.

Another expert not connected to the study, Marie Bakitas, D.NSc., at the University of Alabama at Birmingham School of Nursing, noted that the trial results weren’t surprising, because duloxetine is already being used in clinics. But, she also told Medscape, other treatments such as physical therapy, acupuncture and massage “are often neglected but can be very useful.”

Sources: “Effect of Duloxetine on Pain, Function, and Quality of Life Among Patients With Chemotherapy-Induced Painful Peripheral Neuropathy,” April 3 JAMA Network; “Drug for Depression Mutes Chemo Nerve Pain,”April 2 Medscape; “Antidepressant helps relieve pain from chemotherapy, study finds,” April 2 Univ. of Michigan Health Systems press release.

Searching for genes that could predict peripheral neuropathy

 Mayo Clinic researchers have reported that they’ve found that patients with mutations in  three specific genes were more likely to suffer peripheral neuropathy from chemotherapy.

Currently, doctors have no way to predict who will have the side effect, how severe it will get, nor how long it will last.

At the recent meeting of worldwide cancer researchers (AACR, or American Association of Cancer Researchers), scientists described how they studied more than 20,000 specific genes in 119 patients—over half of whom had developed peripheral neuropathy during chemotherapy. They pinpointed three genes, in which mutations were clearly associated with developing neuropathy. Their next step will be to expand their study of the entire genome in as many as 1000 patients. The ultimate goal would be to use these types of genetic clues to potentially predict which patients might suffer side effects from specific drugs.

Fight Colorectal Cancer’s Board Chair Nancy Roach noted that these first findings are a long way from proving cause-and-effect, creating a test, and actually being able to get a reliable test to doctors and patients.

Source: “Gene Variations Predict Chemotherapy Side Effects,”April 9 2013 Science News.

Disclosure: Fight Colorectal Cancer has accepted funding from Sanofi, manufacturer of Eloxatin, in support of its programs. Fight Colorectal Cancer has ultimate authority over website content.

The U.S. Supreme Court heard arguments Monday in a case that both sides consider absolutely vital to the future of medical research.

The case: Can a company take out a patent on a human gene? Or, as the company Myriad Genetics told the Court, not actually a patent on a gene, but a patent on isolated sections of DNA molecules that they synthetically re-create in the lab to make a test for the gene.

Patents were created 150 years ago in the Constitution as temporary protection of new inventions, thus giving economic incentive for inventors. But there is a clear rule that you cannot patent “a product of nature.”

During oral arguments on Monday, justices batted back and forth discussions of making everything from baseball bats to chocolate chip cookies, as they probed lawyers’ arguments about whether the patent was for a human gene (a product of nature)—or for “a new chemical entity,” as company argued in its legal brief, created through a complicated isolation process into a synthetic section of DNA to be used as a gene test.

Thirty years ago, scientists at the Utah biotech company Myriad painstakingly unraveled the 20,000 human genes that exist in a “6-foot-long molecule that’s coiled and compacted, and stuffed into each cell”. They beat other researchers in the race to isolate two genes, known as BRCA1 and BRCA2. Mutations in those genes greatly raise the risk of breast and ovarian cancer, and that risk that can be passed on to the next generation.

Myriad holds the patent and thus sells all tests for BRAC1 and BRAC2—at least for two more years until its patent expires. Myriad and others in the biotech industry argue that invalidating gene patents would threaten billions of dollars they’ve invested in creating genetic tests, drugs, vaccines, even genetically modified crops.

Opponents from the scientific and patient advocacy community argued that no company should hold rights to what is part of a human body, because it could hinder research and in fact has hindered patient access to lifesaving information turned up in clinical trials.

The Supreme Court justices today “seemed skeptical…that human genes can be patented,” reported National Public Radio’s long-time court reporter Nina Totenberg. She cited Justice Sonia Sotomayor’s remark that it seemed ‘the isolation [of the gene] itself is not valuable,’ but rather what’s done with the isolated gene. The government’s Solicitor General Donald Verrilli agreed that a gene cannot be patented, but he noted that the cDNA—the synthetic substance derived from DNA–could be patented, leaving the gene available for general research.

That’s when they got into making cookies, and baseball bats out of trees. Justice Stephen Breyer noted, “The patient law is filled with uneasy compromises.” If you develop a new process to extract sap from a plant that can cure cancer, he said, you could patent the process, but ‘what you can’t patent is the sap itself.”

Has the horse already left the barn….or is the barn burning

Myriad’s patents at issue will expire over the next two years, and according to an April 14^thNew York Times article. ”Experts say a relatively small number of other diagnostic tests or drugs are protected by patents on single genes….It will soon be possible to sequence a person’s entire genome for less than the $4000 that Myriad charges to analyze just two genes,” and most experts believe that whole-genome sequencing might not infringe on single-gene patents.

However, two researchers reported a study in the March 25 journal Genome Medicine that there are more than 40,000 patents on DNA molecules, essentially covering the whole human genome.

Credit: XnY hateZ/Fotolia

“If these patients are enforced, our genomic liberty is lost,” lead author Dr. Christopher Mason of Weill Cornell Medical College told Science Daily on March 25^th, referring to the upcoming Supreme Court case. “Just as we enter the era of personalized medicine, we are ironically living in the most restrictive age of genomics.”The research team studied two types of DNA sequence patents—for long and short fragments. They found that 41 percent of the human genome is covered by longer DNA patents often covering whole genes. But the short-fragment patents covered DNA sequences that are found in many genes, and even outside of genes, covering virtually the whole human genome. The study examined a Myriad-patented small sequence within BRCA1, which they found in at least 689 other genes; and found the company’s patents technically cover 19 other cancers plus brain development.

Dr. Mason said he undertook the study because he knew that, in his own research into brain and cancer disorders, he was studying genes or sequences actually covered under patents. “I’m extremely pro-patent,” he said, “…but I believe individuals have an innate right to their own genome…Failure to resolve these ambiguities perpetuates a direct threat to genomic liberty.”

Who owns you, and your genes? The court case is just the opening measure in this song.

  Sources:

• “Supreme Court Asks: Can Human Genes Be Patented?”, a 7-minute NPR story explaining court case, April 15, Morning Edition  
• “Justices Appear Skeptical of Patenting Human Genes,” NPR summary of court session April 15  All Things Considered,   
• “You Don’t ‘Own’ Your Own Genes: Researchers Raise Alarm About Loss of Individual ‘Genomic Liberty’ Due to Gene Patents,” Mar. 25 2013 Science Daily,  
• “Justices Consider Whether Patents on Genes Are Valid,” April 14 New York Times  
• “Are Human Genes Patentable?” April 12 ScienceDaily

Disclosure: Fight Colorectal Cancer has accepted funding from Myriad Genetics in support of its patient education program. Fight Colorectal Cancer has ultimate authority over website content.

Carlea Bauman, President of Fight Colorectal Cancer

I am deeply disappointed that President Obama’s fiscal year (FY) 2014 budget would strip nearly $4 million from the Centers for Disease Control and Prevention’s (CDC) Colorectal Cancer Control Program. The CDC estimates that the loss of funding will mean at least five fewer programs (out of the current 29) working to prevent colorectal cancer.

The president’s budget assumes that less federal funding is needed for direct screenings, such as colorectal, breast, and cervical screenings, because most health plans are required to cover these screenings without co-pays or deductibles, and because, starting in 2014, the Affordable Care Act ensures that no one can be denied health insurance because of a pre-existing condition.

However, a number of barriers contribute to low colorectal cancer screening rates, such as lack of awareness and misinformation about screening – not just lack of health coverage. A well-funded colorectal cancer control program is needed to support important awareness and education initiatives across the country.

The hopeful news is that Congress does not have to accept the President’s budget. I urge colorectal cancer patients, survivors, caregivers, and physicians to let their members of Congress know that a cut to the colorectal cancer control programs at the CDC is unacceptable.

On a positive note, the President’s budget would increase research funding to the National Institutes of Health (NIH) by $471 million (a 1.5 percent increase) over FY 2012 amounts. The NIH estimates this will result in 351 more research project grants in FY 2014.

I recognize that the President and Congress are budgeting in a difficult economic environment, but our country needs dynamic thinking from our policymakers when it comes to budget decisions. Preventing colorectal cancer and targeted treatment reduce downstream costs to our health care system and to our federal government. That makes good budget sense to me.

Dr. Pia Morelli with Fight Colorectal Cancer Board Chair Nancy Roach

Fight Colorectal Cancer and its generous Lisa Fund donors struck a blow against late stage colorectal cancer Tuesday, April 9th at the 2013 annual meeting of the American Association for Cancer Research (AACR) in Washington D.C.

Top cancer researchers from around the nation applauded as we, along with the AACR, awarded a $50,000 research grant to Pia Morelli, M.D., Ph.D., a post-doctoral Fellow at the University of Texas MD Anderson Cancer Center in Houston.

With this grant, Dr. Morelli will use highly specific DNA tests on blood samples to identify those patients most likely to respond to drugs that target the Epidermal Growth Factor Receptor (EGFR), and also to detect even more specific KRAS and EGFR mutations that develop over time, which perhaps cause patients to eventually become resistant to anti-EGFR drugs such as Erbitux (cetuximab) and Vectibix (panitumumab).

Currently, tumors of late-stage colorectal cancer patients are tested to detect a KRAS genetic mutation. If they have the mutation, they do not receive Erbitux or Vectibix. However, even those who have wild-type (non-mutated) KRAS and initially respond to anti-EGFR treatments can develop resistance and no longer benefit from these powerful drugs.

Researchers now understand that cancer is usually a “cascade” of events–often involving more than one genetic mutation and/or abnormal cell functions.–and that over time, patients may develop new mutations, even in different sections of one tumor. However, tumors are always leaking DNA into the blood stream. In her research, Dr. Morelli will analyze blood samples of colorectal cancer patients using a highly specialized new technique of DNA analysis that can detect these less frequent mutations that can occur in both the KRAS gene  and in EGFR cell-wall mutations over time, and that might cause chemotheraphy resistance. The ultimate hope would be to eventually use blood DNA analysis instead of repeated tumor biopsies to monitor cancer cell changes during disease progression and treatment.

Working at MD Anderson, she will be able to test large numbers of blood samples to see if the highly sensitive DNA analysis can better predict both initial response and/or developing resistance to the anti-EGFR targeted drugs.

Dr. Morelli graduated summa cum laude in medicine and started her medical oncology fellowship at the Second University at Naples School of Medicine, where she had the rare chance to do “translational research”—doing both patient care and  laboratory research on the EGFR (epidermal growth factor receptor) and VEGF (vascular endothelial growth factor receptor) that stimulate tumor growth. Recruited to the University of Colorado Cancer Center, she completed her medical oncology fellowship and a Ph.D. with world-renowned Dr. Gail Eckhardt, continuing her laboratory research into targeted drugs plus running Phase I clinical trials. She then worked two years at the Spanish National Cancer Research Center, and in 2012 came to the MD Anderson Cancer Center.

According to her supervising mentor, Scott Kopetz, M.D., Ph.D, at the MD Anderson Cancer Center, Dr. Morelli has “a unique insight into questions of particular clinical relevance….She is able to maximize the information derived from patient-based studies [combined with]…her unique molecular biology background.”

Her research, he said, is “anticipated to have profound impact on clinical outcomes.”

An AACR expert committee selected Dr. Morelli as winner of the 2013 Fight Colorectal Cancer-AACR Fellowship, given annually in memory of the late Lisa Dubow.

One of just a few AACR fellowships–and the only one focused on late-stage colorectal cancer–it is funded 100% by donations to the Lisa Fund at Fight Colorectal Cancer.

Lisa Dubow, one of the founding members of Fight Colorectal Cancer, directly credited researchers for giving her extra years of survival with stage IV colorectal cancer. Before her death, she launched what became known as the Lisa Fund to support young scientists who chose advanced (metastatic) colorectal cancer as their research focus.