Women with mutated genes for hereditary non-polyposis colon cancer (Lynch Syndrome) are at increased risk for both endometrial and ovarian cancer, as well as colon cancer.  A hysterectomy to remove uterus and ovaries is sometimes recommended to reduce the risk.

Researchers at the University of California at San Francisco and Stanford University considered the benefits of three different strategies to prevent endometrial and ovarian cancer in women with Lynch Syndrome.

• Annual gynecologic exams
• Annual screening with gynecological exams, transvaginal ultrasound, endometrial biopsy, and measurement of CA 125 in the blood beginning at age 30
• Prophylactic surgery to remove ovaries, fallopian tubes, and uterus (Hysterectomy with Bilateral Salpingo-oophorectomy)

Using Surveillance, Epidemiology and End Results (SEER) data from 1988 to 2001, they found that surgery was most effective in preventing both ovarian and endometrial cancer, following by screening,

• Ovarian cancer would be diagnosed in .0056 percent of women who had surgery, endometrial cancer in .0060 percent.
• 3.7 percent of those who had annual screenings would get ovarian cancer during their lives, 18.4 percent would get endometrial cancer.
• With annual gyn exams 8.3 percent would get ovarian cancer and 48.7 percent would be diagnosed with endometrial cancer during their lifetimes.

Writing for the research team, Lee-may Chen, MD, pointed out,

When comparing prophylactic surgery with the screening option, one would need to perform 75 surgeries to save one woman’s entire life. For cancer prevention, however, only 28 and 6 prophylactic surgeries would need to be performed to prevent one case of ovarian and endometrial cancer, respectively.

She concluded,

Risk-reducing hysterectomy and bilateral salpingo-oophorectomy may be considered in women with Lynch/HNPCC to prevent gynecologic cancers and their associated morbidities.

SOURCE:  Chen et. al. Obstetrics and Gynecology, Volume 110, Issue 1, July 1, 2007.

WHAT THIS MEANS FOR PATIENTS

Women who carry a gene for Lynch Syndrome hereditary non-polyposis colon cancer may want to consider surgery to reduce their risk of ovarian or endometrial cancer.  An alternative to surgery is annual screening with with transvaginal ultrasound, uterine biopsy, and measurement of CA-125.   

Although removal of the ovaries and fallopian tubes greatly reduces risk of ovarian cancer, it does not prevent it entirely.  Ovarian cancer can develop within the peritoneal cavity even when there are no ovaries.

Joel Siegel, entertainment editor and film critic for ABC News, died of colon cancer last Friday, June 29, 2007.  He was 63.

In 1997, the same year he learned he had colon cancer, he also found out that he was to become a father for the first time.  Fearing that his son might have to grow up not knowing his father, Siegel wrote Lessons for Dylan to share those things he wanted his son to know. 

DEAR DYLAN:
They are words you don’t easily forget, “I don’t have good news.” Especially when they’re said by a doctor who’s just finished giving you a colonoscopy.

Talking about dealing with staying “positive and serene through days of discomfort” during radiation treatments and chemotherapy, Siegel wrote,

I pictured my grandmother. I’d see her face, I’d try to feel her hands, her long fingers, wrinkled as if she’d spent too much time in the pool. She, too, had colon cancer. She was diagnosed at 80 and lived till 90 and died of something else.

Chemotherapy ended at the same time Dylan was born, and Siegel had several good months,

I had about three great months. My hair came back. Darker. My colostomy was reversed. That was nice. It took major surgery and I had to figure out a new diet and relearn muscle control and Easter Sunday at friends I ran out of my diapers and had to borrow one of Dylan’s, but life was getting better. My CT-scans were clean, I was getting better.

But then the cancer returned.  He wrote in Lessons for Dylan,

Dylan was happy and gurgling. Ena was painting. I was feeling good. Things were going well.

And the witch came back.

In 1991 Siegel and actor Gene Wilder founded Gilda’s Club to support people living with cancer in honor of Wilder’s wife Gilda Radner who died of ovarian cancer.

He is survived by his wife Eva Swansea and son Dylan.

Pfizer has announced the opening of a multinational Phase III clinical trial to study the safety and effectiveness Sutent (sunitinib malate) combined with FOLFIRI chemotherapy as first-line treatment for colorectal cancer that has spread to organs beyond the colon or rectum.  The trial is designed to be first-line treatment for metastatic cancer.

Seven hundred patients will be recruited internationally and randomized to receive either:

• FOLFIRI — Irinotecan, leucovorin, and continuous infusion 5FU – plus a placebo
• FOLFIRI plus sunitinib

The clinical trial is open and recruiting patients in Europe, Canada, Asia, and South America.

Who is eligible?

• Patients with confirmed colorectal cancer that has spread to organs beyond the colon (metastatic disease).
• Patients who have received no other treatment for metastatic colorectal cancer.
• Patients for whom treatment with FOLFIRI is indicated.
• Patients whose overall organ functioning is adequate based on blood tests.

Who is not eligible?

• Patients who have had different primary cancer within the past three years.
• Patients who have had full field radiotherapy within 4 weeks of enrollment, who have received partial field radiotherapy within 2 weeks, or who have had radiation treatment to more than 30% of their bone marrow.
• Patients whose cancer has spread to their brain or who have compression of their spinal cord.

For more information about the trial, call 1-877-369-9753.

NEWS FROM 2007 WORLD CONGRESS ON GASTROINTESTINAL CANCER

Sutent® (sunitinib maleate) combined with FOLFIRI chemotherapy was active and generally well-tolerated in previously untreated patients with colorectal cancer that had spread according to a Phase I study presented at the World Congress on Gastrointestinal Cancer in Barcelona.

Ten patients received Sutent daily for four weeks, followed by two weeks of rest.  They were also getting FOLFIRI chemo treatments.  FOLFIRI is a combination of intravenous irinotecan, leuvocorin, and 5FU.  The 5FU is given as continuous infusion.

Of the 10 patients in the trial, 4 had a partial response and 6 have had stable disease.  Serious side effects included one respiratory infection and two cases of low white cell counts (neutropenia) with fever.

Alfredo Carrato, MD, who will lead a multinational randomized Phase III study of FOLFIRI plus Sutent, said,

Despite progress in recent years, colorectal cancer remains a hard-to-treat cancer for which new options are sorely needed. These data support further research of sunitinib malate in metastatic colorectal cancer, in an effort to potentially expand the range of therapies available to physicians and patients.

Sutent is currently indicated for patients with advanced renal cell carcinoma or gastrointestinal stromal tumor (GIST).

WHAT THIS MEANS FOR PATIENTS

These are results of a small Phase I study whose goal was to find a dose of Sutent that is safe and has tolerable side effects.  Effectiveness is not an objective of Phase I clinical trials.

The trial was designed for patients who had not been previously treated for metastatic colorectal cancer, so it is not reasonable to conclude that it might have similar activity in patients who had already had other treatments.

It is too soon to assume that Sutent and FOLFIRI  might be a better treatment than FOLFIRI alone.  A randomized Phase III trial is planned to answer that question.

A commercially available yogurt drink can reduce diarrhea and infection associated with use of antibiotics according to a study in the British Medical Journal.  

Older adults who used a probiotic yogurt drink while they were taking antibiotics had 75 percent less diarrhea and no diarrhea associated with c. difficile infection than a similar group who drank a milkshake without active microorganisms.  The two groups were randomized and double-blinded.  Neither participants or nursing staff knew who was receiving what drink.

None of the patients in the study had diarrhea or bowel disease before beginning the study or were lactose intolerant.

Patients in three London hospitals began drinking Actimel® within 48 hours of starting antibiotic therapy and continued using it twice a day until a week after the antibiotics ended.  A control group drank Yazoo®, a sterilized milkshake also commercially available in the United Kingdom. 

During the study

• 12 percent of patients on Actimel developed diarrhea compared to 34 percent of those in the control group.
• No c. difficile was found in the stool of any of the Actimel group compared to 17 percent of controls who developed diarrhea associated with c. difficile infection.

Research dietician Mary Hickson and her team wrote,

Consumption of a probiotic drink containing L casei, L bulgaricus, and S thermophilus can reduce the incidence of antibiotic associated diarrhoea and C difficile associated diarrhoea. This has the potential to decrease morbidity, healthcare costs, and mortality if used routinely in patients aged over 50.

According to the World Health Organization, probiotics are living microorganisms that, when administered in adequate amounts, confer a health benefit on the host .  They contribute to maintaining a healthy balance of beneficial and harmful bacteria in the intestinal tract.

Actimel contains Lactobacillus casei, L casei imunitass, S thermophilus and L bulgaricus.  The research team tested the drinks to be sure that the bacteria were live and active.  It is marketed in the United States as DanActive®.

WHAT THIS MEANS FOR PATIENTS

Although there was a large reduction in diarrhea associated with antibiotic use and no c. difficile infection at all in those patients who drank Activel during their antibiotic therapy, this preventive may not be appropriate for everyone.

• People with diarrhea or bowel disease were excluded from the study.
• The authors point out that they were unable to pinpoint which of the live microorganisms was responsible for the protection from diarrhea and infection so the information may not be valid for other yogurt or probiotic products.
• The drink prevented diarrhea.  It was not used to treat it.

 SOURCE:  Hickson et. al. British Medical Journal, June 29,2007.