Increased taxes on tobacco products are the basis for a $3 million grant to the Colorado Colorectal Screening Program to expand screening to all community health clinics in Colorado.  The program screens uninsured individuals with incomes below 250% of the federal poverty level for polyps and colorectal cancer.

Screening is offered by either flexible sigmoidoscopy or colonoscopy with the goals of preventing colon or rectal cancer by finding and removing pre-cancerous polyps (adenomas) during the procedures or discovering colorectal cancers in early stages when they are most curable.

The program began in January 2006 in clinics in northeastern Colorado, in Denver, and in Pueblo.  It has already screened 600 people, found five cancers, and potentially prevented 12 additional cancers by removing large polyps.  It will expand statewide on November 1 with the additional grant funds.

Tim Byers, MD, MPH, director of the Colorado Colorectal Screening program, said,

We are thrilled to be making such a significant impact with this program.  This new grant will allow us to reach out to more patients, and substantially reduce the suffering from colorectal cancer across Colorado,

The program seeks to screen 12,500 Coloradans by 2010 with a goal of reaching 75% of uninsured people. 

The Colorado Colorectal Cancer Screening Program is part of the University of Colorado Cancer Center in Denver.

Metastatic colon or rectal cancer patients with low standardized uptake values (SUV) on a FDG-PET scan have a longer survival despite treatment choice.

Researchers in the Netherlands followed 151 patients with metastatic colorectal cancer, 67 who were treated with surgery and 85 with chemotherapy.  They measured the SUV of metastases prior to treatment, dividing the results into two groups — low uptake values less than 4.26 and a high group with values greater than 4.26.

Despite treatment, survival was significantly higher for the low-uptake group with median survival time of 32 months.  At 2 years, 59% of patients from the low-uptake group were alive, and 45% were alive at 3 years.  For the high-uptake group, median survival was 19 months with 37% alive at 2 years and 28% alive at 3 years.

Dr. LF de Geus-Oei and colleagues wrote in the November 2006 issue of the Annals of Oncology:

A significant survival benefit was observed in patients with low FDG uptake in metastases of colorectal cancer.

Researchers reviewed information from the State of Ohio Tumor Registry for all patients diagnosed with colon or rectal cancer from 1996 through 2001.  About half of the 27,000 patients in the registry were women.

Women with colorectal cancer in the Ohio data were significantly older than men and had more right-sided cancer.  They were diagnosed at a later stage and at stages with poorer prognosis.

The research team divided diagnoses into

• cancer in situ (stage I)
• local disease (stage II)
• regional disease (stage III)
• distant disease (stage IV)

They also combined stages I and II to form a more favorable prognosis category and stages III and IV to form a poor prognosis category.

Women were less likely than men to have cancer in situ or local disease and more likely to have regional disease.  They were about 10% more likely to have a poor prognosis (stages III and IV).

Scott W. Woods MD, MPH, MEd and colleagues from the Bethesda Family Medicine Residency Program in Cincinnati published their findings in the September 2006 Journal of Women’s Health.

Woods and his team concluded:

In the State of Ohio from 1996 to 2001, women had more advanced colon cancer at diagnosis than men.

Technorati tags: women’s health, women and colorectal cancer

An expert panel of the American Society for has issued a 2006 update of the use of tumor markers in the prevention, screening, treatment, and surveillance of gastrointestinal cancers including colon, rectal, and pancreatic cancer.

The guidelines were last updated in 2000.  This new update reviewed medical literature for evidence that specific tumor markers provided information that could help decision-making for screening and diagnosis of colorectal cancer, prognosis, progression, and recurrence. The panel also considered the role of tumor markers in predicting response to chemotherapy and other treatment.  For the first time, a recommendation for the use of a tumor marker in pancreatic cancer was included.

CEA (CARCINOEMBRYONIC ANTIGEN) AS A MARKER FOR COLORECTAL CANCER

• CEA is not recommended as a screening tool for colorectal cancer.
• CEA may be used preoperatively if it will assist in staging and treatment planning.
• CEA level is not recommended for making decisions about adjuvant treatment.
• Postoperative CEA should be monitored every 3 months for 3 years in patients with stage II or III colorectal cancer.  The panel concluded,
  • “An elevated CEA, if confirmed by retesting, warrants further evaluation for metastatic disease, but by itself does not justify systemic therapy for presumed metastatic disease.”
• In monitoring response to therapy for metastatic cancer, CEA should be measured every 1 to 8 months during active treatment.

In discussing the use of CEA to monitor potential metastatic cancer progression during treatment, the panel wrote:

Persistently rising values above baseline should prompt restaging but suggest progressive disease even in the absence of corroborating radiographs. Caution should be used when interpreting a rising CEA level during the first 4-6 wk of a new therapy, since spurious early rises may occur especially after oxaliplatin.

OTHER POTENTIAL MARKERS FOR COLORECTAL CANCER

After studying available evidence the panel concluded that there is insufficient evidence at this time to recommend the use of the following markers for screening, diagnosis, staging, prognosis, or monitoring treatment of colorectal cancer.

• CA 19-9
• DNA ploidy or flow cytometric proliferation analysis
• p53 expression or mutation
• ras oncogene
• TS (thymidine synthase), DPD (dihydropyrimidine dehydrogenase), or TP (thymidine phosphorylase)
• Microsatellite instability in the hMSH2 or hMLH1 genes
• Assaying for loss of heterozygosity at 18q or DCC (deleted in colon cancer )protein

USE OF CA 19-9 FOR PANCREATIC CANCER

• CA 19-9 is not recommended as a screening test for pancreatic cancer or as a test to determine whether surgery is warranted or what its outcomes might be.
• CA 19-9 is not recommended alone as to provide evidence of pancreatic cancer recurrence without additional imaging studies.
• Present evidence is not sufficient to recommend routine use of CA 19-9 to monitor response to treatment.  However, measuring CA 19-9 at the start of treatment for locally advanced metastatic disease and every 1-3 months during active treatment may provide an indication of progressive disease that should be verified with other studies.

Writing October 23, 2006 in an early online article of the Journal of Clinical Oncology the panel emphasized,

It important to emphasize that guidelines and technology assessments cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to
particular patients or special clinical situations, and cannot be considered inclusive of all proper methods of care or exclusive of other treatments reasonably directed at obtaining the same result. Accordingly,
ASCO considers adherence to this guideline assessment to be voluntary, with the ultimate determination regarding its application to be made by the physician in light of each patient’s individual circumstances

More specific information about the studies used to determine the recommendations is available in the Journal of Clinical Oncology.

The expert panel was co-chaired by Robert C. Bast, Jr. MD from M.D. Anderson Cancer Center and Daniel F. Hayes MD from the University of Michigan Cancer Center.  Dr. Pam McAllister, a C3: Colorectal Cancer Coalition research advocate also served on the panel as a patient representative.

One of the most troublesome side effects of oxaliplatin (Eloxatin®) chemotherapy for colorectal cancer is the development of peripheral sensory neuropathy in hands and feet.  Peripheral sensory neuropathy (PSN) includes tingling, numbness, burning pain, and difficulty using the hands or feet.  In severe cases patients may have problems walking or balancing.

An international trial is enrolling patients to learn whether or not xaliproden can reduce the severity and duration of peripheral sensory neuropathy without reducing the effectiveness of chemotherapy for metastatic colorectal cancer.  EFC5505 will randomize patients to receive either Xaliproden or a placebo during first-line chemotherapy with oxaliplatin.

Patient information about the clinical trial, peripheral sensory neuropathy, and how to enroll is available online at Chemoeffects.com.

Eligible participants include patients who:

• Have metastatic (stage IV or recurrent) colorectal cancer that cannot be treated surgically.
• Have measurable tumors.
• Have not previously received chemotherapy for metastatic colorectal cancer. (Patients with recurrent colorectal cancer who received adjuvant chemo for stage II or III disease may be eligible.)
• If they have recurrent stage II or III cancer, have been cancer-free for at least 6 months since the end of adjuvant treatment or 12 months if chemotherapy included oxaliplatin.

Factors that might exclude participation:

• Existing peripheral sensory neuropathy greater than grade 1.
• Symptoms of brain metastases
• Use of other medications that might affect peripheral sensory neuropathy
• Medical history or condition that would not allow use of oxaliplatin or 5FU.

Peripheral sensory neuropathy is related to the cumulative dose of oxaliplatin.  As treatment progresses, symptoms of peripheral neurotoxicity appear and increase.  Most patients on oxaliplatin will have some level of PSN, about 20% percent will have severe symptoms.  Once chemotherapy ends, neuropathy gets better and will disappear over time in most patients, but even after a year or 18 months a small percentage will continue to have problems.

In a previous phase III trial Xaliproden showed effectiveness in reducing the severe peripheral neuropathy — grade 3 and 4 — where there is pain or loss of function in the hands or feet although it did not reduce overall neurotoxicity of all grades.  In the Xenox trial, about 12% of those on Xaliproden experienced neuropathy severe enough to interfere with their daily activities compared to about 17% of patients who took a placebo.  Overall, about 3 in 4 patients in both Xaliproden and placebo group experienced some peripheral sensory neuropathy.

Additional assistance with choosing or enrolling in clinical trials is available through the C3 Clinical Trials Matching Service.