Can drugs used to help lower cholesterol also keep colon cancer from returning? 

Researchers at the National Surgical Adjuvant Breast and Bowel Project (NSABP) are seeking patients for a one-year clinical trial to determine if cholesterol-lowering drugs (statins) might help prevent the growth of precancerous (adenomatous) polyps and/or recurrent colorectal cancer.

The NSABP trial is sponsored by the National Cancer Institute and has recently expanded to include patients with stage 0, I, II or III colon cancer at diagnosis. Patients can enter the study up to one year after their initial diagnosis.

In 2011, Fight Colorectal Cancer’s late Director of Research Communications Kate Murphy wrote about the trial and its efforts to study whether patients taking statins also saw a side benefit of colorectal cancer prevention.

In her post, Murphy noted that research studies of statins and colorectal cancer showed some conflict. Researchers looking at cell processes have found that statins block a protein that is important in cell growth. Blocking its action may prevent colon cancer from spreading or polyps from developing.

NSABP Protocol Chair Dr. Bruce Boman said that although “some retrospective observational studies suggest that statins prevent colorectal cancer, others do not.” Writing in the NCI Cancer Bulletin, Boman also said that longer term, prospective studies on tumor development were needed to determine the efficacy of statins.

Patients who are already on a statin drug to treat high cholesterol are not eligible for the study. For more information about the trial, patients can email Coloncancer.prevention@nsabp.org or call 1-855-NSABPCA  (1-855-672-2722).  The trial organizers have also posted a detailed video overview of the P-5 Colon Cancer Prevention study.

February is Cancer Prevention Month, and colorectal cancer (CRC) is a poster child, as one of the few cancers that can be literally seen and removed before it becomes cancer, or can be caught early enough in regular screening to be literally cured.

Ponder these facts, based on 20 years of experience and summarized by Linda Rabeneck, MD, MPH of Cancer Care Ontario at the recent “GI-ASCO” (Gastrointestinal Cancers Symposium of the American Society of Clinica Oncology):

• Annual stool tests (fecal occult blood test, or FOBT) reduce deaths from colorectal cancer by 15 to 33 percent.
• The newer FIT stool test (fecal immunochemical test) appears to be even better than the FOBT stool test at detecting CRC and early adenomas.
• Flexible sigmoidoscopy (a scope exam of the lower colon) can reduce the cases of CRC by 21%, and deaths from CRC by 26%.
• So-called ‘virtual colonoscopy’ (a special screening CT scan) finds up to 90% of people having adenomas or cancers that are at least 1 cm in diameter.

Colonoscopy (examining the entire colon with an endoscope) is still considered by many to be the “gold standard” for detecting and removing precancerous lesions. Dr. Rabeneck noted, however, that colonoscopy continues to be much more effective in detecting lesions in the left (lower) colon than the upper (proximal) right colon, where hard-to-spot “flat” lesions are more likely to occur. (Evidence in the past few years shows that these flat “serrated sessile polyps” may develop differently and more quickly into CRC.)

Dr. Rabenick told the conference that updated national screening guidelines will be released in coming months; one likely change is removing barium enemas as a tool for CRC screening. Other research has raised the question about whether African Americans should start screening earlier (e.g. at age 50): Stay tuned.

We can do better; much better

Despite the remarkable ability to detect and even prevent CRC, about 40% of Americans still don’t get the recommended screening. A recent study of 4000-plus Utah residents showed that 37% didn’t have recommended screening, even if they had a family history of colorectal cancer. The numbers of unscreened were much higher in rural areas.

Although it can be harder for some people (especially rural residents or those without full insurance coverage) to get a screening colonoscopy, they have choices:

• A simple yearly stool test (high-sensitivity FOBT or FIT) that is done at home and mailed in;
• Flexible sigmoidoscopy done every 5 years (most doctor’s offices do this test) along with stool tests every 3 years
• A colonoscopy every 10 years or CT colonoscopy every 5 years.

People aged 76 to 85 without risk factors (such as a family history or certain number of polyps found over the years) usually don’t need routine screening (and those over age 85 can skip it because risks outweigh benefits).

Get more information and breaking CRC news

• See a chart here that describes each screening option.
• Stay tuned here for screening updates, and….

Learn more news with GI-ASCO Keynoter

Next Tuesday, Feb. 19, 2013, from 8 – 9:30 pm (EST), the ASCO-GI keynote speaker, internationally renowned CRC specialist (and member of our own Medical Advisory Board) Dr. Richard Goldberg will talk directly to and with you at our webinar “The Latest in Colorectal Cancer.” He’ll share a “Decade of Progress” plus also give us his take on the most interesting news to come out at ASCO-GI. You don’t get many chances to listen to a world-renowned expert: Register to join it live, or listen later to this and all archived webinars. 

Sources: “CRC Screening Tools–The Date and the Guidelines,” ASCO-GI Jan. 26 2013; “Screening for CRC: which Tool and How Often,” ASCO-GI Educational Summary  and “Rural vs. Urban Residence Affects Risk-Appropriate CRC Screening,” in press Clinical Gastroenterology and Hepatology.

A new virus causing diarrhea and vomiting has spread rapidly nationwide, causing an increasing number of outbreaks of what many call the “stomach flu,” according to a Jan. 24 2013 report issued by the CDC (Centers for Disease Control).

The new norovirus strain (named GII.4 Sydney) is highly contagious, and seems to cause more hospitalizations than other gastrointestinal viruses. It hits suddenly with diarrhea, abdominal pain, vomiting, fever, chills, and headache. Most people get better in one or two days, after the stomach or intestinal inflammation eases, but they are still contagious for 3 more days..

Dehydration is Danger

Even healthy people can get dehydrated with this illness if you don’t drink enough liquids to replace the fluids lost from throwing up or having diarrhea many times a day. Special rehydration drinks (such as Gatorade) are best, because they contain nutrients and minerals lost in diarrhea or vomiting.

Norovirus infection can quickly become serious  in young children, the elderly, and people with other health conditions if they become seriously dehydrated. Symptoms include urinating less often,  a dry mouth and throat, and feeling dizzy when standing up—which, for elderly or weakened individuals, greatly increases the chance of a fall during a rush to the bathroom.

Highly contagious

People ill with a norovirus are contagious from the moment they begin feeling sick until at least 3 days after they recover. Some people may be contagious for even longer. So even if you feel better, remember that you can still be infecting others. This is a hardy virus which can survive in food and especially on surfaces for quite awhile–such as bathroom appliances, door handles, bedding, and even on pets.

The CDC recommends that when norovirus hits a household:

(1)    Handwashing is the first defense, scrubbing with soap and water or alcohol-based cleanser before and after cooking and eating, using the bathroom, coming in contact with anyone who is ill, touching your pet, and especially before and after treating a cut or wound or caring for your catheter, port, or ostomy.

(2)    If you are ill, do not prepare food for yourself or others while you have symptoms and then for 3 more days;

(3)    Clean and disinfect contaminated surfaces. After throwing up or having diarrhea, contaminated surfaces should be immediately cleaned with a bleach-based disinfectant.

(4)    Wash laundry thoroughly: any clothing or linens that may be contaminated with vomit or stool should be handled carefully (ideally, wearing gloves, not agitating them to avoid spreading virus, and washing hands after handling). Wash with detergent on the longest possible cycle, and then machine dry.

 Cancer patients, especially if getting chemotherapy, should take special precautions

The CDC also provides clear advice for cancer patients, stating that if you get a fever during your chemotherapy treatment, it’s a medical emergency because infection during chemotherapy can be life-threatening.

And of course for patients with colorectal cancer or having an ostomy, dehydration also can become serious quickly. The CDC advises cancer patients to take your temperature any time you feel warm, flushed, chilled, or not well. If your temperature is 100.4°F (38°C) or higher for more than one hour, or 101°F (38.3°C) or higher for any length of time and you are on chemotherapy especially, call your doctor right away, even if it happens in the middle of the night.

You and anyone who comes around you, including all members of your household, your doctors, and nurses, should clean their hands frequently.

Sources: “Emergence of New Norovirus,” Jan. 25 CDC Morbidity and Mortality Weekly Report ;  “New Norovirus Strain Hits US,” Jan. 24 Medscape ]; “CDC Researchers Spot Increase in New ‘Stomach Bug’ Strain,” Jan. 24 HealthDay News; general tips to “Prevent the Spread of Norovirus,” and “Preventing Infections in Cancer Patients,” Centers for Disease Control.

Fight Colorectal Cancer is partnering together with 23andme and Genentech to help researchers better understand if patients’ genes play a role in how they respond to treatments they receive for their colorectal cancer.  This provides patients a new opportunity to participate in genetics research.

You are invited to participate in the InVite Study.

The InVite Study aims to enroll 1,000 individuals with certain types of advanced cancer who received Avastin before 2013.

In order to participate you simply submit a saliva sample and complete some online surveys.

The InVite Study will allow you to:

• Learn more about your health and genetic ancestry
• Take a direct role in research that may benefit you and other patients with advanced metastatic disease
• Participate in web-based research from the comfort of your own home
• Be kept informed of the discovery process as research advances

The InVite Study will enhance research by:

• Bringing together a large group of people who have taken Avastin to better understand if there are any specific genetic differences between people who do well on Avastin and those who do not
• Understanding if new technologies like genetic analysis and the internet offer a new way to conduct research and help researchers learn how to better use medicines
• Expanding access to people who want to participate in research from home
• Removing some of the time and cost barriers that can slow progress in other types of cancer research

To participate you’ll need to:

• Enroll and consent through the 23andMe website 
• Provide a saliva sample and send it back in the prepaid box
• Take online surveys by signing in to your 23andMe account
• Answer follow-up questions every 3 months in your 23andMe account

To learn more about the InVite Study and how you may participate, read more here.

Have more questions? Check out the InVite study Q&A.

If you have further questions, please contact us directly at the Fight Colorectal Cancer Answer Line at 1-877-427-2111 or email us.

For patients with metastatic colorectal cancer, the Food and Drug Administration (FDA) has approved a new use of Avastin® (bevacizumab): It can be continued as part of ‘second-line’ combination therapy, even if it was used in first-line therapy.

When stage IV cancer progresses despite use of Avastin plus either FOLFOX (5FU plus Eloxatin® or oxalyplatin) or FOLFIRI (5FU plus Camptosar® or irinotecan)-based chemotherapy, the FDA has now approved continued use of Avastin when second-line treatment switches to the other chemotherapy.

Avastin is a monoclonal antibody (a “targeted drug”) that helps prevent a cancer from stimulating growth of new blood-vessels that then help the tumor get bigger.

The FDA’s approval is based on a large, randomized Phase III trial which showed that median overall survival was 11.2 months when patients continued Avastin along with the second-line chemotherapy, compared to a 9.8-month median survival with just the second-line chemotherapy without Avastin. Participants in the trial averaged about 63 years old, and were able to carry out normal activities or at least housework or office work (i.e., ECOG performance status of 0-1).

There was no significant increase in adverse events (such as worse side effects) in those continuing Avastin, versus those who stopped the drug for second-line treatment.

FDA approval for the new use clears the way for insurers to cover the drug’s use, which averages roughly $5,100 a month.

Sources: Jan. 25, 2013 FDA press release; “Avastin Wins New Colorectal Cancer Indication,” Jan. 24 2013 MedPage Today ; “Genentech’s Avastin approved for wider use in colorectal cancer,” Jan. 24 San Francisco Business Times.

Disclosure: Fight Colorectal Cancer accepts  unrestricted educational grants and charitable donations from Genentech, the manufacturers of Avastin. Fight Colorectal Cancer has ultimate control over website content.