Fight Colorectal Cancer

When colon or rectal cancer has spread to the lungs only, removing them surgically can lead to long-term remissions and, in some cases, cures. Reviewing patients who had lung metastases surgically resected, surgeons in Japan identified four factors that led to a better prognosis.

Favorable factors included:

• Three or fewer tumors in the lung
• No spread to hilar and/or mediastinal lymph nodes
• Lung mets occuring later than original colon or rectal tumor
• Normal carcinoembryonic antigen (CEA) before surgery

The research team studied 58 patients who had surgery for lung metastases.  Overall, the five-year survival rate was 29% with a median survival time of 27 months.  Sixteen patients had all four favorable features and had a five-year survival of 67%, significantly better than patients without the characteristics.  Median survival time for these patients was 86 months.

Thirteen patients had a repeat surgery for lung mets.  They had a five-year survival rate of 37% with a median survival time of 32 months.

The team headed by Rintaro Koga concluded:

The four factors selected in our multivariate analysis appear to be favourable factors for the practical identification of those patients who are most likely to benefit from surgical resection. Repeated pulmonary resection for lung-only recurrence may benefit carefully selected patients.

Koga et. al. Japanese Journal of Clinical Oncology published early online on August 25, 2006.

If current colorectal cancer screening methods were maximized and existing chemotherapy used by all age groups, deaths from colon and rectal cancer in the United States could be reduced by 50% by the year 2020.

Researchers used a microsimulation model (MSCAN-COLON) to simulate the 2000 U.S. population with respect to risk factors for colon and rectal cancer, use of colorectal cancer screening, and treatment use. Using this data, they were able to project deaths from colorectal cancer in the year 2020 under three different scenarios:

• No changes in risk factor prevalence, screening use, and treatment use.
• Contining the trends in the three factors during the period from 1995-2000.
• Risk factors are reduced, screening is increased to 70% of the population, and treatment use is extended to all age groups

The simulation model projected:

• If there is no change, mortality from colorectal cancer will decrease by 17% by 2020.
• If the current 1995-2000 trends continue, mortality will decrease by 36%.
• If risk factors are reduced, screening rates increased, and treatment use expanded, deaths will be reduced by 49%.

The team led by Iris Vogelaar and her colleagues in the Netherlands and at Memorial Sloan Kettering in New York wrote in the October 2006 issue of Cancer:

Currently available interventions for risk-factor modification, screening, and treatment have the potential to reduce CRC mortality by almost 50% by the Year 2020. However, without action now to further increase the uptake of current effective interventions, the reduction in CRC mortality may be only 17%

Vogelaar et. al. Cancer Volume 107, Issue 7 Pages 1624 – 1633

The National Institutes of Health (NIH) is authorized by Congress to support the following mission:

NIH is the steward of medical and behavioral research for the Nation. Its mission is science in pursuit of fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to extend healthy life and reduce the burdens of illness and disability.

Congress provides funding for NIH which is distributed to institutions and researchers to achieve this goal.

Periodically, Congress reviews and modifies the legislation which guides NIH, a process called “re-authorization”. Congress reauthorized NIH in 1993. Congressman Joe Barton (R-TX), chair of the House Energy and Commerce Committee, has made NIH reauthorization a priority since becoming chair in 2004.

Since then, Chairman Barton’s staff has worked with stakeholder groups to define legislation that will reform NIH while continuing to support research.

Friends of Cancer Research reports that:

House Energy and Commerce Committee Chairman Joe Barton (R-TX) is bringing an updated version of a bill to reauthorize the National Institutes of Health (NIH) before his Committee for a vote …

Overall, the draft bill focuses on the organization and function of the Office of the Director of NIH and its relationship to the individual NIH institutes and centers by providing enhanced authorities for strategic planning and support of trans-institute initiatives. The bill would standardize a detailed series of reporting requirements covering research and other activities supported by NIH to promote greater accountability and increased transparency of NIH funds.

See C3’s letter to the House Energy and Commerce Committee regarding this legislation.

While adding chemotherapy to radiation treatment given before surgery for rectal cancer did not improve overall survival, it did significantly reduce cancer returning locally at the surgical site.

In a clinical trial reported in the September 14, 2006 New England Journal of Medicine researchers randomly assigned rectal cancer patients who were receiving preoperative radiotherapy to:

• preoperative radiotherapy without any chemotherapy
• preoperative radiotherapy with chemotherapy before surgery
• preoperative radiotherapy with chemotherapy after surgery
• preoperative radiotherapy with chemotherapy both before and after surgery

Radiotherapy was delivered over 5 weeks before surgery.  Chemotherapy consisted of cycles of 5FU (fluorouracil) and leucovorin given for 5 days per cycle.  Preoperative chemotherapy was given for two cycles; postoperative chemo treatment was four cycles.

Over 1000 patients with T3 or T4 surgically resectable rectal cancers were entered in the trial.  There was no significant difference in overall survival among the four groups — chemotherapy, whether given before or after surgery or not given at all had no impact on survival at five years.  The combined five-year survival rate was 62.5%.

However, there was a significant difference in cancer returning to the original site in the rectum where it had been removed — local recurrence.  Local recurrence rates for preoperative chemotherapy, postoperative chemotherapy, or both pre-and-postoperative chemo were 8.7%, 9.6%, and 7.6% respectively. For patients who received no chemotherapy in addition to their radiation treatment, local recurrence incidence was 17.1%.

Jean-Francois Bosset M.D. and his colleagues concluded:

In patients with rectal cancer who receive preoperative radiotherapy, adding fluorouracil-based chemotherapy preoperatively or postoperatively has no significant effect on survival. Chemotherapy, regardless of whether it is administered before or after surgery, confers a significant benefit with respect to local control.

Bosset et. al. New England Journal of Medicine, September 14, 2006, Volume 355:1114-1123

 More information about the study is available from Medpage Today.

The National Cancer Institute sponsors regular teleconferences for cancer advocates, survivors, and their families and friends.  Callers can ask questions of NCI officials during live calls.  All calls are toll-free and replays are available for one month after the original teleconference.

The first teleconference is scheduled for Tuesday, September 19th and will feature newly appointed NCI Director Dr. John Niederhuber.

• Update for the Advocacy Community from the NCI Director
• NCI Director John Niederhuber, MD and Doug Ulman, Chair of the Director’s Consumer Liaison Group (DCLG)
• Tuesday, September 19, 2006
• 1:00 pm (Eastern)
• 1-800-857-6584  Passcode:  NCI
• Telephone Playback available until October 19th at 1-866-372-3809

 Other teleconferences in the fall schedule include:

• October 31, 2006:  The Impact of Nanotechnology Research on Cancer Patients
• November 7, 2006:  What Cancer Patients Should Know About Complementary and Alternative Medicine
• December 5, 2006:  Cancer Chemoprevention:  A Discussion of Benefits and Risks

Details and passcodes for future conferences are available on the NCI website.