FIGHTING ON: CRC Research 2012 in Review

This past year has brought remarkable scientific advances in the understanding of colorectal cancer (CRC), and—as usual with science—opened up even more questions to be answered in 2013 and beyond. Here are just a few highlights:

Your BODY: Peering inside cells

In 2012, scientists penetrated deeper inside cells to better understand why and how normal cells become cancerous and spread (metastasize) through the body.

(1)   For the first time ever, 150 researchers with the Cancer Genome Atlas Project—a collaboration of dozens of U.S. institutions–mapped the entire genome for each of 250 different colorectal cancers. Instead of just looking for specific mutated genes, they mapped literally the entire DNA package of 3.5 billion pairs of the 4-letter genetic “alphabet” contained in each cancer sample.

  1. One surprise was that colon and rectal cancer are genetically virtually indistinguishable, putting to rest a long-held theory that rectal and colon cancers are somehow different.
  2. By comparing cancer cell genomes to normal cells, they identified 24 separate genes involved with colorectal cancer—including 3 new genes. They also identified two other “over-active” genes directing cell proliferation, as well as changes in three different “signaling pathways” that turn genes on or off during cell growth.

(2)   A month later, a 9-year international collaboration called ENCODE (the Encyclopedia of DNA Elements) simultaneously published a blizzard of 30 journal articles, summarizing their findings about how at least four million gene switches can flick genes on and off, or, like an electric outlet dimmer, work together to turn genes up or down. Previously, scientists have only understood about how approximately 3% of DNA matter is normally active in directing cell functions. By analyzing data from 1,600 sets of standardized experiments using the equivalent of 300 years of lightning-fast computer analyses on more than 15 trillion bytes of raw data, scientists took a giant leap forward in understanding how the other 97% of the human genome (previously nicknamed DNA “dark matter”) might explain why many diseases appear.

Both major advances will not only help researchers find new treatments and tests for individual cancers, but they also might begin to explain how non-genetic factors like diet or exercise could affect whether cancer begins, recurs, or spreads.

Your LIFESTYLE: Population studies reveal roles of diet, exercise, aspirin,

While some scientists peered deep into cells, others looked at patterns in whole populations of people who have and don’t have colorectal cancer.

  1. More than half of all cancers could be prevented, a researcher told the International Cancer Control (UICC) World Cancer Congress 2012 , if only people actually followed the lifestyle recommendations and screening or other interventions that we already know prevent cancer, including and perhaps especially colorectal cancer.
  2. Researchers from Dana-Farber Cancer Institute found that those who consistently ate a high-carbohydrate, sugar-laden diet appeared to have markedly higher recurrence rates  of their disease than patients whose diets were more varied and contained less-sugar.
  3. More studies in 2012 strengthened the evidence that daily exercise is closely related to a better quality of life for those having and recovering from CRC, and start regular, moderate exercise is associated with a significantly lower risk of recurrence.
  4. In 2012, studies showed people who take low-dose aspirin—especially those with Lynch syndrome—show lower rates of having colorectal cancer recur.

Your TREATMENT: Two new drugs for metastatic CRC, and a cost challenge

For the first time since 2006, two new drugs—Zaltrap (ziv-aflibercept)  and Stivarga (regorafenib) were approved by the FDA to treat metastatic colorectal cancer which has progressed despite other chemotherapy.

The oncology world was a bit stunned in September 2012, when leaders of the world-renowned Sloan-Kettering Cancer Center in New York City publicly announced they would not use the latest new drug (Zaltrap) because it was no more effective but priced twice as high as Stivarga. The makers of Zaltrap subsequently announced a 50% discount in the price . However, that discount may not immediately apply to patients themselves, so Fight Colorectal Cancer staff remain closely involved in discussions with the FDA and others.

Your COSTS: Drug shortages, grey-markets, fake Avastin, screening coverage

  1. Fight Colorectal Cancer’s Kate Murphy closely followed crucial shortages in CRC treatment drugs in early 2012, as well as a developing “grey market” where those drugs were sold for exorbitant prices, and even the appearance of fake Avastin in the U.S. briefly during the spring of 2012. Leucovorin remains on the FDA’s list of drugs in short supply as 2012 ends.
  2. Also in 2012, Fight Colorectal Cancer worked with Kaiser Family Foundation and other cancer organizations to provide a detailed report to Congress  investigating the problem of patients being billed unexpectedly for costs of screening colonoscopies when polyps are removed.

We at Fight Colorectal Cancer know—and our advocates continually tell their families, communities, and legislators—that the very best way to stop colorectal cancer in its tracks is to never let it get started.

Our Future: The greatest hope of all is prevention and early detection

  • In March 2012, Kate Murphy reported on the first definitive study to prove that colonoscopy and polyp removal reduce deaths from colorectal cancer : In a large followup of the National Polyp Study, people who had adenomas removed—the risky kind of polyps—were half as likely to die from colon or rectal cancer than  the general US population.
  • In its annual summary and budget discussion for 2012-2013, the National Cancer Institute wrote, “Through molecular, epidemiologic, and mathematical studies of colorectal cancer… we now know that…a death from colorectal cancer today will most likely occur because the cancer or its precursor adenoma was not detected during the preceding 27 years.”

Forward into 2013

Science will drive us forward in 2013. Facts show that African Americans get colorectal cancer, and die from it, more often than other groups: We need to reach those populations with better screening. We know that the majority of people at risk for having Lynch syndrome—with its multiple cancers—don’t know they’re at risk, and we must help find and educate those families.

Even as we celebrate the enormous scientific strides forward in 2012, we could lose all momentum and years of invaluable work if we allow cancer research funding to dry up.  And so we keep fighting:

  1. Fight Colorectal Cancer has given its first-ever two-year Lisa Fund grant to a young researcher whose laboratory is using a whole new method of quickly testing different treatments for metastatic colorectal cancer.
  2.  We are training, as we speak, a whole new class of Research Advocates to take the patient’s voice and perspective to the decision-makers in research programs and funding. These 20 new advocates will be stepping into the shoes of two deeply respected advocates whom we lost in 2012: Pat Steer and also Kate Murphy, the founder of this Research News blog.

Here’s part of what Kate wrote last New Year’s Eve. Her words still ring as true as ever:

* Come to Call-on Congress and make sure that programs and funding for colorectal cancer prevention and research are strong and growing.

* Do one last, very important thing: Make a gift to Fight Colorectal Cancer and ensure that our programs and research grants continue until we end suffering and death from colon and rectal cancer.

Here’s to “Another year, full of hope and promises.”

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