2008 brought new information for people with colorectal cancer and those at risk for it. The role of KRAS tumor mutations was a major step forward for personalized medicine. New screening guidelines provided additional resources and guidance for colorectal cancer prevention.
ESA use was restricted further and information was developed to help patients make choices about using the medicines to manage anemia associated with chemotherapy. Flat and highly dangerous colorectal cancer lesions that are different from polyps were uncovered.
The Genetic Information Non-Discrimination Act was passed.
While there were steps forward in research and screening, nearly 50,000 Americans and half a million people worldwide died of colon or rectal cancer.
KRAS and Personalized Medicine
Scientists identified a large group of patients who did not respond to two drugs because of a mutated gene in their tumor tissue. Colorectal cancer patients who had mutated KRAS in their tumors did not respond to the EGFR inhibitors Erbitux® (cetuximab) or Vectibix™ (panitumumab). Not only did their tumors not shrink, they had no better progression free time or overall survival.
Other stories covered patients with high microsatellite instability (MSI) who weren’t helped by 5-FU, and a study that found mutations in the BRAF gene blocked response to Erbitux and Vectibix.
Updated Screening Guidelines
In March, the American Cancer Society in collaboration with the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology updated their colorectal cancer screening guidelines to include CT colonography (so-called virtual colonoscopy) and DNA stool testing. The expert panel that developed the new guidelines emphasized their opinion that colorectal cancer prevention should be the primary goal of screening.
In October, the United States Preventive Services Task Force (USPSTF) issued a slightly different set of guidelines. They did not find sufficient evidence to include CT colonography or stool DNA testing in their recommendations. However, they did recommend against routine screening in people from 76 to 85 and not screening those over 85 at all.
ESA Use Restricted
The FDA recommended restricting the use of further restrictions in the use of erythropoiesis-stimulating agents or ESAs to treat chemotherapy-induced anemia to patients whose treatment goal was not cure. The drugs, marketed as Aranesp®, Epogen®,and Procrit®, are given to prevent blood transfusions during chemotherapy. The recommendations were included in labeling changes for ESAs.
An FDA-approved Medication Guide for patients must be given to patients at the time an ESA is prescribed.
In addition, Amgen changed its pricing policies for Aranesp, no longer offering rebates to physicians or bundling it with other drugs.
Non-Polypoid Colorectal Lesions
Using special techniques, research gastroenterologists found that flat or nonpolypoid colorectal neoplasms (NP-CRNs) were more common that previously believed, occurring in about 1 in 10 people studied.
In addition, the flat or depressed lesions were almost ten times as likely to contain cancer than the polyps that protruded.
GINA Passed
The Genetics Information Non-Discrimination Act (GINA) was passed and signed into law by President Bush on May 21, 2008. GINA prohibits insurance companies and employers from discriminating against anyone based on genetic testing information or family history of possible genetic disease.
GINA protects people in families with inherited colorectal cancers including Lynch syndrome and familial adenomatous polyposis (FAP). It should remove barriers to genetic testing for these conditions allowing early protective surveillance and treatment.
Deaths
- Tony Snow: White House Press Secretary
- Leroy Sievers: CBS News, ABC Nightline and NPR Journalist
- Eartha Kitt: Singer and actress
- Randy Pausch: Carnegie Mellon professor and writer from pancreatic cancer
- Robb Kerr: C3 Patient Advocate
- Judah Folkman: pioneering cancer researcher who discovered the role of angiogenesis in cancer
- Robin Toner: NY Times correspondent
- Tina Kiser: C3 Advocate
- 50,000 Americans and 500,000 people around the world
Leave a Reply
Your comments are welcome. However, specific medical advice will not be provided, and we urge you to consult with a qualified physician for diagnosis and for answers to your personal questions. FightCRC is not responsible for the medical accuracy of any comments left by persons other than FightCRC staff members. FightCRC staff members monitor comments and may respond publicly where appropriate.
Please note that we automatically publish the name that you enter next to your post. Also note that our pages are automatically indexed by Google and other search engines, and your name may therefore appear in search results on those sites. So if you wish to remain anonymous please use a different name or enter 'Anon' as the name.
We regret that we are unable to privately answer questions left as comments. So please do not include your phone number, email or mailing address in the body of your comment. For the best personal and direct response to your colorectal cancer treatment questions, please call our Answer Line at 1-877-4CRC-111 (1-877-427-2111).