Pam McAllister attended the 2010 GI Cancers Symposium in Orlando on a C3 scholarship.
Pam is one of the original colorectal cancer research advocates and has been involved with research advocacy activities for well over a decade. She serves on numerous research panels and has co-authored many articles including the 2008 American Cancer Society Screening Guidelines and the ASCO Clinical Opinion on Testing for KRAS Mutations.
Here is the first of three articles she has written for C3’s Research and Treatment News about what she learned at the Orlando meeting.
Last year we learned that Avastin® (bevacizumab) was not effective in increasing disease free survival in stage III colon cancer except for a possible small transient benefit that disappeared soon after the drug was discontinued.
Some researchers think that any benefit would require continuous exposure to bevacizumab. Patients would need to take it for life to experience any benefit or not take it at all. Lifetime use is not practical for reasons of potential serious toxicity and cost making this an unattractive option.
Recently the trial of Erbitux® (cetuximab) in stage III patients was closed since no benefit was seen in any patient group.
With the demonstration that the addition of either anti-VEGF or anti-EGFR antibodies was without benefit, is there anything these patients can do to decrease the chances of recurrence beyond the currently used chemotherapy?
It was pointed out at the recent ASCO Gastrointestinal Cancers Symposium that patients could reduce recurrence risk by following a “prudent diet” and by exercising regularly.
A prudent diet is one that includes less fat and red meat and increases consumption of fruits and vegetables. Exercising by walking one hour a day at a regular pace or any equivalent such as walking faster for a shorter time or participating in another equivalent exercise program can reduce recurrences. The mechanism by which such interventions can kill cancer cells in patients with no evident disease is unknown. One possible explanation of how such interventions can destroy micrometastases is through an effect on the immune system but there is currently no evidence to support this.
Additional studies in stage III patients currently being planned include evaluation of the duration of treatment with the FOLFOX regimen. The study in the US alone will not include enough patients to have sufficient power to answer the question, so this will include studies in several countries that will be analyzed together. This may present a problem if one or more of the studies are not completed for any reason. Combined studies have been attempted in the past unsuccessfully so the question of treatment duration may or may not be answered.
If a shorter duration of the FOLFOX regimen is as effective as the currently used six month duration, there should be a decrease in the development of peripheral neuropathy, a particularly unpleasant side effect of oxaliplatin treatment. While few patients have long lasting substantial neuropathy, reducing the potential for any long lasting neuropathy would be worthwhile. Reducing the duration of treatment would also increase the convenience to patients while reducing its cost.
Additionally, in the US, potential benefit of the use of celecoxib, a COX 2 inhibitor, will be examined in the same study.