Research & Treatment News
ArchivesXaliproden reduces severe peripheral neuropathy associated with oxaliplatin
Patients with metastatic colorectal cancer who received xaliproden during treatment with oxaliplatin (FOLFOX4) had less severe peripheral neuropathy than patients randomly assigned to a placebo. Xaliproden reduced the risk of severe (grade 3) peripheral neuropathy by about 40%. There was no difference in chemotherapy effectiveness between the two groups.
Results of the Xenox study, which randomly assigned patients receiving first-line treatment FOLFOX for metastatic cancer, to xaliproden or placebo, were reported at the 2006 GI Symposium in San Francisco. James Cassidy M.D., the principal investigator for the study, discussed the research during the meeting. An audio recording of his presentation, along with slides, is available online in the ASCO virtual meeting.
Peripheral neuropathy — tingling, numbness, pain, and difficulty using the hands and feet — limits the amount of oxaliplatin treatment that patients with colorectal cancer can tolerate. The effect is cumulative, with about 20% of patients experiencing severe neuropathy that interferes with their activities of daily living by the time they have received 1000 mg of oxaliplatin.
In the Xenox trial, patients who were receiving FOLFOX chemotherapy began receiving either a daily oral 1 mg dose of xaliproden with their first FOLFOX treatment or a placebo. Xaliproden continued until 15 days after the last oxaliplatin treatment.
Almost three quarters of all patients had some degree of peripheral neuropathy during treatment (73.%% on placebo and 73.2% on xaliproden) but it was significantly less likely that they would experience grade 3 neuropathy if they were taking xaliproden. 11.1% of those on xaliproden had sufficient neuropathy to interfere with their daily activities, compared to 16.7% of those taking a placebo — a 39% decrease.
Xaliproden had no effect on the acute neuropathy that is also a side effect of oxaliplatin — 80% of patients on both arms of the trial experienced extreme sensitivity to cold, about 17% had a painful feeling that they could not breathe, 10% had jaw pain, and 9% experienced muscle cramps.
There was no significant difference in treatment response rates (42.% on placebo, 44.9% on xaliproden), rates of stable disease (41.7% vs. 42.2% for xaliproden) or those patients whose cancers progressed during the trial (7.7% vs. 5.8%). Fewer patients discontinued treatment because of peripheral neuropathy, but 35% in both arms were were forced to stop chemotherapy because of some type of side effects, including peripheral neuropathy.
More people taking xaliproden had diarrhea, including severe diarrhea, dizziness, insomnia, swelling in their hands and feet and anxiety. There was also an increase in ear noises and vertigo, but they were not serious.
An article about the research is available on the February 24, 2006 Medical News Today web site. peripheral neuropathy xaliproden neurotoxicity
Posted by Kate Murphy on February 27th, 2006
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Molly McMaster swings a hockey stick at colon cancer
Molly McMaster, a colon cancer survivor, took to the ice in Glens Falls, NY on Sunday afternoon, February 26th, to skate with the UHL Adirondack Frostbite. The Frostbite were battling the Richmond Riverdogs, and Molly was battling to raise awareness of colorectal cancer.
The Frostbite-Riverdogs hockey game was the first of 13 United Hockey League home games where Molly will skate at least one shift during the month of March — National Colorectal Cancer Awareness Month. McMaster, President of the Colon Club, has teamed up with the hockey league for UHL Cross-Checks Colon Cancer.
In addition to Molly’s appearance with the UHL teams, there will be educational information at games and the UHL players will all wear the colon cancer awareness Blue Star on their home jerseys. Special announcements have been recorded by sports personalities Barry Melrose and Steve Levy to be run during game broadcasts.
Playing with the Adirondack Frostbite is defenseman Chris Mei, whose father died of colon cancer in 2003. Remembering his dad, Mei says,
The Surgeon has told us that had my dad had a colonoscopy at the age of 50 as part of his regular physical exam, they would have noticed a polyp, removed it, and my dad may have still been here with us today. What we wouldn’t give to rewind the time. I can’t even begin to put into words how much he meant and continues to mean, to my family and all the people he came in contact with. There is a huge hole in what our family used to be, and there isn’t a day that goes by that I don’t miss him. He wasn’t only my best friend but he is still my hero.
The complete schedule of UHL games featuring Molly McMaster is on the Colon Club web site.
Posted by Kate Murphy on February 26th, 2006
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MRI not helpful in finding local colorectal cancer recurrences when they are potentially curable
Could routine magnetic resonance imaging (MRI) help find recurrences of colorectal cancer that could be treated and cured surgically?
Knowing that surgical resection of recurrent colorectal cancer is the best option to cure the disease, surgeons added routine MRI surveillance to standard follow-up care for 226 patients with left-sided colon and rectal cancer.
Their results are reported in the March 2006 Annals of Surgery.
Pelvic recurrence was found in 30 (13%) of the 226 patients in the study. MRI found nearly all of the recurrences — 26 of 30 or 87%. Three of the 4 missed recurrences were at the place where the colon or rectum was surgically reconnected (anastomosis). In another 28 (14%) of patients, recurrence was suspected on the initial MR scan, but cleared after further testing.
The standard follow-up test CEA (carcinoembyonic antigen) was elevated for 19 of the 30 recurrences (63%), and 9 patients had cancer symptoms.
Potentially curative surgery was possible in only 6 patients (20%), and there was no difference between MRI and standard follow-up testing in identifying these patients.
The researchers concluded:
Pelvic surveillance by MRI is not justified as part of the routine follow-up after a curative resection for colorectal cancer and should be reserved for selectively imaging patients with clinical, colonoscopic, and/or biochemical suspicion of recurrent disease.
Posted by Kate Murphy on February 24th, 2006
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Fiber in the diet affects men and women differently
The affect of dietary fiber has been controversial in preventing colorectal cancer. Observations of colorectal cancer rates in cultures where larger amount of fibrous food are eaten compared to Western diets led to theories that fiber might protect against the development of cancer.
However, no clear connection between the amount of fiber in the diet and the incidence of polyps or cancer has been found in a number of studies. In a new analysis combining two previous studies that looked risk for colon polyps for men and women separately shows that fiber may help men, but not women. The combined results were published in the February 2006 American Journal of Clinical Nutrition.
Researchers combined information from groups in both the Wheat Bran Fiber Study and the Polyp Prevention Trial. Together there were about 3,200 participants who had pre-cancerous polyps (adenomas) removed during a baseline colonoscopy. They were randomly assigned to either their usual diet or a high-fiber intervention diet with a follow-up colonoscopy 2–4 years later.
Although there was no significant difference overall between participants who had followed an enriched fiber diet and those who did not the team did find that men had about a 20% reduction in recurrent polyps. There was no similar difference for women.
The Wheat Bran Fiber Study design actually provided either a high-fiber or low-fiber cereal for participants. However, when results were published in the New England Journal of Medicine in April 2000, there were no significant differences between the two groups in those who had new polyps and those who didn’t. The team did notice a difference for men, but given the number of male participants enrolled, this could have been due to chance.
In the Polyp Prevention Trial participants were randomly assigned to an intervention group that received nutrition counseling and were advised to eat a low-fat, high-fiber diet with with at least 3 1/2 servings of fruits and vegetables each day. Both groups had about a 40% chance of having another polyp during the 4 year follow-up period, although most polyps were small. About 5% in each group had an adenoma larger than 1 centimeter. For whatever reason, there were more colorectal cancers found in the intervention group (10) than in the control group (4). The full report of the trial from the New England Journal of Medicine is online.
Read an article about the new analysis from Reuters.
Additional information about the Wheat Brain Fiber Study and the Polyp Prevention trial is available from the National Cancer Institute web site.
Posted by Kate Murphy on February 23rd, 2006
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Gum chewing speeds recovery after resection of sigmoid colon
In a community hospital study reported in the February 2006 Archives of Surgery , patients who chewed gum for an hour three times a day after open abdominal surgery to resect their sigmoid colons, recovered bowel function faster and spent less time in the hospital. Patients had surgery because of cancer or diverticulitis.
After surgery 34 patients were randomly assigned either to chew sugarless gum or be part of a control group that did not chew gum. Results showed average times to key events in recovery were:
- Time to first flatus (passing gas) in chewers was 65.4 hours versus 80.2 hours in the control group.
- First bowel movement occurred at 63.2 hours vs. 88.4 hours.
- First feelings of hunger were at 63.5 hours vs. 72.8 hours.
- Total length of hospital stay was 4.3 days vs. 6.8 days.
The research team from the Department of Surgery at Santa Barbara Cottage Hospital in Santa Barbara, CA concluded:
Gum chewing speeds recovery after elective open sigmoid resection by stimulating bowel motility. Gum chewing is an inexpensive and helpful adjunct to postoperative care after colectomy.
A previous study reported here on C3 News and Events found that gum chewing helped patients who had laparoscopic colon surgery but did not improve recovery time for those who had open colectomy. In that study patients chewed a stick of gum for 15 minutes four times a day.
Media reports of the Archives of Surgery study include:
Posted by Kate Murphy on February 21st, 2006
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