Highlights:

• While adding oxaliplatin to 5-FU improves five year survival slightly for stage II colon cancer, it increases side effects, particularly tingling and numbness in the feet.  An analysis of several NSABP trials found that two or three more stage II patients out of every 100 would be alive five years later if they were given oxaliplatin in addition to 5-FU than if they only got 5-FU.  Risk of cancer returning was similar with an absolute improvement of 3 to 5 percent, depending on risk factors.  Doctors and patients need to think about whether the small benefit is worth the risk of neuropathy that may become permanent.
• Two speakers at the Saturday colorectal cancer oral abstract session addressed adding oxaliplatin to 5-FU as part of pre-surgical chemoradiation treatment for rectal cancer.  NSABP R-04 found that oxaliplatin did not help increase complete response rates, avoid colostomies, or downstage cancers. It did increase diarrhea significantly. On the other hand, early results from a German trial did find an increase in complete responses with oxaliplatin, and they didn’t see worse side effects.
• In the PRIME phase III clinical trial, patients receiving their first treatment for advanced colorectal cancer who had normal or wild-type KRAS genes in their tumor did better when Vectibix® (panitumumab) was added to FOLFOX chemotherapy.  But those patients whose tumor KRAS was mutated actually did worse than patients who only got chemotherapy.
• Side effects, while difficult for patients, may predict better outcomes from treatment.  Patients who got capecitabine as part of pre-surgical chemoradiation and developed hand-foot syndrome had fewer recurrences three years later and better survival at five years.  In another study of breast, lung, and colorectal cancer, patients who got high blood pressure while on Avastin® (bevacizumab) lived longer and it took longer before their cancer got worse.

The Cost of Cancer Care

In an editorial in the ASCO Daily News, published every day for ASCO attendees, Jeffrey M. Peppercorn, MD, MPH, discussed the rising out-of-pocket costs of cancer care for patients and their families.  Although cancer care costs overall are growing fast, the costs that patients bear are growing even faster.  About a third of cancer patients say they have trouble paying their bills, and one out of four have exhausted their savings.

Although the ASCO Task Force on Cost of Cancer Care calls for oncologists to discuss out-of-pocket expenses with patients, few do, and a survey found that about half of oncologists are uncomfortable talking about costs in deciding on treatment.

To learn more, join us for our next patient webinar:

The Big News in Colorectal Cancer from the 2011 ASCO Annual Meeting
June 20, 2011
8 – 9 PM Eastern time
Register to join us.

 

Dr. Edith Mitchell

Last night, Dr. Edith Mitchell of Thomas Jefferson University Kimmel Cancer Center in Philadelphia, PA, updated colorectal cancer patients on the latest research and treatment news in an online webinar.

Dr. Mitchell highlighted the most important news for colon and rectal cancer patients to come from the 2011 Gastrointestinal Cancers Symposium held in San Francisco last month. She answer such questions as…

“Can doctors determine the chances that my cancer may return?”

“Can my doctors determine if I need chemotherapy?”

“Does Avastin or Erbitux benefit my stage III cancer treatment?”

“Are there any promising new treatments on the horizon?”

You can view the webinar online here.

The patient webinars are a program of the Colorectal Cancer Coalition and are offered to patients at no cost. If you would like to support this program through a financial donation, visit our Donate page.

“As someone who is committed to winning the fight against cancer, I was pleased to hear the President talk about the importance of innovation. However, it is counterproductive to proclaim that ‘this is our generation’s Sputnik moment’ while calling for a spending freeze for domestic programs.

Now is not the time for across the board cuts to domestic spending. If we are going to find a cure for cancer in our lifetimes, we need a sustained investment in proven research programs – programs that encourage innovation and ensure discoveries make it from bench to bedside as quickly as possible.

On behalf of the thousands of Americans who will be diagnosed with colorectal cancer this year and on behalf of the millions of Americans living with colorectal cancer I urge the President and Congress to renew the fight against cancer with smart and sustained investments in biomedical research that will not only save thousands of lives but encourage innovation and help stimulate the economy by creating much-needed jobs.”

- Carlea Bauman, President of the Colorectal Cancer Coalition

Forty years ago when President Nixon signed the National Cancer Act into law we didn’t understand how a normal cell becomes a cancer cell. Since 1971, we have invested millions and made great advances in biomedical research.

Over the last forty years, we’ve seen a transformation in how we treat cancer from treatments that don’t distinguish between healthy and cancerous cells to more effective, targeted therapies. Scientists working on the Cancer Genome Atlas are building a comprehensive database of the DNA changes associated with 20 major tumor types and we can look forward to the day when cancer treatments are tailored to the specific DNA changes in each patient’s tumor.

To date, the growth in knowledge about cancer biology and genetics is perhaps the greatest success of the national cancer effort since passage of the National Cancer Act.

But we have a long way to go. Cancer still remains a leading cause of death in the United States.

This year over 560,000 Americans will die from cancer – almost one every minute.

Now is not the time for across the board cuts to domestic spending. Americans recognize the importance of federal support for cancer research regardless of the economic climate. Nearly nine in ten respondents (89 percent) to a national nonpartisan poll of households with a history of cancer, think it is important that the President and Congress increase funding for cancer research and related programs. The survey, commissioned by the American Cancer Society Cancer Action Network, also found that support for federal cancer research funding is high regardless of party affiliation, with 85 percent of Republicans, 87 percent of independents, and 96 percent of Democrats polled responding favorably.

Today’s investments in cancer research are the key to addressing tomorrow’s public health and economic crises. Last year, colorectal cancer cost the US economy $14 billion. Cancer incidence is projected to nearly double by 2020, particularly among the baby boomer population. As these rates climb so too will the cost to our economy.

In one of his first addresses to Congress, President Obama called for, ‘a new effort to conquer a disease that has touched the life of nearly every American by seeking a cure for cancer in our time.’

We will be working hard to make sure that the President and Congress live up to that call, and the fight against cancer doesn’t get lost in the push to cut spending. We can’t lose ground in the fight against cancer by reducing spending for life-saving research.

Dr. Rona Yaeger at work in her lab

The grant is fully funded through donations to the Coalition’s Lisa Fund, named after one of our founders, Lisa Dubow. The 2010 grant went to Dr. Rona Yaeger, a researcher at Memorial Sloan Kettering Cancer Center in New York City.

Coalition Board member Dr. Steven Depp, his wife Bonnie and Dr. Rona Yaeger

Last week, Coalition Board member Dr. Steven Depp, his wife Bonnie and I were invited into Dr. Yaeger’s lab. We watched her set up her gel electrophoresis apparatus to separate proteins. It is part of her goal to inhibit key signaling pathways in colorectal cancer.

Watching her research in action – especially research that we are responsible for – was a real thrill and we told Dr. Yaeger so. We all felt quite honored to be in that lab with her.

And, make no mistake, when I say “research we are responsible for,” I’m talking about every person who has contributed to the Lisa Fund. I wish we could have had all of you in there with us; you were certainly there in our hearts.

Help this research continue! Make a donation to the Lisa Fund today. Thank you so very much.

Because of my role in clinical research and laboratory research I am invited to give lectures around the world about the latest in colon cancer research. In the last 12 months, I gave lectures in Japan, China, India, Germany, Spain, Portugal. Israel, Brazil, Argentina, Switzerland, and Greece. It is not easy to travel through so many time zones, but it is very important to understand different cultures and different ways that colon cancer patients are treated in Asia and Europe. The rest of the world is looking at us for what we do in colon cancer research.

We are very blessed in the USA to have access to all these new drugs which is not the case throughout the world. The last three new medications approved in colon cancer were developed in the USA: Erbitux by Imclone, Avastin by Genentech and Vectibix by Amgen. Who would have thought that Erbitux would  just have been approved in Japan and is still not approved in Israel.

Overall survival for patients with advanced disease is much shorter in Europe and Japan compared to the USA because they have less access to the latest therapies and treatments are given not only by medical oncologists but also surgeons and gastroenterologists which slows down the implementation of the most effective therapies.  However in Europe because surgeons play a bigger role in chemotherapy not necessarily do they give the best chemotherapy but they watch very carefully to see  if there is any role for resection of metastases which is the only chance for cure.

In the USA this involvement happens less often, and only centers with multidisciplinary conferences incorporate the expertise of disciplines such as oncology, radiation oncology, colorectal surgery and hepatobiliary surgery. Only with the best therapies and the best expertise in all these areas will we be able to improve outcomes for our patients and hopefully cure more and more patients.

We in the USA should be very thankful for having  cutting edge therapies available for our patients with colon cancer. One of the reasons I stayed at the University of Southern California is because comprehensive cancer centers such as USC/Norris are heaven for clinical scientists who can work easily with population scientists and basic scientists, take advantage of cutting edge technologies, and really do bench to bedside research.

Dr. Jeffrey Chou

Jeffrey Chou, M.D.,Ph.D., is the recipient of the 2009 AACR-Colorectal Cancer Coalition Fellows Grant in memory of Lisa Dubow.

Dr. Chou, a researcher at the Fred Hutchinson Cancer Center at the University of Washington in Seattle, will study how to make colorectal cancer stem cells more vulnerable to the body’s immune system.

The award will be made at the AACR’s 100th Annual Meeting in Denver.  Funds for the grant were raised by C3 through the Lisa Fund. Donations to the fund are targeted for research to develop treatments for patients with late-stage colorectal cancer.

Dr. Chou will be working with both cell cultures and mice to see if the drug decitabine will make colorectal cancer stem cells respond to immunotherapy.  He has identified a protein that is specific to cancer which can be recognized as foreign by the immune system.  Once recognized, the cancer/testis antigen NY-ESO-1 elicits a strong immune response that can kill cancer stem cells.

During his research, Dr. Chou will be trying to find out

• If decitabine increases NY-ESO-1 in colorectal cancer stem cells,
• If treating those cells with decitabine and immunotherapy and transplanting them in mice prevents their growing into cancer, and
• If decitabine and immunotherapy can destroy existing colorectal cancer tumors in mice or slow their growth.

Dr. Chou says,

Results from my proposed studies may potentially provide pre-clinical data supporting a novel therapy using a combination of decitabine and immunotherapy for metastatic CRC. I am honored by and grateful for the generous support provided by AACR, C3: Colorectal Cancer Coalition, and the Lisa Fund, and I would like to thank my mentor Dr. Edus Warren, who has been invaluable in fostering my development as a cancer researcher.

AACR Fellows Grants are made to young researchers to encourage their scientific work in cancer:

The Fellows Grants support innovative research by a meritorious young investigator by presenting the Fellow with research funds to pursue an independent line of investigation within the context of his/her current Fellowship placement. By allowing a Fellow to acquire the equipment and supplies needed to pursue a new direction in his/her research program, the Fellows Grant assists the Fellow in developing preliminary data to support a future project or investigating a new technique that otherwise would not be possible in the absence of this funding.

Lisa Dubow

Lisa Dubow, who died in 2007, credited her nine years of survival with advanced colorectal cancer to cutting edge research and participation in clinical trials.

Before her death she worked with C3 to create the Lisa Fund to focus on better treatment for metastatic disease.  Lisa asked that we not forget about her and other patients battling the hard-to-treat late-stage cancer that had already gotten worse on standard treatments.

Your donation to the Lisa Fund is an investment in colorectal cancer research. Help us assist other researchers looking for better treatments and a cure for colorectal cancer by making a donation to the Lisa Fund today.

Epigenetic modulation of colorectal cancer stem cells for immunotherapy

As the recipient of the 2009 Lisa Dubow Research Fellows Grant, Jeffrey Chou, M.D., Ph.D. will study ways to make colorectal cancer stem cells more vulnerable to the body’s own immune system.

He will be working with both cell cultures and specially-bred mice to see if the drug decitabine can increase levels of a specific protein that induces a strong immune response.  If so, a combination of decitabine and a vaccine against that protein might be an effective treatment for advanced colorectal cancer.

In his proposal, Dr. Chou writes,

“Despite advances in surgery, radiation, and chemotherapy, the majority of patients with advanced or metastatic disease ultimately die from their cancer. Treatment failures in colorectal cancer may be due to incomplete elimination of the colorectal cancer stem cell which can initiate and sustain tumor growth. Thus, an urgent need exists for the development of better systemic therapies which target the colorectal cancer stem cell.”

Colorectal tumors are composed of different cell types. A small number of tumor cells have the ability to move from where they first developed to new sites in the body to establish new tumors. Cells with this property are called cancer initiating stem cells. These cells are particularly resistant to chemotherapy. Even if 99 percent of a tumor is killed by chemo or other therapy, but cancer stem cells remain, the tumor will grow back and continue to spread.

Find new ways of targeting and destroying colorectal cancer stem cells may lead to new and more effective treatment for colorectal cancer.

One way to destroy cancer stem cells is to harness the body’s own immune system to recognize them as a threat and eliminate them.  Ordinarily, the immune system accepts the proteins in cancer as a normal part of the body and basically ignores them.

However special proteins known as cancer/testis antigens (CTAs) stimulate an immune response in many cancers.  CTAs are only found in cells in the testicles, where they are invisible to the immune system, and in some cancers.  Because they are not found in normal tissue outside of testes, an immune system attack on cells with CTA can target cancer and leave healthy cells alone, ideal for cancer treatment.

Unfortunately, colorectal cancer cells have very low levels of CTAs so treatments for advanced colorectal cancer that evoke immune response (immunotherapy) haven’t been very effective. However, preliminary data show that the drug decitabine increases CTA levels in many types of cancers allowing  immune system cells to recognize and kill them.

One cancer/testis antigen (NY-ESO-1) induces strong immune responses in cancer cells.  Immune cells called cytotoxic T lymphocytes (CTLs) that can specifically recognize and kill cells producing NY-ESO-1 have been discovered.  When colorectal cancer cells are treated with decitabine in the laboratory NY-ESO-1-specific CTLs kill the cancer cells but not normal or untreated cells.

Dr. Chou is planning to build on this knowledge in his research, asking three questions:

• Will treating colorectal cancer stem cell cultures with decitabine increase the levels of NY-ESO-1 in those cells?
• If colorectal cancer cells are treated with decitabine and immunotherapy (cytotoxic T lymphocytes) and transplanted into mice, will the mice develop cancer?
• Can treating mice who already have cancerous tumors with decitabine slow tumor growth or destroy those tumors completely?

If successful, Dr. Chou’s basic research with colorectal cancer cells and mice may lead to effective vaccine therapies for colorectal cancer, killing the stem cells that keep it from being completely eliminated by conventional treatments.

The choice of Dr. Chou’s proposal for the 2009 award was made in collaboration with the American Association for Cancer Research (AACR) as part of its Fellows Grants Program for talented young investigators.

Lisa Dubow dreamed of a day when even the most dangerous and deadly colorectal cancer could be cured. You can help Fight Colorectal Cancer make those dreams come true by supporting the work of imaginative young cancer researchers by investing in the Lisa Fund.