Despite better screening for colorectal cancer (CRC), about 1 in 5 newly diagnosed patients will have metastatic CRC that already has spread to distant organs.  Many will have symptoms of fatigue or weight loss, but only a minority will have symptoms (significant bleeding or abdominal pain, or a blocked bowel) caused by the colon tumor itself.

In those people first diagnosed with stage IV CRC, about 80% have metastases that cannot be removed by surgery. There’s been intense debate—but no clear evidence—about whether patients whose colon tumor isn’t causing symptoms should have the colon tumor surgically removed routinely before they start chemotherapy. 

A recent important study provides the first evidence that such patients often do just as well to start systemic chemotherapy immediately without having their colon tumor surgically removed. Read the rest of this entry »

Ziv-Aflibercept Approved as 2^nd line treatment for metastatic CRC  

For the first time in more than five years, the FDA has approved a new drug for certain patients who have metastatic colorectal cancer.

The FDA has approved ZALTRAP® (ziv-aflibercept) to be used with FOLFIRI as a “second-line” treatment for patients with stage IV colorectal cancer whose cancer got worse despite an initial oxaliplatin-based treatment (e.g. FOLFOX).  Read the rest of this entry »

It doesn’t hurt to stop XELOX chemotherapy combined with Avastin after six treatments and continue with Avastin alone until colorectal cancer gets worse, according to a study reported at the 2010 Annual Meeting of the American Society of Clinical Oncology in Chicago.

Many patients have to stop oxaliplatin chemotherapy with before getting its maximum effectiveness because of peripheral neuropathy — tingling, numbness, or pain in their hands and feet.  Xeloda® (capecitabine) can cause painful skin redness and cracking on the hands and feet or hand-foot syndrome, which can also affect time on chemotherapy.

Giving only six treatments of Avastin® (bevacizumab) plus XELOX chemotherapy and then stopping XELOX and using only Avastin until cancer progressed was as effective for the initial or first-line treatment of colorectal cancer as continuing XELOX.  XELOX combines Xeloda® (capecitabine) with oxaliplatin.

In addition, the strategy reduced both severe peripheral neuropathy and hand-foot syndrome.

Read the rest of this entry »

In disappointing news, adding the Hedgehog inhibitor GDC-0449 to standard chemotherapy failed to increase the time before advanced colorectal cancer got worse.

Researchers compared progression-free survival between patients who got either FOLFOX or FOLFIRI chemotherapy with Avastin and a group who got the same chemo regimen with GDC-0449. There was no difference Read the rest of this entry »

Does adding Erbitux to chemotherapy help people whose colorectal cancer has spread beyond the colon or rectum to distant body sites?

The answer is yes, according to a pooled analysis of two large randomized clinical trials comparing chemotherapy alone to chemotherapy plus Erbitux® (cetuximab).  However, benefits depend on whether or not patient tumors have mutations of two genes, KRAS and BRAF.

Previous studies have shown that only patients with normal or wild type KRAS get any benefit from EGFR inhibitors Erbitux or Vectibix™ (panitumumab) so a combined analysis of the CRYSTAL and OPUS studies looked only a outcomes in KRAS wild type tumors.  In addition, the research team studied the effect of mutations to BRAF.

They found that adding Erbitux to initial chemotherapy improved overall survival time, time until cancers got worse (progression-free survival), the percent of tumors that shrank with treatment (overall response rate) for tumors with wild-type KRAS.  The best outcomes were in patients who had both wild-type KRAS and wild-type BRAF. Read the rest of this entry »