There was frost on the grass this morning when I let the little dog out.  A hard freeze is predicted for the next few nights, a sign that winter and its ice and snow isn’t far off.

Cold is a special problem for people who are getting Eloxatin® (oxaliplatin) for colon and rectal cancer.  Almost all patients on FOLFOX will experience acute neuropathy within a few hours of each oxaliplatin infusion.  This is acute, short-term, and ends within few days.

About a third will go on to a chronic peripheral neuropathy that begins as oxaliplatin doses accumulate.  Most patients will experience some tingling and numbness in their hands and feet.  A very few will have pain and difficulty walking.

Chronic neuropathy usually fades in the months after treatment ends, but may linger as long as a year or 18 months.  It remains a long-term problem for a small percentage of patients.

As cold weather approaches, you need to take care if you are on FOLFOX treatment or have peripheral neuropathy left over from previous treatment. Read the rest of this entry »

While there weren’t new blockbuster announcements for colorectal cancer this year at the American Society for Clinical Oncology’s (ASCO) Annual Meeting, there was plenty of focus on making what we already have work better and on choosing the patients who will benefit the most from treatments, as well as those who might not be helped at all. (Note, many of these issues will be discussed in detail on our upcoming patient webinar.)

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.

Read the rest of this entry »

Colorectal cancer patients getting oxaliplatin quickly learn to avoid cold. Drinks with ice, chilly air, even opening the freezer can produce sudden, sharp pain, burning, or an unpleasant pins and needle feeling in their throat and hands.

A small study has found that venlafaxine (Effexor) can completely eliminate acute neurotoxicity from oxaliplatin in about 1 out of 3 people.  More than half of patients who took it had more than 50 percent relief from symptoms. Read the rest of this entry »

Update from 2010 GI Cancers Symposium

Colon cancer patients over 70 actually had a greater reduction in disease-free survival than did younger ones with a new regimen of Xeloda® and oxaliplatin compared to older IV 5-FU treatments according to a new analysis reported at the GI Cancers Symposium in Orlando.

With the bolus IV 5-FU and leucovorin regimens, stage III colon cancer patients over 70 had about a 60 percent chance of being alive and free from cancer three years after surgery. With a combination of Xeloda (capecitabine) and oxaliplatin in a treatment called XELOX, their three-year disease-free survival was 66 percent.

Younger patients had about a 3 percent absolute improvement between the two treatments from 69 percent to 72 percent. Read the rest of this entry »

Briefly

Patients with diabetes aren’t any more likely to develop neuropathy in hands and feet when treated with oxaliplatin.

Learn more about  current colorectal cancer prevention and treatment at a Memorial Sloan Kettering CancerSmart workshop on November 12.  NIH has a downloaded booklet on palliative care, and Oncology on Canvas is looking for artwork from cancer patients and their families and caregivers. Read the rest of this entry »