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 »

We need to monitor not only for liver function but also for kidney function. However kidney problems are much less frequent.

Patients who undergo chemotherapy know that every time they receive chemotherapy, oncologists take blood to test for blood counts and also for liver and kidney function. Read the rest of this entry »

Cancer patients are often very tired, a bone-weary fatigue that doesn’t get better with rest.  Fatigue is the most common complaint from patients during chemotherapy.  However, a recent study found that one in four patients are already severely fatigued before treatment ever begins.

Severe fatigue was most common in patients with gastrointestinal cancer, where almost one in three were fatigued at diagnosis. Read the rest of this entry »

Five randomized studies have shown that chewing gum after colon surgery reduces the time it takes for patients to pass gas and have a bowel movement.

Patients in the studies chewed sugarless gum from 5 to 45 minutes, three times a day after surgery.  Control groups had similar surgeries but didn’t chew gum.

There was a trend toward leaving the hospital sooner, but the studies were too small to definitely show fewer hospital days for the gum chewers.

Still, the study authors wrote,

The potential cost savings from the reduction of even one postoperative day compared with the cost of several sticks of chewing gum are huge.

During intestinal surgery, the bowels stop moving contents forward, a situation known as ileus.  After surgery doctors listen for sounds in the bowel and wait for gas to pass through the rectum as signs that bowel activity is resuming.

Overall in the five studies, patients who chewed gum passed gas about half a day sooner and had their first bowel movement a day sooner.

The team concluded,

Chewing gum may enhance intestinal recoveryfollowing colectomy and reduce the length of hospital stay. Owing to the potential for substantial cost savings, larger-scale,blinded, randomized controlled trials with placebo arms are warranted.

Previously, C3 News has reported post-surgical gum chewing studies in California and Dallas and Pittsburgh.

More information about the overview of gum studies is on Medpage Today.

SOURCE: Purkayastha et al., Archives of Surgery, Volume 143, Number 8, August, 2008.