On Monday, September 20th, the Colorectal Cancer Coalition held a free patient webinar on the issue facing patients diagnosed with stage II colon cancer: chemo, or not?

Coalition staff Kate Murphy and Kim Ryan were joined by Dr. John L. Marshall of the Georgetown Lombardi Comprehensive Cancer Center to discuss this issue and took questions from patients at the end. You can view the webinar here:

Stage II Colon Cancer: Chemo or Not? Find Your Solution

Stage II colon cancer patients face tough decisions about whether the possible benefits of chemotherapy outweigh its risks and challenges. The Coalition is grateful to Dr. Marshall for helping patients explore this issue.

Some colon cancer patients don’t benefit from treatment with 5-FU based chemotherapy and may even have worse outcomes than if they no chemo at all.

Of every 100 people with colon cancer, about 15 will have cancers that arise when mistakes in DNA during cell division are not caught and fixed.  Scientists call this defective mismatch repair or dMMR.

More often, colon cancer occurs when mutations in chromosomes accumulate but DNA repair pathways remain intact and mismatch repair is proficient (pMMR). This is true for about 85 percent of colon cancer.

Both prognosis and the potential benefit from FU-based chemotherapy appear to be very different for these two types of colon cancer. Knowing mismatch repair status of colon tumors can help patients and their doctors make better treatment decisions.

Patients with defective mismatch repair have better disease-free and overall survival and don’t seem to benefit from 5-FU at either stage II or stage III.  Stage II patients with dMMR have significantly poorer overall survival if they get chemo after surgery.

Caution:  These results come from studies of 5-FU plus levamisole or 5-FU plus leucovorin.  They don’t include any information from the current standard treatments of FOLFOX or FLOX which contain oxaliplatin in addition to 5-FU and leucovorin.

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Young patients with stage II or III colon cancer get equal benefit from chemotherapy as older patients, and they have similar side effects.

Five years after treatment, 67 percent of patients under the age of fifty hadn’t had their cancer spread beyond the colon (recurrence-free interval), the same percentage that applied to patients who were fifty or over.

Overall survival and disease-free survival were somewhat better for young patients because they had fewer other reasons for dying.  Overall and disease-free survival reflect patients who are alive five years after beginning treatment.  Neither includes people who have died from any cause, including their cancer. Read the rest of this entry »

How likely is it that an individual colon cancer will return?

Stage II colon cancer patients have a tough time knowing how likely it is that their cancer will recur and making a decision about having chemotherapy after surgery.

A test is now on the market that can help with that decision.  OncoType DX® Colon Assay analyzes 12 key genes from a tumor sample to produce a recurrence score that indicates how likely stage II colon cancer will return.

While OncoType DX Colon can’t predict whether chemotherapy will reduce the chance that cancer will come back, it can help patients and their doctors decide on chemotherapy in combination with other factors.

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Here’s a second article from C3 research advocate, Pam McAllister, based on information she learned at the 2010 GI Cancers Symposium in Orlando.

Pam’s experience with colorectal cancer research advocacy goes back more than a decade.  She has been a patient advocate with several cancer cooperative groups and now chairs the Radiation Therapy Oncology Group (RTOG) Patient Advocacy Committee.

While most patients with stage II colon cancer are at low risk of recurrence, there are patients in this group who are at increased risk and who may need chemotherapy to reduce their risk. Read the rest of this entry »