Since the last ASCO meeting in June 2008 not only has KRAS made headlines but also microsatellite instability (MSI).

Microsatellite instability has developed into the most important prognostic and predictive marker for patients with stage II colon cancer. Recent studies presented by Dr. Daniel Sargent at ASCO showed that patients with stage II colon cancer who have microsatellite instability did not benefit from 5-FU chemotherapy. Therefore these patients with no risk factors such as clinical obstruction, lymphovascular invasion, poorly differentiated adenocarcinoma, or insufficient lymph node collection should not receive 5-FU. Read the rest of this entry »

Looking into the future, I have no doubt that we will use colon cancer stem cells to find more effective therapies for colon cancer patients and develop novel chemoprevention strategies.

I am collaborating with a basic scientist, Michael Kahn, from the USC Stem Cell Institute. He moved from the Fred Hutchinson Cancer Center to USC to develop novel strategies for cancer stem cells. As many of you know, California will spend over $3 billion over the next 10 years on stem cell research. I have no doubt in my mind that California will be the world leader in a couple of of years in stem cell research and the development of new therapies for a lot of different disorders including cancer. Read the rest of this entry »

There are more and more interactions between surgeons and oncologists for patients with metastatic colon cancer.

Colon cancer is very special since we can cure metastatic disease which is not usually possible for cancer. In colon cancer we talk about cure and not only survival. Because we can cure, we need to make sure we don’t miss any opportunity to do so.

Over the last five years our approach in patients with metastatic disease with liver-limited lesions has changed. We know that with more successful chemotherapies, we are able to convert more and more patients to a situation which allows a surgical resection with the intention to cure. Not all surgeries will cure, but it gives us a chance to cure. Read the rest of this entry »

Most of us love cocktails. . .Manhattan, gin and tonic etc. We know, depending on what we use and how they are mixed, they may taste different.

Well, for the treatment of colon cancer patients we have different cocktails to choose from such as FOLFOX and FOLFIRI. Both are combinations of 5-FU and leucovorin and either irinotecan or oxaliplatin. Both regimens have similar efficacy and similar extent of side effects, with oxaliplatin having more neurotoxicity and irinotecan more diarrhea.

However, depending how you mix and deliver the three drugs you may have significant differences in toxicity. It is amazing what differences exist among oncologists in how they mix up their chemotherapeutic cocktails. Not only the doses but also the timing of administration can differ dramatically, which can result in differences in toxicities for patients.

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Many patients with metastatic disease ask how long we should do chemotherapy. This is astonishing since when we are diagnosed with diabetes or hypertension we usually would not ask the same question. Of course, for patients with metastatic disease we continue as long the chemotherapy works.

A lot of patients ask whether you can take a break from chemotherapy, particularly around the holidays or vacation times. Do you take a break from insulin or your high blood pressure medication? In the last two years, clinical trials have been conducted to answer exactly this question.
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