Studies Identify Significant Findings In Treating People Living With GI Cancers

Main Category: GastroIntestinal / Gastroenterology
Also Included In: Cancer / Oncology;  Colorectal Cancer
Article Date: 24 Jan 2010 - 1:00 PDT

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Seven additional studies on the early detection, treatment and prevention of gastrointestinal cancers were highlighted today by the co-sponsoring organizations of the 2010 GI Cancers Symposium. The symposium is being held January 22-24 at the Orlando World Center Marriott in Florida.

Abstract 3

Transhiatal approach is superior to left thoracoabdominal approach for treating certain forms of esophageal and gastric cancer: Researchers have confirmed that the abdominal and transhiatal (AT) approach is superior to the left thoracoabdominal (LT) approach for surgical treatment of two forms of esophagogastric cancer (cancer of the junction between the stomach and esophagus), called true cardia and sub-cardia cancer. In the LT approach, the surgeon makes a large incision from the left side of the chest to the middle of the abdomen. During the AT approach, the incision is smaller in the upper abdomen. The AT approach does not provide as much space to remove lymph nodes for analysis as the LT approach, but it is also less invasive, and therefore, less taxing on the patient. In this study, 167 patients were randomly assigned to undergo surgery with AT or LT between 1995 and 2003. After a median follow-up of 7.7 years, researchers determined that five-year survival rates were higher in the AT group than the LT group (51 percent vs. 37 percent) and that patients in the AT group experienced significantly less deterioration in respiratory function, body weight and other symptoms.

Abstract 5

Large study confirms that presence of cancer cells in the peritoneum (abdomen) predicts poor disease-specific survival for patients with stomach cancer; chemotherapy may be beneficial: Findings from a large study have confirmed that the presence of microscopic cancer cells in the abdominal cavity - called positive peritoneal cytology - predicts poor disease-specific survival (DSS) among patients with gastric (stomach) cancer, even in the absence of visible peritoneal or visceral metastases (median DSS just over 1 year). Additionally, researchers found that about half of the patients (27/48) selected for repeat staging laparoscopy with positive peritoneal cytology who were initially treated with chemotherapy before surgical resection were converted to negative peritoneal cytology patients, and that these patients have significantly longer DSS than those that did not convert (median 2.5 years vs. 1.4 years). Peritoneal cytology is frequently used to determine the presence of cancer spread in gastric cancer patients that is not visible to the naked eye, and it is performed by microscopic examination of cell samples collected during surgery.

Abstract 45

First clinical trial of TNFerade Biologic (TNF) for locally advanced esophageal cancer finds increased survival, compared to historic controls: Findings from a small, multi-center study suggest that TNF combined with chemoradiation increases survival in patients with surgically removable stage II or III esophageal cancer. TNFerade, which has not yet been approved for use, is an adenovector, or DNA carrier, which contains the gene for tumor necrosis factor-alpha (TNFa), an immune system protein with potent and well-documented anti-cancer effects, used for direct injection into tumors. In this dose-escalating study, varying doses of TNF were given with concurrent neoadjuvant chemoradiation plus cisplatin to 24 patients. Researchers found that median survival was greater among patients in this study than historical controls (47.7 months vs. 9.7 to 34 months), and that five-year survival was highest among patients who received the three lower doses of TNF. The authors concluded these results are encouraging and that TNF warrants additional evaluation in this setting.

Abstract 128

Sorafenib (Nexavar) following response (=25% tumor shrinkage or necrosis) to transarterial chemoembolization (TACE) may not significantly slow hepatocellular carcinoma (HCC) progression: Primary findings from a phase III trial conducted in Japan and Korea suggest that sorafenib treatment initiated several weeks following one or two standard TACE procedures does not increase time to cancer progression (TTP) or recurrence among patients with advanced HCC. In the randomized, phase III study reported here, 458 patients received either 400 mg of sorafenib or placebo twice daily. Median time to progression or recurrence by central review was 5.4 months in the sorafenib arm and 3.7 months in the placebo arm, but the difference was not statistically significant. Overall survival was similar in the two groups. Several exploratory secondary analyses of the trial reported here did suggest a positive impact associated with sorafenib treatment. An exploratory analysis of TTP conducted by the investigators found that median TTP was 7.2 months in the sorafenib arm, compared with 5.3 months in the placebo arm. In multiple other exploratory subgroup analyses of TTP conducted by central review, the hazard ratios also favored patients treated with sorafenib, compared to those in the placebo group. The researchers concluded that further study evaluating the safety and efficacy of sorafenib in combination with TACE is warranted.

Abstract 279

Controlling dietary polyamines may be an effective strategy for preventing colorectal cancer: Polyamines are associated with cell growth and cancer development, and previous research has shown that a polyamine-inhibiting regimen of difluoromethylornithine (DFMO) plus sulindac (Clinoril) can prevent precancerous colorectal adenomas. Food products rich in polyamines include orange juice, meat, green peas and corn. In this randomized, phase III clinical trial researchers investigated the role of dietary intake of polyamines and the efficacy of DFMO/sulindac for preventing adenomas among 188 individuals. Researchers found that patients with the highest dietary polyamine intake were more likely to have colorectal adenomas greater than 1 cm and advanced adenomas, compared to those with the lowest dietary polyamine intake (43.6 percent vs. 26.4 percent, and 52.7 percent vs. 35.9 percent, respectively). However, they found that DFMO/sulindac treatment only reduced adenoma risk among patients with lower intake of dietary polyamines, and not among those with higher dietary polyamine intake. They conclude that control of dietary intake of polyamines may be an effective adjunctive strategy to polyamine inhibitors for preventing colorectal adenomas and cancer

Abstract 282

Second-line treatment with panitumumab (Vectibix) and FOLFIRI for metastatic colorectal cancer is only effective for wild-type KRAS tumors: A randomized, phase III trial, finds that adding panitumumab to second-line FOLFIRI (5-fluorouracil, irinotecan and leucovorin) treatment improves median progression survival for metastatic colorectal cancer patients whose tumors have the normal (wild-type) form of the KRAS gene (5.9 months vs. 3.9 months for FOLFIRI alone). The addition of panitumumab had no effect on patients with KRAS gene mutations.

Abstract 283

Adding panitumumab (Vectibix) to first-line treatment FOLFOX4 for metastatic colorectal cancer patients is only effective in patients with wild-type KRAS tumors: A randomized, phase III trial finds that adding panitumumab to first-line FOLFOX4 (oxaliplatin, leucovorin and 5-fluorouracil) treatment improves progression-free survival for advanced colorectal cancer patients with the normal (wild-type) form of the KRAS gene (9.6 months vs. 8 months with FOLFOX4 alone). However, they found that FOLFOX4 alone is superior for patients whose tumors have KRAS gene mutations (8.8 months vs. 7.3 months for patients who received both therapies).

Four leading medical specialty societies co-sponsor the three-day, multidisciplinary symposium, including the American Gastroenterological Association (AGA) Institute, the American Society of Clinical Oncology (ASCO), the American Society for Radiation Oncology (ASTRO) and the Society of Surgical Oncology (SSO). There are approximately 275,000 cases and more than 135,000 deaths due to these cancers in the U.S. every year.

Source
ASCO

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