Cancer Treatment Today » New Drugs

Gemzar for colon and rectal cancer

M Levin, MD — Fri, 09 Nov 2012 19:17:56 +0000

Gemzar( gemcitabine) has been tested for colon and recatl cancer. A 1992 study found that Gemcitabine did not demonstrate activity against advanced colorectal adenocarcinoma. ON teh other hand,a much later study found that Gemcitabine has a modest activity in heavily pre-treated colorectal cancer patients and may be an option in good performance status patients. There are a number of reports and ongoing studies of gemcitabine in combination for colorectal cancer. A recent study, Gemcitabine in Treating Patients With Advanced Colorectal Cancer, NCT00007943, was completed in 2009 but not published as of 2012.

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Afinitor for colon cancer

M Levin, MD — Fri, 21 Sep 2012 18:08:24 +0000

Afinitor is a new exciting drug that is approved for breast and kidney cancer and other conditions. Evidence for using Afinitor for colorectal cancer is weak – one small trial with weak results. There is some evidence from this trial ( Altomare et al) reported in ASCO 2012 that some colorectal cancer patients whose tumors had gotten worse on all standard treatments can benefit from a combination of Afinitor® (everolimus) and Avastin® (bevacizumab). This was a small trial in 50 patients. It showed a tumor control rate of 47%. Median progression-free survival time was 2.28 months, median overall survival time was 7.87 months. 46 percent of patients had disease control that lasted a median of 6.1 months. There were no complete or partial responses. 8 had a minor response lasting median 4.1 months. 15 had stable disease lasting median 6.7 months.

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Zaltrap: A new drug for colon cancer

M Levin, MD — Fri, 24 Aug 2012 16:57:15 +0000

Zaltrap was approved by the FDA in the beginning of August 2012. It is also known as aflibercept, VEGF trap or, when used for macular degeneration, Eylea. By binding to and inhibiting vessel growth(angiogenic) growth factors, aflibercept inhibits tumor vessel production and supply.

Aflibercept has demonstrated efficacy in treating metastatic colorectal cancer in a recent randomized Phase III trial. The approval for colon cancer was based on a phase III trial. ZALTRAP, in combination with 5-fluorouracil, leucovorin, irinotecan-(FOLFIRI), is indicated for patients with metastatic colorectal cancer (mCRC) that is resistant to or has progressed following an oxaliplatin-containing regimen.

Ith hs not fared as well in ither cancertypes. Aflibercept failed its primary endpoint of overall survival in the Vital phase III trial for second-line treatment of locally advanced or metastatic non-small cell lung cancer (NSCLC), although it improved the secondary endpoint of progression-free survival. It is also in trials for prostate cancer.

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Chemo Options for Later Lines of Therapy for Metastatic Colon Cancer

M Levin, MD — Thu, 19 Jul 2012 02:55:29 +0000

There are now five different classes of drugs with significant antitumor activity in colon cancer:

Fluoropyrimidine(5-fluorouracil [5-FU] which is usually given with leucovorin [LV], capecitabine, tegafur plus uracil [UFT]), Irinotecan, Oxaliplatin, Cetuximab and panitumumab (Vectbix). The latter two are monoclonal antibodies (MoAbs) directed against the epidermal growth factor receptor (EGFR), and bevacizumab, is a monoclonal antibody targeting vascular endothelial growth factor (VEGF).

The best way to combine and sequence all of these drugs to optimize treatment is not yet established, although for initial treatment of metastatic colorectal cancer NCCN recommends combinations of 5FU and Lekovorin with oxaliplatin or irinotecan with or without Avastin, CAPEOX, 5FU/Leukovorin, Xeloda and Avastin or Folfoxiri.

For second or third line therapy, single agents are acceptable but NCCN lists only irinotecan as a single agent. It also lists combinations of these drugs, Erbitux and Vectbix(for wild type KRA patients), see p. COL-C of the NCCN guideline for colon cancer. NCCN has a complex schema when to give what for second line and also lists Erbitux and Vectbix. However, capecitabine is also FDA approved as a single agent. NCCN does not list 5FU/Leikovorin but it can also be considered appropriate given the long history of its use for colorectal metastatic cancer and support form many older papers.

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