Colon Cancer

5 Florouracyl – weekly or every 21 days? – pro

Fluoropyrimidine (5-fluorouracil [5-FU] is the oldest chemotherapy drug for colon cancer and it is usually given with leucovorin [LV]. For second or third line therapy, single agents are acceptable  and NCCN has a complex schema when to give what for second line and also lists Erbitux and Vectbix. Capecitabine is also FDA approved as a single agent. NCCN does not list 5FU/Leukovorin but it can also be considered appropriate given the long history

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Gemzar alone for colorectal cancer – pro

The role of gemcitabine for colorectal can has not been defined. Moore et al found that Gemcitabine, at the doses and schedule used in his study, did not demonstrate activity against advanced colorectal adenocarcinoma. A much later study from Columbia University(Saif et al) 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

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Sprycel for colon cancer – pro

Dasatinib, also known as Sprycel, is a cancer drug produced by Bristol-Myers Squibb and sold under the trade name Sprycel. It is a drug that is approved by the FDA for chronic myelogenous leukemia. It has an effect on the Src kinases, which interact with the EGFR receptor. One phase II trial(Nautiyal et al) showed that Dasatinib is inactive in previously treated metastatic colorectal patients patients. There is a trial that is studying this drug:

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Colovantage test for colon cancer – pro

ColoVantage is a new test available from Quest. It is a screening test that is not meant to be a substitute for colonoscopy. It was approved by NY State in March of 2011. It  detects circulating methylated DNA from the SEPT9 gene, which is involved in cytokinesis and cell cycle control. A case-control study performed at Quest Diagnostics showed that the ColoVantage test is 70% sensitive for CRC detection at a specificity of 89%.  ColoVantage has

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PET to detect recurrence of colon cancer with serially rising CEA levels – pro

PET is being more frequenlty used to detect and identify recurrence. More recently NCCN has been more supportive of PET in this setting. It used to support PET only in the situation of rising CEA and no identified recurrence for localization of disease recurrence in patients with rising CEA level and non-diagnostic imaging studies, such as CT scans.However,  PET scan can potentially identify occult disease in this setting that CT misses. Therefore, 

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Xeliri second line for metastatic colorectal cancer – pro

The issue that we will discuss is Xeliri (Xeloda and irinotecan) in second or later line of therapy. It is a tempting regimen because Xeldoa is an generally effective drug for colorectal cancer and it is oral.  We start by pointing out that there are now six 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

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Afinitor for colon cancer – pro

Evidence for using Afinitor for colorectal cancer is weak - one small trial with weak results. There is some evidence from a small 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

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Nexavar for colon cancer – pro

Nexavar is currently in a phase II clinical trial for colorectal cancer. In this trial, researchers are combining the targeted monoclonal antibody cetuximab (Erbitux) with another targeted drug called sorafenib (Nexavar) to treat patients with metastatic colorectal cancer whose tumors show epidermal growth factor receptor (EGFR) activity. I was not able to find any other published liteature on the use of Nexavar for colon cancer. Sorafenib works

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PET for colon cancer staging – pro

Lay Summary: PET is an acceptable way to stage colon cancer, although some resistance remains. More recently NCCN has been more supportive of PET in colorectal cancer staging. It supports PET in the situation of rising CEA and no identified recurrence but also in some other settings (p.13). CMS guidelines state that PET would rarely be used in the diagnosis of colorectal cancer. However, starting July 1, 2001, HCFA, now called the Centers for Medicare

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Vectibix in combination – pro

Panitumumab (Vectibix, Amgen) was approved by the FDA for the treatment of patients with EGFR-expressing, metastatic colorectal carcinoma with disease progression on or following fluoropyrimidine-, oxaliplatin-, or irinotecan-containing regimens. The NCCN Colon Cancer panel added panitumumab as alternate option to cetuximab after first or second progression on previous therapy. This addition came with a recommendation that patients should not be

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