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Colon Cancer

Treating Colon Cancer With Chemotherapy

Summary & Participants

Although there are only a few agents available, chemotherapy is the most common form of treatment for colon cancer. What treatments are most effective, and when should they be used? What is the newest treatment available? What future agents are on the horizon? Join our panel of experts as they discuss the latest in chemotherapy for colorectal cancer.

Medically Reviewed On: June 19, 2008

Webcast Transcript

MICHAEL LIEBERMAN, MD: In terms of the peri-surgical management of patients with colorectal cancer, very useful techniques to make the tumors more amenable to resection, particularly in the rectum, have utilized both the combination of chemotherapy and radiation therapy prior to surgery. And then we would follow up with resection.

There's been some association with sphincter salvaging surgery by utilizing this technique for rectal cancers. And also downsizing the tumor, making it more amenable to a complete resection when it's in the rectum.

DAVID R. MARKS, MD: So it gives a person a greater chance of being cured with surgery?

MICHAEL LIEBERMAN, MD: Of resectability, and of functional improvement, by being able to preserve their sphincter, and give us a negative margin. So we've used that as a useful technique for rectal cancer. We've also seen utility in utilizing chemotherapy following liver resection for metastatic disease from colorectal cancer, and there's been some nice work that has demonstrated an advantage to adding chemotherapy delivered through a continuous pump placed in the operating room, at the time of liver resection.

There's some very interesting modalities, where we're interacting as a team, both the surgeon, radiation oncologist and the medical oncologist, in taking care of patients with this disease.

DAVID R. MARKS, MD: What are the agents that are being used?

JOHN MacDONALD, MD: The agents that are used, the main agent is an agent called 5FU, which has really been around for over 30 years. We know how to use it differently now. It's also now being used in combination with some newer drugs.

In the last 10 years, we've had several newer drugs which are really effective. One is called Camptosar. The other name is irinotecan. The third name for this drug is CPT11. But the combination of 5FU with this drug has almost doubled the response rate, seeing an improved survival. So that's been a real leap forward, as it were. Another drug is called oxaliplatin, which is experimental in investigational treatment, but is really quite valuable, and is going to be very useful.

Now there are even some oral chemotherapy agents. One called Xeloda, another called UFT, which are effective in colon cancer.

DAVID R. MARKS, MD: Are there any other agents that are coming down the road that may be even better than what we have?

JOHN MacDONALD, MD: I think one of the things that's been intriguing about colorectal cancer is, we understand more about the molecular genetics of this malignancy than almost any other human malignancy. So what we've been able to do is, we've been able to target the differences, the molecular differences between normal cells and colon cancer cells, and we're beginning to look at agents that affect that.

For example, agents that inhibit the epidermal growth factor receptor. There's a monoclonal antibody called C225 which is of interest. There are molecules, small molecules that inhibit the way this epidermal growth factor interacts with the colon cancer.

There are agents that inhibit the ability of the colon cancer to develop new vascularity, new blood vessels. These are called anti-angiogenesis strategies. There are a number of agents out there in clinical development, which are of real important and will be clinically available to many oncologists and combined modality surgical oncology, medical oncology, radiation oncology teams in the near future.

DAVID R. MARKS, MD: How does a patient find out about clinical trials that are ongoing right now? If they want to get involved in them?

JOHN MacDONALD, MD: One of the ways is to look at the cancer centers. Cancer centers in the United States participate in many national clinical trials, and all the cancer centers also have their own menu of local clinical trials. Certainly the National Cancer Institute has websites, and has information. The PDQ database, for example, which will allow people to know what clinical trials are out there.

And I think the other message is that clinical trials are frequently the best treatment for any cancer, because you're getting an opportunity to be involved on the cutting edge of what's out there.

DAVID R. MARKS, MD: Okay, good. We'll end it on good news. Thank you both for being here. Thank you for joining our webcast. I'm Dr. David Marks. Goodbye.

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