New Advances Aim to Improve Detection, Prognosis, and Treatment of GI Cancers

The 2012 Gastrointestinal Cancers Symposium held last week in San Francisco brought oncologists, surgeons, radiation oncologists, gastroenterologists, and other members of the cancer care community together to gain greater awareness of how to optimize management of gastrointestinal cancers through interactive and educational sessions featuring the latest research in the field. Key highlights of the meeting were numerous. Full article

Stool Test for Colorectal Cancer Screening

Provocative data indicate that a novel stool DNA test has been developed that accurately detects early-stage colorectal cancer and large adenomas throughout the colon. The test itself is relatively simple: It detects select methylated genes and mutated KRAS and also quantifies hemoglobin in stool samples from patients. Full article

Related article: Increasing CRC Screening in Minorities and Disadvantaged Populations

Benefits of Second-Line Panitumumab in mCRC Correlate With Skin Toxicity

Final data from Study 181, a phase III trial conducted in 1,186 patients with metastatic colorectal cancer (mCRC), confirm the benefit of adding panitumumab to second-line leucovorin/5-fluorouracil/irinotecan (FOLFIRI) in patients with wild-type KRAS (Abstract 387). Full article

Large Study Supports Adjuvant XELOX for Stage III Colon Cancer

Long-term results from the randomized phase III NO16968 study conducted in 1,886 patients with resected stage III colon cancer show that the disease-free survival benefit initially observed with adjuvant capecitabine/oxaliplatin (XELOX) versus bolus 5-flurouracil/leucovorin at 4.75 years translates into a significant overall survival benefit by 7 years (Abstract 388). Full article

CORRECT Trial Results: Regorafenib Potential New Standard of Care for Refractory mCRC

Findings from the CORRECT trial indicate that regorafenib, an investigational, oral multi-kinase inhibitor, is the first and only agent in phase III analysis to significantly improve overall survival in patients with metastatic colorectal cancer (mCRC) who have failed all approved standard therapies (Abstract LBA385). Consequently, regorafenib could help address the high unmet clinical need faced by this patient population once the drug receives regulatory approval, according to principal investigator Axel Grothey, MD, of the Mayo Clinic in Minnesota. Full article 

RADIANT-2 Reanalysis: Everolimus Might Be More Beneficial Against Advanced NETs Than Previously Recognized

The phase III RADIANT-2 trial conducted in 429 patients with advanced neuroendocrine tumors (NETs) previously established that the addition of everolimus to long-acting octreotide led to a clinically meaningful 5.1-month delay in disease progression compared with octreotide alone. However, this value just missed the prespecified boundary for statistical significance (prespecified p value ≤ 0.0246; actual p value = 0.026). Full article 

Doubt Cast on Safety of Vascular Reconstruction During Pancreaticoduodenectomy

Contrary to the results of several single-center studies with relatively small sample sizes, a large retrospective analysis of data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) indicates that vascular reconstruction during pancreaticoduodenectomy substantially increases the short-term risk of complications and death (Abstract 153). Full article 

PAM4 Immunoassay May Help Detect Early-Stage Pancreatic Cancer

A new enzyme immunoassay that quantitates serum levels of the PAM4 biomarker may hold the key to detecting pancreatic ductal adenocarcinoma (PDAC) in its earliest stages, thereby improving patients’ chances of surviving this insidious disease.  Full article 

Cost-Benefit Data Shows Neoadjuvant Chemoradiation Improves Survival, More Cost Effective than Surgery First

Clinicians looking for guidance as to the optimal sequence of chemotherapy, radiation therapy, and surgery for resectable pancreatic cancer now have some direction: A systematic comparison of costs and outcomes reveals that neoadjuvant chemoradiation not only improves survival in patients with resectable pancreatic head adenocarcinoma, but does so at lesser cost compared with surgery first (Abstract 156). Full article

Adenocarcinoma Risk to Whole Pancreatic Gland Found in Patients with IPMN

Based on a study of patients diagnosed with a pancreatic intraductal papillary mucinous neoplasm (IPMN) and followed with radiographic surveillance, the entire pancreatic gland appears to be at risk for adenocarcinoma, not just the target cyst (Abstract 152). Full article

Nanoscale Optical Biomarkers Show Promise for Identifying Patients with Barrett’s Esophagus at High Risk for Adenocarcinoma

A feasibility study has identified three biomarkers signaling nanoscale changes in the nuclei of cells lining the esophagus that distinguish patients with Barrett’s esophagus who are at high risk for developing esophageal cancer (Abstract 14). Full article

AVAGAST Suggests Gastric Cancer Subtype Influences Prognosis, Bevacizumab Response

IAn unplanned exploratory analysis of data from the global phase III AVAGAST trial conducted in locally advanced or metastatic gastric cancer suggests that prognosis differs markedly based on disease subtype, as does the response to bevacizumab-containing therapy (Abstract 5). Full article

Related article:
Progress in the Management of Upper Gastrointestinal Malignancies

Molecular Analysis and FDG-PET Combination Useful in Response Prediction in EGJAc

In patients with advanced esophagogastric junction adenocarcinoma (EGJAc) who attain a metabolic response to platinum-based neoadjuvant chemotherapy according to fluorodeoxyglucose positron emission tomography (FDG-PET), a gene expression signature has been identified that discriminates between those who will and will not go on to attain an objective radiologic response (Abstract 1). Full article

Read full coverage of the Symposium