A second study, also presented Saturday at ASCO, essentially discarded the notion that patients newly diagnosed with metastatic colorectal cancer should get surgery right away. Instead, the trial found that these patients can simply receive standard chemotherapy and wait until the tumor is actually causing problems -- such as a bowel perforation, intestinal blockage or bleeding -- before initiating any surgery. Early surgery is often performed in these patients to deal with complications, not to cure the disease, the researchers noted.
In the trial, "the vast majority -- 89 percent of these patients -- never developed symptoms from their colon tumor that required urgent surgical intervention," said study senior author Dr. Philip B. Paty, attending surgeon and vice chairman of clinical research at Memorial Sloan-Kettering Cancer Center in New York City. "We believe this non-surgical approach should be regarded as the standard approach for this patient population."
Other research looking at gastrointestinal cancers also turned up largely negative results.
One trial found no difference in survival for pancreatic cancer patients who received the chemotherapy regimen Gemzar (gemcitabine) or 5-FU/FA (fluorouracil/folinic acid) after surgery.
Gemzar, however, did have fewer side effects, which is "extremely important," said study lead author Dr. John Neoptolemos, head of surgery and oncology at the University of Liverpool in Great Britain. "There had been a tendency to reject 5-FU/FA and now it's very much back on stage," he said at the press conference.
And the standard of care for anal cancer -- radiation therapy plus 5-FU and mitomycin-C chemotherapy -- remains the best bet for patients with this rare malignancy. Chemotherapy with cisplatin showed no superior benefit, according to researchers at the National Cancer Research Institute in Britain. The authors also concluded that maintenance chemotherapy resulted in no added benefit. In either case, however, the prognosis was excellent, with about an 85 percent survival rate at three years.
Finally, Italian researchers from E.O. Ospedali Galleria in Genoa reported that for patients battling rectal cancer, adding another chemotherapy regimen to the standard radiation-plus-chemotherapy protocol did not shrink the tumor any further, although some initial data suggested that it may reduce the spread of the cancer.
There's more on digestive and gastrointestinal cancers at the U.S. National Cancer Institute.
SOURCES: May 30, 2009, American Society of Clinical Oncology news conference with Norman Wolmark, M.D., chairman, department of human oncology, Allegheny General Hospital, Pittsburgh; Philip B. Paty, M.D., attending surgeon and vice chairman of clinical research, Memorial Sloan-Kettering Cancer Center, New York City; John Neoptolemos, M.D., head, division of surgery and oncology, University of Liverpool, Liverpool, U.K.; study abstracts