In Brief

From OncoLog, June 2009, Vol. 54, No. 6

In Brief

Dramatic Increases in Metastatic Colorectal Cancer Survival Documented

Patients with metastatic colorectal cancer are surviving much longer than they did two decades ago, thanks to novel chemotherapy and biological agents and surgical advances in liver resection, an M. D. Anderson study has found.

The median overall survival duration for patients diagnosed with advanced colorectal cancer is now nearly 30 months, compared with 8 months for patients diagnosed before 1990. Also, the 5-year overall survival rate of patients diagnosed after 2004 is projected to be more than 30%, according to the study, which was published in the Journal of Clinical Oncology.

Recently, the U.S. Food and Drug Administration approved numerous chemotherapeutic agents that are effective against metastatic colorectal carcinoma, said Scott Kopetz, M.D., corresponding author on the study and an assistant professor in the Department of Gastrointestinal Medical Oncology. Also, over the past decade, the concept that specific metastatic liver lesions can be surgically removed has become more widely accepted as practice. Thus, more emphasis is now placed on identifying candidates for resection of liver metastasis.

The researchers wanted to determine whether those changes in therapy resulted in longer survival in a large group of patients. The retrospective study included 2,470 patients with newly diagnosed metastatic colorectal cancer who were treated at M. D. Anderson or Mayo Clinic between 1990 and 2006.

No significant change in overall survival was found in patients diagnosed between 1990 and 1997. But by 2006, the median overall survival duration had increased to 29.2 months. Five-year overall survival also increased over time: from 9.1% (diagnosed 1990–1997), to 13% (diagnosed 1998–2000), to 19.2% (diagnosed 2001–2003). Five-year survival for patients diagnosed in 2004–2006 has not yet been determined but is projected to be more than 30%. The findings were confirmed through analysis of survival data in the U.S. National Cancer Institute’s Surveillance, Epidemiology and End Results cancer registry.

“We found not only a significant improvement in the overall survival of metastatic colorectal cancer patients, but we also demonstrated that the degree and rapidity of the improvement are of a magnitude that is rarely seen in metastatic cancers,” Dr. Kopetz said.

The researchers noted two periods in which survival increased the most: in the late 1990s, when surgeons started performing higher numbers of hepatic resections, and beginning around 2004, following the approval of the agents cetuximab, bevacizumab, and oxaliplatin.

“However, surgery and chemotherapy are not independent and certainly complement each other,” Dr. Kopetz said. “As chemotherapy improves, we can remove more tumors, and as surgery for metastatic disease is more commonly performed, then patients can receive more chemotherapy.”

Despite the study’s reported gains, metastatic colorectal cancer remains incurable for most patients, and continued research is needed to further extend survival, Dr. Kopetz said.

The study was funded by grants from the National Cancer Institute.

Acupuncture Relieves Dry Mouth Following Radiation Therapy, Study Shows

Researchers at M. D. Anderson have found that acupuncture made patients less likely to experience xerostomia—severe dry mouth—following repeated radiation therapy for head and neck cancers.

In the study, 19 patients suffering from xerostomia due to radiation therapy underwent twice-weekly acupuncture sessions for 4 weeks. The patients were then tested for saliva flow and completed questionnaires designed to gauge the effects of the acupuncture sessions on their quality of life. “Patients in the study had improvements in their physical well-being and in subjective symptoms,” said Mark S. Chambers, D.M.D., a professor in the Department of Head and Neck Surgery and a study author. “Although the patient population was small, the positive results are encouraging and warrant a larger trial to assess patients over a longer period of time.”

In fact, a phase III, placebo-controlled trial is planned and is currently under review, said M. Kay Garcia, Dr.P.H., first author on the pilot study. In other studies, M. D. Anderson researchers are examining whether acupuncture can prevent—not just treat—xerostomia in head and neck cancer patients who receive radiation.

People who have cancers of the head and neck typically receive large cumulative radiation doses, which can leave the salivary glands incapable of producing adequate saliva. Saliva substitutes, lozenges, and chewing gum bring only temporary relief, and a commonly prescribed medication (pilocarpine) may have short-lived benefits and bothersome side effects. Acupuncture may bring relief by increasing blood flow to the affected area through the stimulation of precise points, though further study is needed.

Results of the M. D. Anderson study were reported online in the journal Head & Neck.

For more information on this topic or for questions about M. D. Anderson’s treatments, programs, or services, call askMDAnderson at (877) MDA-6789.

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