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| |  NCCN: Newer Drugs Added to Colorectal Cancer Guidelines By Ed Susman HOLLYWOOD, FL -- March 14, 2003 -- Doctors should have the option to use newer drugs in the treatment of recurrent colorectal cancer, according to a new treatment algorithm written for the National Comprehensive Cancer Network (NCCN). "We must use all drugs that are available to treat patients with colorectal disease," said Dr. Leonard B. Saltz, MD, associate attending physician at Memorial Sloan-Kettering Cancer Center, New York. In presenting the updated NCCN guidelines for treatment of colon cancer at the organization's 8th annual conference, Saltz said recent clinical studies pointed out that both oxaliplatin and irinotecan offered patients another option in treatment if their cancer remained uncontrolled. The new guidelines call for use of several different salvage chemotherapy combinations following recurrence: - Bolus or infusional 5-fluorouracil (5FU) plus leucovorin. Dr. Saltz, in presenting the updated guidelines, said, "FOLFOX [5FU plus leucovorin plus oxaliplatin] is an appropriate first-line treatment for metastatic colorectal cancer." He said that either oxaliplatin or irinotecan could be used as a first-line treatment, or one could follow the other sequentially. In contrast, "We don't believe that combining these drugs is a good idea," said Dr. Paul F. Engstrom, MD, professor of medicine at Temple University and senior vice president of the Fox Chance Cancer Center, Philadelphia, PA, "because we don't know if we would get greater benefit at the risk of getting greater adverse events." He said studies of the combinations are underway. However, Engstrom said that any of the treatments would be appropriate. For, example, doctors might prefer to administer the oral drug capecitabine to patients who were elderly, frail or had other co-morbidities. He noted that the new chemotherapy regimens have been able to extend survival of patients with recurrent colon cancer from about six months to around 18 months. The guidelines do not suggest the use of irinotecan, oxaliplatin or capecitabine as adjuvant therapy for stage 3 colon cancer patients. The use of the drugs enters the treatment algorithm when recurrence of disease occurs or if the patient presented at stage 4, Engstrom said. Also new in the guidelines is the use of Positron Emission Tomography (PET) scans. According to Engstrom, the scans will help determine which patients should go on to have resection of recurrent colon cancers or who might require more systemic chemotherapy treatment. He said the imaging studies were also an important part of planning for further treatment for patients with recurrent or suspected recurrent rectal cancer.
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