A PATIENT-FOCUSED ORGANIZATION
COLORECTAL CANCER TREATMENT & CLINICAL RESEARCH UPDATES
Month Ending February 16th, 2021
The following colorectal cancer treatment and research updates extend from January 14th , 2021 to February 16th, 2021, inclusive and are intended for informational purposes only.
This content is not intended to be a substitute for professional medical advice. Always consult your treating physician or guidance of a qualified health professional with any questions you may have regarding your health or a medical condition. Never disregard the advice of a medical professional or delay in seeking it because of something you have read on this website.
1. Phase II LEAP Clinical Trial to Treat mCRC.
2. Health Canada approves VITRAKVI (Larotrectinib), first tumour agnostic cancer treatment for advanced solid tumours harbouring an NTRK gene fusion.
3. A Phase II, Open-Label, Multicentre, Study of an Immunotherapeutic Treatment for the MSI High Colorectal Cancer Metastatic Population
4. Phase III Study at the Odette Cancer Centre Comparing Arfolitixorin vs. Leucovorin: Both in Combination with 5FU, Oxaliplatin, and Bevacizumab in Patients with Advanced Colorectal Cancer
5. Does Aspirin Lower CRC Risk?
6. Weekly vs Biweekly Cetuximab for mCRC
7. Avastin-Lonsurf Combo Improves Survival in Patients with mCRC Ineligible for Standard Chemo
8. Can KRAS Positive Colorectal and Lung Cancer Finally be Targeted?
9. Pembrolizumab Prolongs PFS vs. Chemotherapy for Certain Patients with CRC
10. Triplet Demonstrates Activity in mCRC
11. TAS-102 Plus Bevacizumab Is Potential New Option in Refractory mCRC
12. Allogeneic CAR T-cell Therapy Safe, Clinically Active in mCRC
13. Merck’s Keytruda Nabs EU Approval for CRCs
14. Phase II Single Arm Study of Durvalumab and Tremelimumab with Concurrent Radiotherapy in Patients with Mismatch Repair Proficient mCRC
15. Hepatic Artery Infusion Pump (HAIP) Chemotherapy Program – Sunnybrook Hospital
16. Living Donor Liver Transplantation for Unresectable Colorectal Cancer Liver Metastases
17. Study Offered at the Odette Cancer Centre to Treat Recurrent Rectal Cancer
18. Trends in the Incidence of Young-Onset CRC with a Focus on Years Approaching Screening Age
19. Analysis of Early-Onset CRC Incidence by Age, Subsite, and Histologic Subtype
20. Personalized Blood Test Can Detect Colon Cancer Recurrence Sooner than Scans
21. Delaying Colonoscopy Following Abnormal Stool Test Increases Risk of CRC
22. Young Adult Colorectal Cancer Clinic Available at Sunnybrook Hospital
23. Strange Colon Discovery Explains Racial Disparities In CRC
24. Evaluation of the Prognostic Relevance of the Recommended Minimum Number of Lymph Nodes in CRC
25. New TMB Recommendations Help to Guide Treatment Decisions in Oncology
26. MSI-High and Colon Cancer: What It Means, Treatment Options, and More
27. HRQoL Low Among Young Adult CRC Survivors
28. Do Cancer-Fighting Foods Work?
29. COVID-19’s Collateral Damage: Reduced CRC Care
30. CDC Finds COVID-19 Vaccines Safe After 22 Million Vaccinations
31. The Latest on Covid-19
32. Frequently Asked Questions for COVID-19
DRUGS / SYSTEMIC THERAPIES
- Phase II LEAP Clinical Trial For mCRC (Mar.01/20)
The purpose of this study is to determine the safety and efficacy of combination therapy with pembrolizumab (MK-3475) and Levantine (E7080/MK-7902) in patients with triple-negative breast cancer (TNBC), ovarian cancer, gastric cancer, colorectal cancer (CRC), glioblastoma (GBM), or biliary tract cancers (BTC). Participants will be enrolled in initial tumor-specific cohorts, which will be expanded if adequate efficacy is determined. The trial is available at the Odette Cancer Centre and at the Princess Margaret Cancer Centre in Toronto as well as the following Centres throughout Canada: Abbotsford, BC; Winnipeg, MB; CHU de Quebec. For information, visit the link below.
- TRK Fusion Cancer And How to Test For It (Feb.16/21)
- A Phase 2, Open-label, Multicenter, Study of an Immunotherapeutic Treatment for the MSI High CRC Metastatic Population (Oct.01/20)
The purpose of this study is to look at the effectiveness of the vaccine DPX-Survivac in combination with the drugs cyclophosphamide and the immunotherapy Pembrolizumab in patients with solid cancers who are identified to be MSI-High. All patients will receive combination therapy of DPX-Survivac, cyclophosphamide, and pembrolizumab. Patients participating will know which treatment they are receiving. The trial is currently hosted at the Odette Cancer Centre, and a new site is opening at Mt. Sinai Hospital.
- Phase III Study at the Odette Cancer Centre Comparing Arfolitixorin vs. Leucovorin in Combination with 5FU, Oxaliplatin and Bevacizumab in Patients with Advanced CRC (Oct.01/20)
The purpose of this study is to look at the effectiveness of the drug Arfolitixorin in combination with 5-fluorouracil (5FU), oxaliplatin, and bevacizumab in patients with colorectal cancer (CRC). Patients with advanced/metastatic CRC who meet certain criteria may be able to participate. There will be two groups of patients participating in this study;
- one group will receive Arfolitixorin in combination with 5FU), oxaliplatin, and bevacizumab,
- while the other group will receive the drug Leucovorin in combination with 5FU, oxaliplatin, and bevacizumab (standard of care).
The doctor and study staff will not know which group a patient is in. Patients will be randomized to receive one treatment or the other.
Arfolitixorin is Isofol’s proprietary drug candidate being developed to increase the efficacy of standard of care chemotherapy for advanced CRC. The drug candidate is currently being studied in a global Phase 3 clinical trial. As the key active metabolite of the widely used folate-based drugs, arfolitixorin can potentially benefit all patients with advanced CRC, as it does not require complicated metabolic activation to become effective.
Treating cancer patients with arfolitixorin – The goals:
- When treating CRC, for example, arfolitixorin is administered in combination with 5-FU to increase cell mortality in circulating cancer cells and in cancerous tumours.
- Arfolitixorin is administered in conjunction with rescue therapy after high-dose treatment with the cytotoxic agent, methotrexate, in order to suppress the cytotoxic effect in surrounding healthy tissue. The treatment is used for certain types of cancer, such as osteosarcoma, a type of bone cancer. This involves administering arfolitixorin separately, 24 hours after the chemotherapy.
- Does Aspirin Lower CRC Risk? (Jan.21/21)
Regular aspirin use has, according to this study, clear benefits in reducing colorectal cancer (CRC) incidence among middle-aged adults, but also comes with some risk, such as gastrointestinal bleeding. There is substantial evidence that a daily aspirin can reduce risk of CRC in adults up to age 70. But until now there was little evidence about whether older adults should start taking aspirin. A team of scientists, at Harvard Medical School set out to study this question. They carried out a pooled analysis of two large U.S. cohort studies: The Nurses’ Health Study (January 1980-June 2014) and the Health Professionals Follow-up Study (January 1986-January 2014). These two studies contributed data on more than 94,500 participants’ use of aspirin over about 35 years, offering a unique opportunity to understand the effect of aspirin use across the lifespan on cancer risk. The researchers found that regular aspirin use was linked to lower CRC risk among people aged 70 or older. However, this advantage was only significant among people who started taking aspirin before the age of 70. People who started regular aspirin use at the age of 70 or older did not seem to reap any benefit.
Aspirin is considered the most well-established agent that protects against CRC. It is currently recommended by the U.S. Preventive Services Task Force for people aged 50-59 years with specific cardiovascular risk profiles because of its protective effect against heart disease. However, the recent Aspirin in Reducing Events in the Elderly (ASPREE) trial reported that participants who took a daily low dose of aspirin (100 mg) after age 70 for about five years had an unexpected 30% higher risk of death from cancer. The vast majority of the ASPREE participants (89%) had never taken aspirin regularly before joining the study. Chan’s team also recently reported that ASPREE participants on aspirin did not experience an increase or decrease in risk of developing a cancer despite having an increase in risk of death from cancer.
That led to the questions: Does regular aspirin benefit or harm people older than 70 and does it matter when aspirin was started? The current study confirms that initiating aspirin at an older age was not associated with a lower risk of CRC. However, importantly, there is a potential benefit of continuing aspirin if is started at an earlier age. These results, the researchers say, “strongly suggest that there is a potential biological difference in the effect of aspirin at older ages which requires further research.” Adds Chan: “As people get older, if they are not already taking aspirin, a discussion is warranted about whether to start aspirin after weighing the benefits against the risks.”
- Weekly vs Biweekly Cetuximab for Metastatic CRC (Jan/19/21)
Cetuximab (Erbitux) administered biweekly has comparable efficacy to a weekly dosing schedule for patients with metastatic colorectal cancer (mCRC), according to results from a study assessing real-world overall survival (OS) in this patient population. These results were presented at the virtual 2021 ASCO Gastrointestinal Cancers Symposium. “Cetuximab 250mg/m2 weekly after an initial dose of 400mg/m2 is approved for treatment of KRas wild-type mCRC. In real world, 29% of patients received cetuximab 500mg/m2 biweekly,” explained Himani Aggarwal, MA, MPhil, PhD, Eli Lilly and Company (Indianapolis, IN), and colleagues. This study compared real-world OS associated with biweekly versus weekly dosing of cetuximab for mCRC in the US. The Flatiron Health electronic health record database was used to identify patients with mCRC who received cetuximab plus FOLFIRI/FOLFOX/irinotecan, or cetuximab monotherapy as first-, second- or third-line therapy from January 1, 2012 to December 31, 2019. Patients were split into groups according to the frequency in which they received cetuximab treatments (weekly vs biweekly). The study found that patients with mCRC receiving cetuximab achieved similar OS rates, regardless of whether these treatments were administered weekly or biweekly.
- Avastin-Lonsurf Combo Improves Survival in Patients with mCRC Ineligible for Standard Chemo (Jan.19/21)
Data from the final analysis of the phase 2 TASCO1 trial demonstrated that when used in combination with Avastin (bevacizumab), Lonsurf (trifluridine/tipiracil) improved overall survival (OS) in the frontline treatment of patients with unresectable metastatic colorectal cancer (mCRC) ineligible for standard chemotherapy, compared to Xeloda (capecitabine) in combination with Avastin.
The study included patients with CRC who had not received prior systemic chemotherapy for their unresectable metastatic disease. Additionally, they were ineligible for intensive therapy due to investigator judgment, for such reasons as advanced age, low tumor burden and comorbidities. Patients were randomized between the two treatment arms to receive Lonsurf and Avastin (77 patients) or Xeloda and Avastin (76 patients). The median age of all patients was 75 years (33 to 91 years) with 43% over 75 years. Treatment was continued until the disease progressed, unacceptable toxicity was reached, or the investigator/patient decided to discontinue the therapy. In the primary analysis, the median progression-free survival (PFS) was 9.2 months in the Lonsurf and Avastin arm versus 7.8 months in the Xeloda and Avastin arm. At 12 months, treatment with Lonsurf and Avastin induced a PFS rate of 40% versus 30% with the Xeloda-based treatment.
In results presented during the 2021 Gastrointestinal Cancers Symposium, patients within the Lonsurf and Avastin arm reached a median OS of 22.31 months compared with 17.67 months in the Xeloda and Avastin arm. At the end of the study, 14.29% of patients in the Lonsurf and Avastin arm were still alive and 86.84% were dead whereas 13.16% of patients in the Xeloda and Avastin arm were alive and 85.71% were dead. Patients in the Lonsurf and Avastin arm discontinued treatment as a result of adverse events (23.38%), progressive disease (61.04%) or for other reasons (11.84%). Treatment discontinuations were similar in the Xeloda and Avastin arm with 22.37% of patients discontinuing because of adverse events, 65.79% because of progressive disease and 15.59% because of other reasons.
The two combinations are expected to be further examined among patients with mCRC who are ineligible for intensive therapy in the phase 3 SOLSTICE trial.
- Can KRAS Positive Colorectal and Lung Cancer Finally be Targeted? (Oct.27/20)
According the results from the phase I – II Krystal clinical trials, the investigational KRAS G12C inhibitor drug, Adagrasib yielded clinical responses in patients with non-small cell lung cancer (NSCLC) and colorectal cancer (CRC), and other solid tumors harboring KRAS G12C mutations.
Adagrasib is an investigational, orally available small molecule that is designed to potently and selectively inhibit a form of KRAS which harbors a substitution mutation (G12C). Adagrasib works by irreversibly and selectively binding to KRAS G12C in its inactive state, blocking its signaling to other cells and preventing cancer cell growth and proliferation; this leads to cancer cell death.
Out of 18 CRC patients 3 (17%) had a confirmed objective response and 2 of them continue to receive treatment. Disease control was seen in 17 of the patients (94%) and 12 of these patients continue to be treated. Side effects included nausea (54%), diarrhea (51%), vomiting (35%), fatigue (32%) and increased levels of an enzyme that indicates minor liver irritation (20%). The only serious adverse side effect to occur in more than one patient was low sodium in the blood.
If the early findings with MRTX849 hold true doctors may finally have a treatment for this difficult to treat genetically driven cancer.
- Pembrolizumab Prolongs PFS vs. Chemotherapy for Certain Patients with CRC (Jan.22/21)
Pembrolizumab monotherapy demonstrated superior progression-free survival (PFS) and PFS2 (defined as the time from randomization to progression on the next line of therapy or death of any cause) compared with standard-of-care chemotherapy among patients with microsatellite-instability high/mismatch repair-deficient metastatic colorectal cancer (CRC). Pembrolizumab (Keytruda, Merck), an anti-PD-1 antibody, also had an acceptable safety profile, with fewer treatment-associated adverse events than chemotherapy, according to results of the phase KEYNOTE-177 trial presented at Gastrointestinal Cancers Symposium.
KEYNOTE-177 analyzed pembrolizumab vs. chemotherapy plus bevacizumab (Avastin, Genentech) or cetuximab (Erbitux, Eli Lilly) as first-line treatment for patients with microsatellite-instability high/mismatch repair deficient metastatic CRC. Kai-Keen Shiu, MD, and colleagues randomly assigned 307 patients to either 200 mg pembrolizumab every 3 weeks for up to 2 years (n = 153; median age, 63 years) or investigator’s choice of one of six standard chemotherapy regimens selected prior to randomization (n = 154; median age, 62.5 years). Chemotherapy regimens included modified FOLFOX-6, which consists of 5-FU, leucovorin and oxaliplatin; modified FOLFOX-6 plus bevacizumab; modified FOLFOX-6 plus cetuximab; FOLFIRI, which consists of leucovorin, 5-FU and irinotecan; FOLFIRI plus bevacizumab; or FOLFIRI plus cetuximab.
Median follow-up was 32.4 months. Healio previously reported that pembrolizumab conferred longer median PFS than chemotherapy (16.5 months vs. 8.2 months), as well as higher rates of PFS at 1 year (55.3% vs. 37.3%) and at 2 years (48.3% vs. 18.6%). During the symposium, Shiu also reported longer median PFS2 with pembrolizumab vs. chemotherapy (not yet reached vs. 23.5 months). Confirmed overall response rates (ORRs) were 43.8% with pembrolizumab vs. 33.1% with chemotherapy. “56 patients assigned chemotherapy [36%] crossed over to pembrolizumab and 35 additional patients received anti-PD-1/PD-L1 therapy outside of the study, for an effective crossover rate of 59% in the intention-to-treat population,” Shiu said. “Final OS analysis is ongoing.” Grade 3 treatment-related adverse events occurred among 22% assigned pembrolizumab and 66% of those assigned chemotherapy. Researchers also observed improvements in health-related quality of life scores with pembrolizumab vs. chemotherapy, according to Shiu.
- Triplet Demonstrates Activity in mCRC (Jan.19/21)
The combination of panitumumab, ipilimumab and nivolumab induced responses among patients with metastatic colorectal cancer (mCRC), according to phase 2 study results presented at Gastrointestinal Cancers Symposium. According to Michael Sangmin Lee, MD, assistant professor at The University of Texas MD Anderson Cancer Center, “standard-of-care options for patients in the third-line setting may include trifluridine-tipiracil [Lonsurf] or regorafenib [Stivarga]; these have low response rates and modest PFS”. In his study, panitumumab [Vectibix], ipilimumab [Yervoy] and nivolumab [Opdivo] showed a promising response rate, higher than expected with panitumumab monotherapy. Anti-EGFR therapies, such as panitumumab, are standard for the treatment of patients with KRAS, NRAS and BRAF wild-type mCRC, and researchers have found that these agents are immunomodulatory and induce immunogenic cell death, Lee added.
Lee and colleagues tested their hypothesis in a cohort of 56 patients (median age, 56 years; range, 36-74; 66% men; 77% white), six of whom were included in a safety run-in phase, which demonstrated no dose-limiting toxicities in the first 12 weeks. Researchers observed 17 responses at week 12, for a response rate of 35%, meeting the prespecified criteria for further study. All these were partial responses, with an additional 43% of patients showing stable disease and 22% of patients experiencing disease progression. The best response rate at any time, which included confirmed and unconfirmed responses, was 41%. The confirmed overall response rate was 18%.
Median PFS was 5.7 months and median OS, data for which are still immature, was 27 months. No unexpected toxicities occurred, Lee said. The most common treatment-related grade 3 to grade 4 adverse events included hypomagnesemia (11%), rash acneiform (11%), lipase increase (9%), amylase increase (7%), aspartate aminotransferase increase (5%), alanine aminotransferase increase (5%), diarrhea (5%), hypophosphatemia (5%) and maculopapular rash (5%). Two grade 5 toxicities occurred — myocarditis and colonic perforation — but only the former was considered possibly related to treatment.
Lee told Healio that he and his team are continuing their work on translational studies to establish more biomarkers of activity in this setting. However, in the Q&A session of the virtual presentation, some experts described the median PFS as “relatively disappointing” and the response rate as lower than expected for the combination.
- TAS-102 Plus Bevacizumab Is Potential New Option in Refractory mCRC (Mar.12/20)
The addition of bevacizumab (Avastin) to TAS-102 (trifluridine/tipiracil; Lonsurf) reduced the risk of disease progression or death by 55% compared with TAS-102 alone in patients with chemorefractory metastatic colorectal cancer (mCRC), according to findings from an investigator-initiated, open-label, randomized phase II trial published in The Lancet Oncology. At a median follow-up of 10 months, the median progression-free survival (PFS) was 4.6 months with the combination compared with 2.6 months with TAS-102 alone.
Between August 24, 2017, and October 31, 2018, the study accrued 93 patients with histopathologically confirmed mCRC refractory or intolerant to a fluoropyrimidine, irinotecan, oxaliplatin, and cetuximab or panitumumab (only for RAS wild-type). TAS-102 was administered at 35 mg/m² twice daily on days 1 to 5 and 8 to 12 every 28 days, and bevacizumab was administered at 5 mg/kg on days 1 and 15. The disease control rate was 67% in the combination arm compared with 51% in the control arm. The median overall survival (OS) was 9.4 months versus 6.7 months, respectively. Serious AEs occurred in 41% of the TAS-102 plus bevacizumab group compared with 45% of the control arm. There were no treatment-related deaths.
“This trial supports the promising preclinical and phase 1/2 data for TAS-102 and shows that bevacizumab might be an excellent partner for TAS-102 in patients with chemorefractory mCRC both in terms of activity and safety. We will continue to search for prognostic and predictive markers using the blood samples collected in this study,” first author Per Pfeiffer, MD, PhD, Department of Oncology, Odense University Hospital, Odense 5000, Denmark, and coinvestigators wrote. “Ongoing clinical trials are investigating this combination in earlier treatment lines for patients with mCRC.”
TAS-102 is approved by the FDA for the treatment of patients with mCRC who have been previously treated with fluoropyrimidine-, oxaliplatin- and irinotecan-based chemotherapy, an anti-VEGF biological therapy, and if RAS wild-type, an anti-EGFR therapy. Avastin has 2 approved indications in this disease: mCRC, in combination with intravenous fluorouracil-based chemotherapy for first- or second-line treatment; and mCRC, in combination with fluoropyrimidine-irinotecan- or fluoropyrimidine/oxaliplatin-based chemotherapy for second-line treatment in patients who have progressed on a first-line bevacizumab-containing regimen.
- Allogeneic CAR T-cell Therapy Safe, Clinically Active in mCRC (Jan.25/21)
An allogeneic chimeric antigen T-cell therapy showed evidence of clinical activity among patients with metastatic colorectal cancer (mCRC), according to results of a dose-escalation study presented at Gastrointestinal Cancers Symposium. No patients treated so far in the trial have experienced a serious adverse event or developed graft-versus-host disease, according to the study investigators.
CYAD-101 (Celyad) is an investigational, non-gene edited allogeneic CAR T-cell therapy that targets the natural killer group 2D ligand (NKG2DL). The CAR co-expresses a T-cell receptor (TCR) inhibitory peptide, which interferes with signaling by the endogenous TCR to prevent GVHD (graft-versus-host disease, typically occurring after allogenic stem cell transplant), according to the manufacturer. “CAR T cells have shown clinical efficacy in patients with advanced B-cell malignancies but, to date, have failed to deliver a clinically relevant impact on solid tumor indications,” Hans Prenen, MD, PhD, deputy head of the oncology department at University Hospital Antwerp in Belgium, said during his presentation.
Prenen and colleagues evaluated the safety and optimal dose of CYAD-101 produced from a single donor among patients with unresectable mCRC as part of the phase 1 alloSHRINK study. The study included patients with relapsed or refractory disease who experienced progression after treatment with oxaliplatin-based chemotherapy, with or without irinotecan-based chemotherapy. Patients received three infusions of CYAD-101 at one of three dose levels: 1 × 108, 3 × 108 or 1 × 109 T cells per infusion. Each infusion was preceded by standard FOLFOX preconditioning chemotherapy. Fifteen patients had been treated in the study at the time of data reporting.
Results showed two patients had a partial response to therapy, including one patient with KRAS-mutant disease. Nine patients had stable disease, including seven with stable disease lasting 3 months or longer. Among the nine patients who received the highest dose of CYAD-101, six had some evidence of tumor control. Investigators chose the highest dose level of 1 × 109 T cells per infusion as the recommended dose for subsequent studies. Median PFS was 3.9 months and median OS was 10.58 months. Safety results showed no dose-limiting toxicities, grade 3 or greater adverse events or GVHD associated with CYAD-101 infusions.
Prenen mentioned that there are plans to evaluate the clinical effectiveness of CYAD-101 in combination with other immunotherapies — including immune checkpoint inhibitors — in the KEYNOTE-B79 study, which is set to begin enrolling patients with refractory mCRC later this year.
- Merck’s Keytruda Nabs EU Approval for CRCs (Jan.29/21)
Merck’s blockbuster cancer drug Keytruda (pembrolizumab) has received European Commission approval as a standalone therapy for two types of colorectal cancer (CRC). The approval is for first-line treatment of adult patients with metastatic microsatellite instability-high or mismatch repair-deficient CRC. The commission based its approval on results from a pivotal phase 3 trial in which Keytruda as a standalone therapy reduced the risk of disease progression or death by 40% and “more than doubled median progression-free survival” compared with alternative therapies, the company said. Merck earned almost $10.4 billion in global Keytruda sales for the first three quarters of 2020. Full-year 2020 sales data will be released Feb. 4.
Image Source: https://intelligencepharma.wordpress.com/2019/11/28/mercks-keytruda-a-deep-dive/
- Phase II Single Arm Study of Durvalumab and Tremelimumab with Concurrent Radiotherapy in Patients with Mismatch Repair Proficient mCRC (Jan.27/21)
Immune checkpoint inhibition (ICI) alone is not active in mismatch repair-proficient (MMR-P) metastatic colorectal cancer (mCRC), nor does radiotherapy (RT) alone result in objective systemic benefit. However, combined RT plus ICI can induce systemic anti-tumor immunity in pre-clinical and clinical models.
In this single-center, phase II study, patients with chemotherapy-refractory MMR-P mCRC received durvalumab 1500 mg plus tremelimumab 75 mg every 4 weeks plus RT. The primary endpoint was objective response rate (ORR) in non-irradiated lesions. Treatment and efficacy were correlated with peripheral immune cell profiles.
24 patients were enrolled, and report outcomes after a median follow up of 21.8 months. The ORR was 8.3% (2 patients). The median progression-free survival (PFS) was 1.8 months, median overall survival (OS) was 11.4 months. 25% of patients had treatment-related grade 3-4 adverse events. There was an observed increased circulating CD8+ T lymphocyte activation, differentiation, and proliferation in patients with objective response.
This combination of RT plus ICI study did not meet the prespecified end point criteria to be considered worthwhile for further study. However, rare instances of systemic immune augmentation and regression in non-irradiated lesions were observed (an abscopal response). Combination durvalumab and tremelimumab plus RT is feasible in MMR-P mCRC with a manageable safety profile. Further studies of novel immunotherapy combinations, and identification of biomarkers predictive of abscopal response are warranted.
15. Hepatic Artery Infusion Pump (HAIP) Chemotherapy Program — Sunnybrook Odette Cancer Centre (July 16/20)
The HAIP program is a first-in-Canada for individuals where colon or rectal cancer (colorectal cancer) has spread to the liver and cannot be removed with surgery. The program involves a coordinated, multidisciplinary team approach to care, with close collaboration across surgical oncology, medical oncology (chemotherapy), interventional radiology, nuclear medicine, and oncology nursing. The Hepatic Artery Infusion Pump (HAIP) is a small, disc-shaped device that is surgically implanted just below the skin of the patient and is connected via a catheter to the hepatic (main) artery of the liver. About 95 percent of the chemotherapy that is directed through this pump stays in the liver, sparing the rest of the body from side effects. Patients receive HAIP-directed chemotherapy in addition to regular intravenous (IV) chemotherapy (systemic chemotherapy), to reduce the number and size of tumours. Drs. Paul Karanicolas and Yooj Ko are the program leads and happy to see patients eligible for the therapy.
Presently at Sunnybrook Odette Cancer Centre, HAIP is being used in patients with colorectal cancer that has spread to the liver that cannot be removed surgically and has not spread to anywhere else in the body. Patients who have few (1-5) and very small tumors in the lungs may be considered if the lung disease is deemed treatable prior to HAIP. If you believe you may benefit from this therapy and/or would like to learn more about the clinical trial, your medical oncologist or surgeon may fax a referral to 416-480-6179. For more information on the HAIP clinical trial, please click on the link provided below.
16. Living Donor Liver Transplantation for Unresectable Colorectal Cancer Liver Metastases (July 12/20)
Approximately half of all colorectal cancer (CRC) patients develop metastases, commonly to the liver and lung. Surgical removal of liver metastases (LM) is the only treatment option, though only 20-40% of patients are candidates for surgical therapy. Surgical therapy adds a significant survival benefit, with 5-year survival after liver resection for LM of 40-50%, compared to 10-20% 5-year survival for chemotherapy alone. Liver transplantation (LT) would remove all evident disease in cases where the colorectal metastases are isolated to the liver but considered unresectable.
Image Source: https://www.slideshare.net/AhmedAdel65/preoperative
While CRC LM is considered a contraindication for LT at most cancer centers, a single center in Oslo, Norway demonstrated a 5-year survival of 56%. A clinical trial sponsored by the University Health Network in Toronto will offer live donor liver transplantation (LDLT) to select patients with unresectable metastases limited to the liver and are non-progressing on standard chemotherapy. Patients will be screened for liver transplant suitability and must also have a healthy living donor come forward for evaluation. Patients who undergo LDLT will be followed for survival, disease-free survival, and quality of life for 5 years and compared to a control group who discontinue the study before transplantation due to reasons other than cancer progression. Despite the trial’s negative outcome, investigation of HIPEC, and other strategies to prevent peritoneal metastasis, should continue, they concluded in Lancet Gastroenterology & Hepatology. “The 21% peritoneal recurrence noted in the overall study population indicates the magnitude of the clinical problem in locally advanced colon cancer, and therapeutic strategies have to be further explored,” they said. “Outcomes of other trials investigating adjuvant HIPEC are eagerly awaited.”
RADIATION THERAPIES/INTERVENTIONAL RADIOLOGY
17. Study Offered at the Odette Cancer Centre to Treat Recurrent Rectal Cancer (Mar.12/20)
Magnetic resonance-guided focused ultrasound (MRg-FU) is a lessinvasive, outpatient modality being investigated for the thermal treatment of cancer. In MRg-FU, a specially designed transducer is used to focus a beam of low-intensity ultrasound energy into a small volume at a specific target site in the body. MR is used to identify and delineate the tumour, focus the ultrasound beam on the target, and provide a real-time thermal mapping to ensure accurate heating of the designated target with minimal effect to the adjacent healthy tissue. The focused ultrasound beam produces therapeutic hyperthermia (40-42°C) in the target field, causing protein denaturation and cell damage. Currently, there is no prospective clinical data reported on the use of MRg-FU in the setting of recurrent rectal cancer. Recurrent rectal cancer is a vexing clinical problem. Current retreatment protocols have limited efficacy. The addition of hyperthermia to radiation and chemotherapy may enhance the therapeutic response. With recent advances in technology, the investigators hypothesize that MRg-FU is technically feasible and can be safely used in combination with concurrent reirradiation and chemotherapy for the treatment of recurrent rectal cancer without increased side-effects. The study is being offered at the Odette Cancer Centre. Here is the link to the study protocol:
18. Trends in the Incidence of Young-Onset CRC with a Focus on Years Approaching Screening Age (Jan.25/21)
With recent evidence for the increasing risk of young-onset colorectal cancer (yCRC), the objective of this population-based longitudinal study was to evaluate the incidence of yCRC in one-year age increments, particularly focusing on the screening age of 50 years. The study was conducted using linked administrative health databases in British Columbia, Canada including a provincial cancer registry, inpatient/outpatient visits, and vital statistics from January 1, 1986 to December 31, 2016. We calculated incidence rates per 100,000 at every age from 20 to 60 years and estimated annual percent change in incidence (APCi) of yCRC using joinpoint regression analysis.
3,614 individuals were identified with yCRC (49.9% women). The incidence of CRC steadily rose from 20 to 60 years, with a marked increase from 49 to 50 years. Furthermore, there was a trend of increased incidence of yCRC among women. Analyses stratified by age yielded APCi’s of 2.49% and 0.12% for women aged 30-39 years and 40-49 years, respectively and 2.97% and 1.86% for men. These findings indicate a steady increase over one-year age increments in the risk of yCRC during the years approaching and beyond screening age. These findings highlight the need to raise awareness as well as continue discussions regarding considerations of lowering the screening age.
19. Analysis of Early-Onset CRC Incidence by Age, Subsite, and Histologic Subtype (Jan.28/21)
While the overall incidence of colorectal cancer (CRC) has been decreasing for the past several decades according to SEER data, detected cases of early-onset colorectal cancer (EOCRC) have instead been steadily rising in number. Previous analyses have generally focused on overall CRC incidence with little emphasis on specific histological subtypes. However, identification of the fastest-growing cancer types and the highest risk groups is critical in order to better inform the potential modification of controversial screening guidelines.
This study utilized SEER 18 data from 2000 to 2016 to examine all CRC cases in patients between the ages of 20 and 54 years. While the two younger age groups had manifold fewer cases overall compared to the two older age groups (16131 versus 107012 cases), they also had the greatest change in adenocarcinoma incidence. Specifically, there were increases of 39% in rectal-only cases in both patients aged 20-29 years (0.33 to 0.46 per 100,000) and those aged 30-39 years (1.92 to 2.66 per 100,000); colon-only cases in those aged 30-39 years also increased by 20% (3.30 to 3.97 per 100,000). Smaller increases in the range of 10-16% were also observed in the 40-49 and 50-54 age groups. The only categories that did not display a statistically significant gain in adenocarcinoma incidence over time were colon-only cases in the youngest age group and both colon-only and colorectal cases in the oldest. On the other hand, rectal carcinoid tumors increased significantly in all age groups, with the steepest changes occurring in those aged 20-29 (113% [0.08 to 0.17 per 100,000]) and those aged 50-54 (+159% [2.36 to 6.10 per 100,000]).
It is unclear whether these trends can be attributed to a true increase in tumors due to lifestyle factors or simply to advances in endoscopic detection, but the results of this study reflected the importance of maximizing screening efforts in older and higher-risk individuals. Further, the finding that adenocarcinomas were found to be increasing in the most early-onset subgroups had implications for the adjustment of the average-risk screening age from 50 to 45 years.
20. Personalized Blood Test Can Detect Colon Cancer Recurrence Sooner than Scans (Jan.26/21)
Around 20-30% of people with CRC relapse after surgery, and earlier detection of recurrence could increase the proportion of patients able to receive curative treatment, leading to improved survival. Tenna Henriksen, a PhD candidate at Aarhus University in Denmark, and colleagues conducted a study to determine whether repeated ctDNA testing after surgery could identify CRC patients at high risk for recurrence, assess the effectiveness of adjuvant (post-surgery) chemotherapy and detect relapse sooner than radiological imaging.
The study included 260 people with Stage I to III CRC, all of which underwent surgery to remove their tumors, and nearly two thirds (165) then received adjuvant chemotherapy; 48 (18%) eventually relapsed. Unlike a standard liquid biopsy test, Signatera is not intended to match patients with a particular therapy, but rather it is used to detect and quantify how much cancer is left in the body, detect recurrence earlier and help optimize treatment decisions.
20 people were found to have molecular residual disease (MRD) according to the test. Within this subgroup, 15 people (75%) relapsed. In contrast, just 14% of the 198 people found to be MRD negative experienced recurrence. People with detectable ctDNA immediately after surgery had a high risk of recurrence, Henriksen said. After that, the risk increased over time in patients who tested MRD positive (reaching 89%) but decreased in those who tested MRD negative (falling to 3%). Results from the ctDNA tests were compared against those from a more frequently used test for a tumor biomarker known as carcinoembryonic antigen (CEA). While testing positive for ctDNA right after surgery was significantly associated with reduction in relapse-free survival, this was not the case for a positive CEA test. Over time, repeated ctDNA testing predicted recurrence better than repeated CEA tests. ctDNA monitoring detected MRD a median of 8.1 months before recurrence was seen on a scan. Based on these findings, the researchers concluded that ctDNA analysis can predict the risk of colon cancer recurrence and is a more reliable biomarker for treatment response monitoring. The study also showed that post-surgery chemotherapy can cure some MRD positive patients.
21. Delaying Colonoscopy Following Abnormal Stool Test Increases Risk of CRC (Feb.02/21)
In a retrospective study of more than 200,000 Veterans, the researchers found that patients who received colonoscopy more than 13 months after an abnormal stool blood test were up to 1.3 times more likely to have colorectal cancer (CRC), compared with those who had colonoscopy up to three months after the stool test. Odds of an advanced stage of cancer at diagnosis were up to 1.7 times higher when colonoscopy was delayed beyond 16 months. The findings also showed the risk of CRC-related death increased by up to 1.5 times when colonoscopy was delayed more than 19 months. The cohort included Veterans who had an abnormal fecal immunochemical test (FIT) or fecal occult blood test (FOBT). Both are common stool blood screening tests that, when abnormal, require a follow-up colonoscopy to evaluate for precancerous and cancerous colorectal growths known as polyps.
Dr. Folasade May, a gastroenterologist at the VA Greater Los Angeles Healthcare System, who led the study, and her team emphasize that improved CRC outcomes call for colonoscopy within one year of an abnormal stool test, which is when blood is detected after a sample is sent to a lab. A recommended interval that is too long can contribute to polyp progression and stage migration of CRC, risking the need for more aggressive and morbid treatment, as well as less favorable outcomes.
The results of this study should raise awareness that delaying colonoscopy after an abnormal stool test can have major consequences, including increased risk for cancer diagnosis, late-stage cancer at diagnosis, and death from CRC. These findings can also help motivate patients and providers to make sure colonoscopies are completed after an abnormal test. The study findings will have even greater implications as more non-invasive tests for CRC screening come on the market.
22. Young Adult CRC Clinic Available at Sunnybrook (Mar.12/20)
A recent study led by the University of Toronto doctors has observed a rise in colorectal cancer rates in patients under the age of 50. The study mirrors findings from the U.S., Australia and Europe. The growing colorectal cancer rates in young people come after decades of declining rates in people over 50, which have occurred most likely due to increased use of colorectal cancer screening (through population-based screening programs) which can identify and remove precancerous polyps. Patients diagnosed under the age of 50 have a unique set of needs, challenges and worries. They are unlike those diagnosed over the age of 50. Dr. Shady Ashamalla (colorectal cancer surgical oncologist), and his team at the Sunnybrook Health Sciences Centre understand the needs of this patient population.
Dr. Ashamalla belongs to a multidisciplinary team of experts in the Young Adult Colorectal Cancer Clinic who will work with young colorectal cancer patients, regardless of disease stage, to create an individualized treatment plan to support each patient through their cancer journey. Their needs and concerns will be addressed as they relate to:
- Fertility concerns and issues
- Young children at home
- Dating/intimacy issues
- Challenges at work
- Concerns about hereditary cancer
- Relationships with family and friends
- Psychological stress due to any or all of the above
The team of experts consists of:
- Oncologists (medical, surgical, radiation)
- Social workers
- Nurse navigator
Should a patient wish to be referred to Sunnybrook, they may have their primary care physician, or their specialist refer them to Sunnybrook via the e-referral form, which can be accessed through the link appearing below. Once the referral is received, the Young Adult Colorectal Cancer Clinic will be notified if the patient is under the age of 50. An appointment will then be issued wherein the patient will meet with various members of the team to address their specific set of concerns.
23. Strange Colon Discovery Explains Racial Disparities In CRC (Jan.21/20)
New research reveals that the colons of African Americans and people of European descent age differently, helping explain racial disparities in colorectal cancer (CRC). Scientists led by UVA Health’s Dr. Li and Graham Casey found that one side of the colon ages biologically faster than the other in both African Americans and people of European descent. In African Americans, however, the right-side ages significantly faster, explaining why African Americans are more likely to develop cancerous lesions on the right side and why they are more likely to suffer CRC at a younger age, the researchers say. The American Cancer Society reports that African Americans are 20% more likely to develop CRC and 40% more likely to die from it. Overall CRC rates have declined in America in recent years, but African Americans have not seen the same decreases as people of European descent.
This new study is the first to show that the right and left side of the colon age differently. Researchers made this determination by looking at the DNA in colon tissue, and the “epigenetic” changes that come with age. These epigenetic changes are not alterations to the genes, but changes that affect how the genes work and how well they can do their jobs. The scientists found that the right side of the colon in most African Americans had suffered a unique pattern of “hypermethylation,” affecting gene expression. It was, in essence, like the right side was old beyond its years. This, the researchers believe, could contribute to African Americans’ increased cancer risk and could explain why they are more likely to develop cancerous lesions on the right side.
The research could also explain why younger people of European descent are more likely to develop lesions on the left side – the side that tends to age faster in that group. “These findings highlight the importance of colon sidedness to biology of CRC,” Casey said. “The fact that the colon biology of people of African and European ancestry differ further highlights the critical importance of more research involving participation of people of African descent.”
Image Source: https://www.cancer.gov/about-nci/organization/crchd/inp/screen-to-save/connect
24. Evaluation of the Prognostic Relevance of the Recommended Minimum Number of Lymph Nodes in CRC (Jan.16/21)
Nodal status in colorectal cancer (CRC) is an important prognostic factor, and adequate lymph node (LN) staging is crucial. Whether the number of resected and analyzed LN has a direct impact on overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS) is much discussed. The aim of this study was to test whether the threshold of 12 resected and analyzed LN marks a prognostic relevant cut-off level regarding cancer-specific outcome in patients operated for CRC, using propensity score matching. Patients operated for stage I–III CRC were identified from a prospectively maintained database. The impact of the number of analyzed LN on OS, CSS and DFS was assessed using Cox regression and propensity score analysis.
Of the 687 patients, 81.8% had ≥ 12 LN resected and analyzed. Median LN yield was 17.0. Resection and analysis of ≥ 12 LN was associated with improved OS, CSS and DFS in multivariate Cox analysis. After adjusting for biasing factors with propensity score matching, resection of ≥ 12 LN was significantly associated with improved OS, CSS and DFS compared to patients with < 12 LN.
Eliminating biasing factors by a propensity score matching analysis underlines the prognostic importance of the number of analyzed LN. The set threshold marks the minimum number of required LN but nevertheless represents a cut-off regarding outcome in stage I–III CRC. This analysis therefore highlights the significance and importance of adherence to surgical oncological standards.
25. New TMB Recommendations Help to Guide Treatment Decisions in Oncology (Jan.27/21)
Detection of actionable genomic alterations and genomic signatures, such as a high tumor mutational burden (TMB), through comprehensive genomic profiling (CGP) is becoming increasingly important in cancer care. TMB (the number of somatic protein-coding base substitutions and insertion/deletions per megabase in a tumor specimen) approximates the burden of immunogenic neoantigens produced by a tumor: patients with a higher TMB may be more likely to develop an anti-tumor immune response.
Formerly considered to be a “one-size-fits-all” approach, immune checkpoint inhibition via the PD-1/PD-L1 axis has since demonstrated improved response rates in patients with a high TMB across ten solid tumor types: response rates were 29% and 6% in patients with a high TMB and a low TMB across different cancer types, respectively. These data build on findings from a TMB analysis across 29 tumor types, which found a positive correlation between TMB and objective response rate with anti-PD-(L)1 treatment.
CGP combines a highly sensitive assay and sophisticated algorithm that the accurate measurement of TMB demands. Compared with alternative analytical methods, CGP assessment of TMB also has a lower cost, shorter turnaround time, and lower requirement for DNA: crucial factors when considering its deployment in community clinical practice. Furthermore, CGP can facilitate parallel analysis of other genomic signatures, such as microsatellite instability (MSI), thus allowing for potential identification of multiple actionable biomarkers from a single analysis.
MSI was the first biomarker to lead to tumor-agnostic approval of an immune checkpoint inhibitor, after data showed favorable responses to PD-1 blockade in solid tumors with high levels of MSI (MSI-H). MSI-H tumors generate increased levels of neoantigens that are recognized by the patient’s immune system, allowing T-cells to launch an anti-tumor immune response. Across a variety of tumor types, MSI-H is a partial subset of TMB-high: the majority of MSI-H samples are also TMB-high, but not vice versa. This was demonstrated through MSI-only testing in CRC, which failed to identify TMB-high tumors that could have responded well to immune checkpoint inhibition. PD-L1 has also demonstrated clinical utility as a predictive biomarker for response to checkpoint inhibition. Current evidence suggests that PD-L1 expression predicts response independently from TMB, with low correlation between the two biomarkers in various advanced solid tumors. A combined biomarker analysis of TMB, MSI and PD-L1 may offer complementary detail to prescribing clinicians, compared with a reliance on one test in isolation, to inform a treatment decision.
26. MSI-High and Colon Cancer: What It Means, Treatment Options, and More (Feb.02/21)
What is MSI-high Colon Cancer?
Microsatellite instability-high (MSI-high) colon cancer involves tumors with a high amount of instability. It occurs when mismatch repair (MMR) genes, whose job is to correct errors that happen during cell division, stop functioning properly. When the MMR system is defective, it stops making repairs, allowing errors to accumulate. That is how a tumor becomes highly unstable. MSI-high cancer cells look and behave in an abnormal way. That is not necessarily a bad thing when it comes to colon cancer, though. While many cancer cells can easily hide from the immune system, MSI-high cancer cells stand out. That makes it easier for the immune system to recognize them as invaders. They also tend to respond well to treatment. About 15% of colon cancer tumors are MSI-high, according to a 2016 study.
Treatment for colon cancer depends on several factors, such as the stage and location of the tumors. MSI status can play an important role in forming a treatment plan.
Surgery can remove many tumors in the colon. In the early stages of colon cancer, surgery may be the only treatment you need. Cancer that has spread to other organs or tissues can sometimes be surgically removed as well.
Regional and systemic chemotherapy can help shrink tumors and prevent cancer from spreading. It can be used alone or in combination with other treatments.
Immunotherapy is a promising treatment choice for many types of cancer. It’s a way of strengthening your own immune system to fight cancer. Three immune checkpoint inhibitors are approved to treat MSI-high metastatic colon cancer, all of which are all given through intravenous infusions. Two of these drugs can only be used when cancer has progressed after treatment with certain chemotherapy drugs. There is also pembrolizumab (Keytruda), which was approved by the FDA in 2020. It’s a first-line immunotherapy for MSI-high metastatic colon cancer. That means you don’t have to try chemotherapy first. In a clinical trial, researchers compared pembrolizumab to chemotherapy as a first-line therapy for MSI-high metastatic colon cancer. Pembrolizumab led to significantly longer progression-free survival. Trial participants who were treated with pembrolizumab also had fewer adverse events than those in the chemotherapy group.
Targeted therapies for colon cancer help prevent tumors from forming new blood vessels. They are administered intravenously, often in combination with chemotherapy.
Radiation targets high-energy rays to a specific area of the body. This can help shrink tumors and kill cancer cells.
27. Health Related Quality of Life (HRQoL) Low Among Young Adult CRC Survivors (Feb.04/21)
Kimberly Miller, PhD, MPH, University of Southern California Keck School of Medicine, Los Angeles, discusses results from a study exploring health-related quality of life (HRQoL) in colorectal cancer (CRC) survivors who were diagnosed before age 50. These results were presented at the virtual 2021 ASCO Gastrointestinal Cancers Symposium.
Miller and colleagues wanted to examine QoL in young CRC survivors, particularly those diagnosed under age 50. Incidence of CRC has been steeply increasing in this young patient population, and little is known about their QoL. Researchers conducted a cross-sectional survey of 235 young adult CRC survivors, and used the Functional Assessment of Cancer Therapy or the FACT-C which is specific to CRC to examine their QoL. Results indicated that their QoL, both globally and across the specific domains (i.e., emotional, physical, social, and functional), was quite low. In terms of the literature, low in comparison to those who were older, ages 60 and over.
Miller and colleagues then stratified the sample from 6 to 18 months post-diagnosis, and then 19 to 36 months. Comparing mean scores, they found that for the survivors were farther from diagnosis, their emotional and their physical and their functional QoL scores were significantly higher, compared to those who were more recently diagnosed, but that was not the case, by contrast, for social QoL, or social well-being. For those who were farther from diagnosis, their social well-being was significantly lower than those closer.
Overall, what we take from this study is, first, that this at-risk young adult group has low quality of life. It’s an area where targeting counselling, age-appropriate interventions are needed. Miller’s recommendation and takeaway from this is that target interventions, patient counseling and support is needed, and specifically looking into social well-being and providing supportive services that respond to helping patients and survivors socially connect, perhaps, with others.
28. Do Cancer-Fighting Foods Work? (Feb.11/21)
Research suggests that diet and lifestyle changes can reduce the risk of developing cancer by approximately 40%. It also suggests that a healthy diet can increase the recovery from cancer. However, much of the research about nutrition’s impact on cancer is limited and there is no guarantee that your diet can help protect from cancer developing or to help to cure cancer. Therefore, diet recommendations cannot be recommended from research.
This article will uncover what the research says about specific claims related to nutrition and cancer risk.
Protecting Cells From Cancer
Antioxidants are compounds that stop the oxidation process. This effect can be seen in food, like when lemon juice is put on apple slices, the ascorbic acid prevents oxygen from browning the apples as quickly. Antioxidants also help within the body by stopping free radicals from oxidizing and damaging cells. It’s claimed that having antioxidants can help to protect cells from becoming cancerous and that it can slow the growth of cancer cells. Research supports this claim that antioxidants have anti-tumor, anti-carcinogenic, and anti-inflammatory effects. It supports that these effects help to treat cancer cell turnover, which slows down cell growth and protects healthy cells from mutating into cancerous cells. Commonly recommended antioxidants include carotenoids, flavonoids, and other phytochemicals.
Carotenoids are the pigment responsible for the orange, yellow, and red colors in foods. A common carotenoid, beta carotene, is also a precursor to vitamin A. Research has associated the antioxidant effects of this compound with being protective against developing cancer. Sources of catenoids include:
- Sweet potato
Lycopene is a bright red pigment found in foods. Its antioxidant effects have been associated with preventing and treating cancer. Sources of lycopene include:
- Pink grapefruit
Early research suggests the intake of lutein is associated with a decreased risk for developing cancer because it helps to protect cells. Lutein is found in foods such as:
- Yellow Carrots
- Egg Yolks
- Herbs—dill and chives
Kaempferol and Quercetin
Both kaempferol and quercetin are flavonoids that help to control the activity of cells and protect them from damage from free radicals. Research has associated these with a decreased risk of developing cancer.
Sources of kaempferol include:
Sources of quercetin include:
- Red grapes
- Green leafy vegetables
Slowing Tumor Growth
Proteases have long been associated with increased tumor growth and disease progression. Protease inhibitors have been used to help slow down tumor growth and the progression of cancer. Protease inhibitors are found in medication and some foods. Food sources include:
- Whole grains
Phytates and phytic acid in cancer therapy has been researched for decades. Research has associated phytic acid with decreased cell growth and decreased metastasis of tumors.
Phytates can be found in:
- Whole grains
Killing Cancer Cells
A high fiber diet is associated with better gastrointestinal health because it helps with regularity and is considered protective against multiple diseases. Dietary fiber is associated with decreased risk for colon cancer because it helps maintain a healthy gut microbiome, stops the growth the cancer cells, and increases cell death for cancer cells. Further research is still needed to fully understand the effects of dietary fiber on cancer because research is still limited in human subjects. Foods that are high in fiber include:
- Whole grains
Image Source: https://www.today.com/health/eat-more-antioxidants-add-these-7-foods-your-diet-t95646
29. COVID-19’s Collateral Damage: Reduced CRC Care (Jan.19/21)
The COVID-19 pandemic adversely impacted the detection and management of colorectal cancer (CRC) across England, according to a population-based study. The number of people being referred to hospitals with suspected lower gastrointestinal cancer, and the number subsequently diagnosed, fell sharply during the first lockdown in March and a deficit persisted until September. This translated to >3,500 fewer people than expected starting treatment in the period April to October 2020, reported Eva J.A. Morris, PhD, of the Big Data Institute at the University of Oxford, and colleagues.
The study examined data from four population-based datasets for all CRC-related referrals, colonoscopies, surgical procedures, and rectal radiotherapy courses from Jan. 1, 2019 to Oct. 31, 2020. Morris’ group reported that April 2020 saw a 63% reduction from 36,274 to 13,440 in the monthly number of 2-week referrals for suspected cancer versus the month average in April 2019. Also, there was a 92% reduction in the number of colonoscopies, from 46,441 to 3,484, although the numbers recovered by October. Overall, there was a 22% relative reduction in the number of cases referred for treatment, from a monthly average of 2,781 in 2019 to 2,158 in April 2020. There was also a 31% relative reduction in the numbers receiving surgery in April 2020, as well as a lower proportion of laparoscopic, and a greater proportion of stoma-forming procedures, relative to the monthly average in 2019. For rectal cancer, there was a 44% relative increase in the use of neoadjuvant radiotherapy in April 2020, relative to 2019’s monthly average owing to greater use of short-course regimens, according to the authors. By October, achievement of care pathway targets had returned to 2019 levels, but with smaller patient volumes and modifications to usual practice, they noted.
“As pressure grows in the NHS [National Health Service] due to the second wave of COVID-19, urgent action is needed to address the growing burden of undetected and untreated CRC in England,” they wrote. In the U.S., an August 2020 study showed a 46.4% decline in weekly new diagnoses across six cancers, including CRC, during the pandemic. In a September 2020 study, Clare Turnbull, PhD, of the Institute of Cancer Research in London, suggested that one remedial measure would be to prioritize symptomatic patients with suspected CRC using fecal immunochemical testing, which could reduce diagnostic and therapeutic delays during the coronavirus pandemic and potentially prevent CRC deaths.
30. CDC Finds COVID-19 Vaccines Safe After 22 Million Vaccinations (Jan.31/21)
The Centers for Disease Control and Prevention (CDC) has released a new report summarizing the safety of the messenger RNA (mRNA) vaccines. The report shows the Pfizer and Moderna vaccines are safe and associated with few serious side effects based on recent safety surveillance data of 22 million people.
Now that millions of doses have been administered, researchers are getting a clearer picture of the vaccine reactogenicity, or the body’s inflammatory response to a vaccine. Most commonly, the reactogenicity included pain at the injection site. Fatigue, headache, and chills were also reported, more commonly after the second dose. “What is assumed is the first dose primes the immune system, letting the immune system experience the vaccine for the first time,” Dr. Henry Bernstein, a pediatrician at Northwell Health’s Cohen Children’s Medical Center and a member of the CDC Advisory Committee on Immunization Practices (ACIP) committee, told Healthline. “Then the second dose uses the immune system’s memory of that first dose to boost a person’s immunity. This may be why the potential for more side effects occurs,” Bernstein explained.
Anaphylaxis, or severe allergic reactions, to the vaccine remain rare. There were 50 cases of anaphylaxis reported following the Pfizer vaccine and 21 cases of anaphylaxis linked to the Moderna vaccine. Most events occurred within 15 minutes of vaccination, with one case occurring 20 hours after vaccination. More than 80% of cases occurred in individuals with a history of allergies or allergic reactions. About a quarter occurred in people with a history of anaphylaxis. “For any vaccine, usually the risk of anaphylaxis is 1 to 2 per million,” Bernstein said. With Pfizer and Moderna, the risk originally appeared to be higher, but as more people are vaccinated, the incidence of anaphylaxis is approaching the 1 to 2 per million range. “It’s getting closer toward what we would expect or what we have seen in the past with all other vaccines that are given to people,” Bernstein said. As more people are vaccinated, researchers note the rare, uncommon side effects.
- The Latest on Covid-19 (Feb.03/21)
New vaccines to fight COVID-19 variants being developed
Drug maker GlaxoSmithKline (GSK) announced on February 3rd that it would work with German biopharmaceutical company CureVac to develop new vaccines targeting COVID-19 variants amid concerns some mutations make the virus harder to combat, reported the Associated Press (AP). According to the AP, this announcement comes as public health officials worldwide raise concerns about new and potentially more contagious or vaccine-resistant COVID variants. Scientists are closely tracking these mutations to make sure they quickly identify variants of concern. “The increase in emerging variants with the potential to reduce the efficacy of first generation COVID-19 vaccines requires acceleration of efforts to develop vaccines against new variants to keep one step ahead of the pandemic,” the companies said in a statement.
Younger Americans are biggest COVID spreaders, study finds
A new study from Imperial College London finds Americans between ages 20 to 49 are the biggest spreader of new coronavirus infection. Researchers recommend prioritizing this age group for vaccination to speed school reopenings. According to the study’s findings, people in that age range accounted for roughly 72% of cases detected after schools reopened in October. However, less than 10% came from teens, and children caused less than 5%. “We believe this study is important because we demonstrate that adults aged 20-49 are the only age groups that have consistently sustained COVID-19 spread across the U.S.,” said Oliver Ratmann PhD, from Imperial College London in a statement. “Additional interventions targeting the 20-49 age group could bring resurgent epidemics under control and avert deaths.”
Image Source: https://www.bbc.com/news/world-asia-china-54982910
32. Frequently Asked Questions for COVID-19
Q: What is COVID-19 (or novel Coronavirus Disease – 19)?
A: Coronaviruses are a large family of viruses that can cause illnesses in humans and animals. Coronaviruses can cause illnesses that range in severity from the common cold, to more severe diseases such as Severe Acute Respiratory Syndrome (SARS) and most recently, COVID-19. COVID-19 or novel coronavirus originated from an outbreak in Wuhan, China in December 2019. The most common symptoms associated with COVID-19 can include fever, fatigue, and a dry cough. Though additional symptoms have now been linked with the disease, which may include aches and pains, nasal congestion, runny nose, sore throat, diarrhea, skin rash and vomiting. It is also possible to become infected with COVID-19 and not experience any symptoms or feeling ill. The spread of COVID-19 is mainly through the transmission of droplets from the nose or mouth when a person coughs, exhales or sneezes. These droplets land on surfaces around a nearby person. COVID-19 can be transmitted to that nearby person who may end up touching the surface contaminated with COVID-19 and then end up touching their nose, mouth, or eyes. A person can also contract COVID-19 through inhaling these droplets from someone with COVID-19. Although research is still ongoing, it is important to note that older populations (over the age of 65), those with a compromised immune system and those with pre-existing conditions including heart disease, high blood pressure, lung disease, diabetes or cancer may be at a higher risk of severe illness due to COVID-19.
Q: What can I do to avoid getting Coronavirus?
A: There are various ways in which we can reduce our risk of contracting COVID-19. Below are some measures suggested by the World Health Organization
- Keep at least 2 metres (or 6 feet) between yourself and other people. This will reduce the risk of inhaling droplets from those infected with COVID-19.
- Regularly clean your hands for at least 20 seconds with warm water and soap, or an alcohol-based hand rub. This will kill any viruses on your hands.
- Avoid touching your eyes, nose and mouth. If the virus is on your hands, it can enter the body through these areas.
- Follow good respiratory hygiene by covering your mouth and nose with a tissue or elbow when you cough and sneeze. This prevents the droplets from settling on surfaces or being released into the air around you.
- Stay home as much as possible, especially if you are feeling unwell. If you think you may have the Coronavirus, please see “What should I do if I think I have Coronavirus?” section.
- Please wear a face covering or mask in public when physical distancing is not possible.
Q: Are there any treatments available for Coronavirus?
A: People with cancer are at a higher risk of severe illness due to COVID-19 as cancer is considered a pre-existing health issue. Some cancer treatments including chemotherapy, radiation and surgery can weaken the immune system, making it harder for the body to fight infections and viruses, such as Coronavirus. It is important to diligently follow the World Health Organization’s recommendations above to reduce the risk of contracting COVID-19. If you have any concerns about your risk, it is best to contact your doctor or healthcare team.
There are currently no treatments available for COVID-19 but trials are underway to determine how to best treat and manage those afflicted with the virus. Vaccine candidates are being vigorously tested in a number of countries around the world, Canada included. The US government is funding 3 major phase 3 trials on potential COVID-19 vaccines and all 3 trials are being conducted by 3 different pharmaceutical companies looking at different vaccine candidates. The hope is to have a vaccine by the end of the year!
Q: Are there special precautions that people with cancer can take?
A: People with cancer (and other chronic ailments such as heart disease, diabetes, high blood pressure and lung disease) are at a higher risk of severe illness due to COVID-19 as cancer is considered a pre-existing health issue. Some cancer treatments including chemotherapy, radiation and surgery can weaken the immune system, making it harder for the body to fight infections and viruses, such as Coronavirus. It is important to diligently follow the World Health Organization’s recommendations above to reduce the risk of contracting COVID-19. If you have any concerns about your risk, it is best to contact your doctor or healthcare team.
Will anything change with regards to my cancer related medical visits? As each patient and treatment plan is unique, it is always best to contact your health care provider for updated information about your treatment plan. In some cases, it is safe to delay cancer treatment until after the pandemic risk has decreased. In other cases, it may be safe to attend a clinic that is separate from where COVID-19 patients are being treated. Oral treatment options could be prescribed by your care provider virtually, without the need to attend the clinic. Finally, some follow-up appointments or discussions could be held virtually (via skype or zoom for example) or over the phone to minimize your risk. As we know, conditions and protocols are changing daily due to the nature of the COVID-19 outbreak, and vary based on location, therefore, the best first step is to reach out to your care provider for guidance.
Should you wish to contact your local public health agency, please see below.
COVID-19 info for Albertans
Social media: Instagram @albertahealthservices, Facebook @albertahealthservices, Twitter @GoAHealth
Phone number: 811
British Columbia COVID-19
Social media: Facebook @ImmunizeBC, Twitter @CDCofBC
Phone number: 811
Social media: Facebook @manitobagovernment, Twitter @mbgov
Phone number: 1-888-315-9257
New Brunswick Coronavirus
Social media: Facebook @GovNB, Twitter @Gov_NB, Instagram @gnbca
Phone number: 811
Newfoundland and Labrador
Newfoundland and Labrador COVID-19 information
Social media: Facebook @GovNL, Twitter @GovNL, Instagram @govnlsocial
Phone number: 811 or 1-888-709-2929
Northwest Territories coronavirus disease (COVID-19)
Social media: Facebook @NTHSSA
Phone number: 811
Nova Scotia novel coronavirus (COVID-19)
Social media: Facebook @NovaScotiaHealthAuthority , Twitter @healthns, Instagram @novascotiahealthauthority
Phone number: 811
Nunavut COVID-19 (novel coronavirus)
Social media: Facebook @GovofNunavut , Twitter @GovofNunavut, Instagram @governmentofnunavut
Phone number: 1-888-975-8601
Ontario: The 2019 Novel Coronavirus (COVID-19)
Social media: Facebook @ONThealth, Twitter @ONThealth , Instagram @ongov
Phone number: 1-866-797-0000
Prince Edward Island
Prince Edward Island COVID-19
Social media: Facebook @GovPe, Twitter @InfoPEI,
Coronavirus disease (COVID-19) in Québec
Social media: Facebook @GouvQc, Twitter @sante_qc
Phone number: 1-877-644-4545
Social media: Facebook @SKGov, Twitter @SKGov
Phone number: 811
Yukon: Find information about coronavirus (COVID-19)
Social media: Facebook @yukonhss, Twitter @hssyukon
Phone number: 811