A PATIENT-FOCUSED ORGANIZATION
COLORECTAL CANCER TREATMENT & CLINICAL RESEARCH UPDATES
Month Ending March 18th, 2021
The following colorectal cancer treatment and research updates extend from February 16th, 2021 to March 18th, 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.
CONTENT
1. Phase II LEAP Clinical Trial to Treat mCRC.
2. TRK Fusion Cancer and How to Test For It
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. Keytruda Granted Notice of Compliance
6. New Immunotherapy Study Poses Question: Can Microbiome Influence Treatment?
7. KRAS Inhibitor Sotorasib Appears Safe, Achieves Durable Clinical Benefit in Early Trial
8. Hepatic Artery Infusion Pump (HAIP) Chemotherapy Program – Sunnybrook Hospital
9. Living Donor Liver Transplantation for Unresectable Colorectal Cancer Liver Metastases
10. Study Offered at the Odette Cancer Centre to Treat Recurrent Rectal Cancer
11. Trends in the Incidence of Young-Onset CRC with a Focus on Years Approaching Screening Age
12. Delaying Colonoscopy Following Abnormal Stool Test Increases Risk of CRC
13. New Guideline Lowers Age to Begin Colorectal Cancer Screening
14. Increasing Disparities in the Age-Related Incidences of Colon and Rectal Cancers
15. Colorectal Cancer Awareness Month
16. Bum Run is Back
17. Young Adult CRC Clinic Available at Sunnybrook Hospital
18. Ask the Experts About Circulating Tumor DNA in the Management of Cancer
19. Family and Caregiver Support Accounting for Unique Aspects of Care a Top Need of CRC Patients
20. SAVE THE DATE: EARLY AGE ONSET COLORECTAL CANCER VIRTUAL SYMPOSIUM
21. And the Magic Number for Daily Fruit, Vegetable Intake Is..
22. A Daily Roundup of News on COVID-19
23. Why You Should Trust the COVID Vaccine
24. Stop Stressing Post-Vax Risk of Spreading Coronavirus
25. Does Pfizer’s COVID Vaccine Protect Against Asymptomatic Infection?
26. Moderna COVID-19 Vaccine Side Effects: How Long They Last
27. How Do COVID-19 Vaccines Compare?
28. 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)
https://www.bayer.ca/en/media/news/?dt=TmpBPQ==&st=1
- 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.
About Arfolitixorin:
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.
https://sunnybrook.ca/trials/item/?i=293&page=49335 and https://clinicaltrials.gov/ct2/show/NCT03750786
(https://isofolmedical.com/arfolitixorin/ )
- Keytruda Granted Notice of Compliance (Mar.03/21)
Health Canada granted Notice of Compliance (March 3, 2021) for KEYTRUDA® for the first line treatment of colorectal cancer:
KEYTRUDA® is indicated, as monotherapy, for the first-line treatment of adult patients with metastatic MSI-H or MMR-D colorectal cancer (CRC).
- New Immunotherapy Study Poses Question: Can Microbiome Influence Treatment? (Feb.20/21)
What is the Microbiome?
There is a community of 38,000,000,000,000 microorganisms (mostly bacteria) living in and on us. These bacteria are essential to our health. They digest our food, regulate inflammation, and synthesize key vitamins, metabolites, and neurotransmitters—in exchange for just a portion of our daily calories and a warm place to live. A new era of research examines the role of the bacteria in our intestines (microbiota) as a potentially important regulator of health and a contributor to a variety of diseases. The bacteria in the gut, referred to as the gut microbiome, appears to play a significant role in disease.
Microbiome May Influence Response to Immunotherapy
The composition of the gut microbiota can influence whether patients with advanced cancer respond to immune checkpoint inhibitor therapy (ICIs) and treatment with antibiotics has been demonstrated to interfere with the clinical benefit of ICIs.
In a recently published clinical trial doctors evaluated 196 patients the majority of whom were treated with ICIs for metastatic cancer, 29 had received prior and 69 concurrent antibiotic therapy. The response rate for patients not receiving prior antibiotic therapy was nearly double that observed for patients treated with antibiotics before ICI therapy. Analysis showed that prior antibiotic, but not concurrent antibiotic therapy was associated with worse overall survival. NSCLC, melanoma, and other cancers not previously exposed to antibiotics survived 1-2 years longer on average than those. In another small immunotherapy trial researchers analyzed the gut microbiome in NSCLC patients and found that pathologic response to combination immunotherapy was associated with the presence of certain fecal microbes that also have been correlated with immunotherapy response in melanoma and other cancers. These findings are suggestive that maintenance of healthy gut microbiota can impact immunotherapy treatment.
- KRAS Inhibitor Sotorasib Appears Safe, Achieves Durable Clinical Benefit in Early Trial (Mar.1/21)
In a Phase I clinical trial for patients with advanced solid cancers marked by KRAS G12C mutations, the KRASG12C inhibitor sotorasib (AMG 510) resulted in manageable toxicities and durable clinical benefits. Sotorasib is a small-molecule inhibitor that specifically and irreversibly binds the mutant KRASG12C protein to lock it in an inactive state.
For patients with KRAS G12C-mutant colorectal cancer (CRC), this targeted therapy resulted in a confirmed response rate (tumor shrinkage) of 7.1% and disease control rate (tumor shrinkage or stable disease) of 73.8% across all dose levels. Additionally, in CRC, the median duration of response was 6.9 months and median PFS was 4.0 months.
“The next steps for this inhibitor are many,” said lead author, David S. Hong, M.D., professor of Investigational Cancer Therapeutics, “We are working to finish the existing Phase II study and transition to larger patient populations to understand the true benefit and toxicities. Understanding the best combinations of sotorasib with other therapies will also be key next steps to advancing this as an effective treatment option for patients.”
SURGICAL THERAPIES
8. 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.
http://sunnybrook.ca/content/?page=colorectal-colon-bowel-haip-chemotherapy
9. 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
10. 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:
SCREENING
11. 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.
- Delaying Colonoscopy Following Abnormal Stool Test Increases Risk of CRC (Mar.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.
Colonoscopy within year of abnormal stool test
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, 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. “These findings extend current knowledge about the clinical implications of time to follow-up after abnormal FIT-FOBT,” the researchers write. “Further work should include [efforts] that address barriers to [undergoing] colonoscopy after abnormal non-colonoscopic screening results and policies to encourage the routine monitoring of follow-up rates.”
Use of stool tests has increased during COVID
Many health care experts believe that stool tests, such as FIT, are as reliable as colonoscopy in screening for colorectal cancer. “If your doctor tells you a colonoscopy is better, that’s not accurate,” Dr. Alex Krist, chairman of the U.S. Preventive Services Task Force, an independent panel that reviews evidence and issues recommendations, told The New York Times. “The data show the tests are equally effective at saving lives.” The use of stool tests has increased during the COVID-19 pandemic because of the convenience and safety of home testing and because patients may be reluctant to go to a health care facility for colonoscopy.
Image Source: https://afmc.org/afmc-healthspot/colon-cancer-screening-can-save-life/
- New Guideline Lowers Age to Begin Colorectal Cancer Screening in the U.S. (Mar.09/21)
Data on colorectal cancer (CRC) screening gathered over the past decade have prompted the American College of Gastroenterology (ACG) to update its guidelines, last issued in 2009. The new recommendations, published online in the American Journal of Gastroenterology, state that screening should start at age 45 for persons of average risk.
“We now know that the risk is higher than we appreciated for people from age 40 onward. Today, a 45-year-old has the same risk as a 50-year-old had 10 years ago,” said Aasma Shaukat, MD, MPH, of the University of Minnesota School of Medicine in Minneapolis, in an ACG introductory podcast to the new guidelines. Screening has changed a lot since 2009, Shaukat noted, and CRC is unique in that there are now seven different screening modalities. Patients have a wealth of choices, ranging from two-step procedures such as guaiac fecal occult blood assays, stool DNA testing, and CT colonography, to one-step diagnosis with colonoscopy. While the ideal test is safe, non-invasive, accurate, readily available, and inexpensive, “the best test is one that the patient is willing to have and the healthcare system is willing to give,” Shaukat said.
Guideline Highlights
Age for starting CRC screening in average-risk men and women should be lowered to 45 from 50, with routine screening still recommended to age 75. Screening beyond age 75 should be individualized to the patient. African Americans in particular should begin screening at age 45, and special efforts are needed to improve screening rates and reduce disparities in treatment and outcomes. Compared with white patients, incidence rates are 24% higher in Black men and 19% higher in Black women, the authors noted. Stage-adjusted CRC mortality is also disproportionately higher in African Americans, with rates 47% higher in men and 34% higher in women versus their white counterparts. For individuals with a family history of CRC or an advanced polyp in one first-degree relative at age <60 years or CRC or an advanced polyp in two or more first-degree relatives at any age, guidelines conditionally suggest initiating colonoscopy at the earlier age of 40 or 10 years before the youngest affected relative (whichever is earlier).
The following intervals should be followed for different screening modalities:
- FIT annually
- Colonoscopy every 10 years
- Multi-target stool DNA test every 3 years
- Flexible sigmoidoscopy every 5 to 10 years
- CT colonography and colon capsule endoscopy every 5 years
A positive multi-target stool DNA test followed by a colonoscopy with no findings should not prompt any further workup, and repeat screening should be offered at 10 years.
https://www.medpagetoday.com/gastroenterology/coloncancer/91544
Image Source: https://www.healthhub.sg/programmes/172/colorectal-cancer-screening
- Increasing Disparities in the Age-Related Incidences of Colon and Rectal Cancers (Mar.1/21)
Researchers performed a retrospective cohort study of patients with histologically confirmed colon or rectal cancer to evaluate age-related disparities in secular trends in colorectal cancer (CRC) incidence in the United States. Data were obtained using the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) CRC registry from January 1, 1975, through December 31, 2010.
The overall age-adjusted CRC incidence rate decreased by 0.92% between 1975 and 2010. There has been a steady decline in the incidence of CRC in patients age 50 years or older, but the opposite trend has been observed for young adults. For patients 20 to 34 years, the incidence rates of localized, regional, and distant colon and rectal cancers have increased. An increasing incidence rate was also observed for patients with rectal cancer aged 35 to 49 years. Based on current trends, in 2030, the incidence rates for colon and rectal cancers will increase by 90.0% and 124.2%, respectively, for patients 20 to 34 years and by 27.7% and 46.0%, respectively, for patients 35 to 49 years. Further studies are needed to determine the cause for these trends and identify potential preventive and early detection strategies.
OTHER
- Colorectal Cancer Awareness Month
- BumRun is Back !
BUMRUN IS BACK!! And this year, it is back in a powerful way. Some of you will recall that BUMRUN has been a very successful colorectal cancer awareness event in Toronto for over 10 years. It was started by Dr. Ian Bookman, a Toronto gastroenterologist, determined to promote much needed awareness of colorectal cancer screening by organizing a 5km walk/run through the streets of Toronto every last Sunday of the month of April. BUMRUN has raised significant funds for colorectal cancer charities in the past to assist with their mandate. 
It is with great pride that CCRAN has been asked to partner with BUMRUN this year and moving forward, the event may become CCRAN’s annual signature awareness event!! The BUMRUN event will be held virtually in the following cities on April 25th, 2021:
- Halifax
- Toronto
- Ottawa
- Winnipeg
- Edmonton
- Vancouver
Each city has a registration page www.bumrun.com so that the event can be promoted locally. Check it out, the video is adorable!
BUMRUN is a fun, easy, and a healthy way to raise awareness of the disease, promote much needed screening as well as help CCRAN with its patient programs. Here is how you can get involved/participate and help CCRAN:
- Register at one of the six locations (Halifax, Toronto, Ottawa, Winnipeg, Edmonton, or Vancouver) by clicking: www.bumrun.com
(PLEASE NOTE: All cities need to select BUMRUN as the charity of choice, or preferred fundraising organization, for CCRAN to receive proceeds from the event. Tax receipts will be issued by BUMRUN.)
- Solicit pledges by kindly asking family, friends, and making online pleas through social media etc.
- Walk or run in your neighborhood in a safe manner, respecting the public health restrictions at all times, by no later than April 25th, 2021. A live broadcast for all the locations will take place on April 25th, 2021. Please visit the website www.bumrun.com for additional details.
We look forward to having you all join us virtually at BUMRUN which will serve as a great opportunity to familiarize people with CCRAN and the great work we do for patients and caregivers every day!
Questions? Please contact Frank Pitman at CCRAN: frank.p@ccran.org
17. 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
- Psychologists
- Geneticists
- 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.
http://sunnybrook.ca/content/?page=young-adult-colorectal-cancer-clinic
18. Ask the Experts About Circulating Tumor DNA in the Management of Cancer (Mar.04/21)
What is circulating tumor DNA (ctDNA)?
Circulating tumor DNA (ctDNA) is 150–200-base-pair fragments of DNA, which originate from cancer cells and are present in the bloodstream or other body fluids.
When should ctDNA be collected?
Both tissue and blood samples are required initially to build the ctDNA test. Once the test is built, only blood samples are required for the periodic follow-up tests performed to monitor for MRD (minimal residual disease) or recurrence. Since DNA assays require ctDNA shedding into the bloodstream, the performance of ctDNA assays is improved when blood is collected after—rather than during—active chemotherapy.
How can ctDNA help manage cancer?
There are currently four clinical applications of ctDNA to guide precision medicine in patients with cancer:
- Detection of minimal residual disease (MRD) following surgery.
- Monitoring the treatment response in the metastatic setting.
- Identifying genomic drivers of therapeutic sensitivity and resistance.
- Guiding treatment strategies to overcome resistance to treatment.
How is ctDNA used for the management of early-stage cancers?
Across all stages of surgically removed cancer, detection of ctDNA following surgery is a strong predictor of cancer recurrence. The detection of ctDNA could lead clinicians to intensify therapy in certain situations. Conversely, the absence of ctDNA could provide an opportunity to minimize surveillance or adjuvant treatment.
How is ctDNA used for the management of metastatic cancer?
ctDNA can be used to monitor treatment response, identify genomic drivers of treatment sensitivity or resistance, or identify new therapies that could overcome genomic drivers of treatment resistance.
- Family and Caregiver Support Accounting for Unique Aspects of Care a Top Need of CRC Patients (Mar. 02/21)
Support from family members and caregivers who understand the unique aspects of caring for a colorectal cancer (CRC) patient is a top need amongst CRC patients today, according to a study published by the national advocacy organization Fight Colorectal Cancer (Fight CRC). The research study consisted of more than six focus groups hosted between 2015–2018 with 79 participants who volunteered for the groups and were asked two questions: “What information do you wish you had at diagnosis?” and “What information do you need now?”. Following the focus groups, the team reviewed the data and found several key themes emerge.
When asked about the information and support they wished they had at the time of diagnosis, respondents’ top answers included:
- Increased communication and coordination with care teams
- increased access to CRC resources
- A better understanding of cancer diagnosis and care
When asked about the information and support patients need now, top answers included:
- Support for families and caregivers, specifically programs tailored to the independent needs and unique aspects of care for CRC patients
- Mental and behavioural support
- Access to treatment and survivorship care plans. and the supportive care beyond treatment, to provide patients with the necessary tools to utilize complementary health and manage cancer as a chronic disease
The results of the study are paving the way for care teams, nonprofit organizations, and policymakers to understand how to effectively fight for CRC patients and reduce the stress of a diagnosis. The study is a foundation for future research, programmatic interventions, and policy initiatives at Fight CRC and beyond.
20. SAVE THE DATE: EARLY AGE ONSET COLORECTAL CANCER VIRTUAL SYMPOSIUM
In response to the rising rates in young adult colorectal cancer, CCRAN is hosting a virtual symposium to explore the research landscape to help explain why so many young Canadians are being diagnosed with colorectal cancer. It will serve as the basis for CCRAN’s educational and advocacy campaign. Please join us on June 17th, 2021.
NUTRITION/HEALTHY LIFESTYLE
21. And the Magic Number for Daily Fruit, Vegetable Intake Is… (Mar.01/21)
Two servings per day of fruit and three of vegetables conferred the greatest benefit; any more servings than that did not yield additional mortality risk reduction, according to researchers led by Dong Wang, MD, ScD, of Brigham and Women’s Hospital and Harvard Medical School. Exceptions were starchy vegetables (e.g., peas, corn), fruit juices, and potatoes, which were not associated with decreased mortality over 3 decades in the report.
Similar findings were observed in a meta-analysis incorporating these two studies with 24 other prospective cohort studies with a total of 1,892,885 participants. “These findings support current dietary recommendations to increase intakes of fruits and vegetables, and that the succinct 5-a-day message is consistent with available evidence,” Wang’s group concluded.
The widely promoted “five-a-day” was, in fact, better than two servings per day in terms of:
- Total mortality
- Cardiovascular disease mortality
- Cancer mortality
- Respiratory disease mortality
https://www.medpagetoday.com/primarycare/dietnutrition/91424
Image Source: https://www.today.com/health/daily-diet-2-fruits-3-veggies-could-lead-longer-life-t210266
COVID-19 UPDATES
22. A Daily Roundup of News on COVID-19 (Mar.02/21)
The link below includes separate articles for each of the following COVID updates:
- Single doses of the Oxford/AstraZeneca COVID-19 and Pfizer/BioNTech vaccines led to “substantial” reduction in risk of illness for people 70 and up, though less than previously seen with two doses, according to an unreviewed manuscript posted online by British researchers Monday.
- While the U.S. focuses on Western companies’ vaccines, much of the world is quietly relying on shots from China.
- Merck, which dropped out of the COVID vaccine race after its candidate flopped, is reportedly offering to manufacture Johnson & Johnson’s.
- It is “premature” and “unrealistic” to expect the pandemic to end this year, a WHO leader said.
- Another at-home coronavirus antigen test, from Quidel, received emergency use authorization for prescription use, and the NIH said it’s now testing a companion smartphone app.
https://www.medpagetoday.com/infectiousdisease/covid19/91430
23. Why You Should Trust the COVID Vaccine (Feb.27/21)
Key drivers of COVID-19 vaccine hesitancy are complacency, convenience, and most of all, lack of confidence and trust in the vaccines. A salient and widespread concern expressed by those who are hesitant to get either the Pfizer/BioNTech or Moderna vaccine is safety in relation to the speed at which these vaccines were developed. However, both vaccines have demonstrated a level of efficacy of more than 94% for preventing symptomatic disease, with reassuring safety profiles.
So how could these two mRNA COVID-19 vaccines developed in just under one year be evaluated as safe and effective? There are a number of factors which directly and intentionally resulted in the shortened timeline for development and rollout of the two mRNA COVID-19 vaccines, without compromising vaccine safety.
First, the context of the COVID-19 pandemic is a historic international public health crisis, reminiscent of the 1918 Spanish flu pandemic; an extraordinary level of financial and other resources including human expertise, were brought to bear in an unprecedented spirit of international collaboration and cooperation. Just days following the identification of SARS-CoV-2 – the virus that causes COVID-19 – in China, the entire genetic composition of the virus was published. This provided vaccine researchers an early blueprint for conceptualizing the development of vaccines using different vaccine platform technologies to maximize the probability of quickly identifying potentially viable vaccine candidates.
The vaccine manufacturing timing was another key factor that contributed to the reduced duration for rollout of the vaccines. Traditionally, vaccine manufacturing begins to scale up once a vaccine is authorized, however, for the mRNA COVID-19 vaccines manufacturing took place in parallel with the clinical trials. Indeed, this was financially risky, but was informed by the “proof of concept” or biological plausibility of the vaccine candidates established in the preclinical trials and was justified in the context of a deadly and explosive pandemic. The continuous or overlapping phase I/II/III trial design also helped to shorten the vaccine development timelines.
https://www.medpagetoday.com/infectiousdisease/vaccines/91376
24. Stop Stressing Post-Vax Risk of Spreading Coronavirus (Feb.22.21)
Recent public messaging harps on the idea that people can still become infected and transmit COVID-19 after they get vaccinated. While that is a risk, it is an extremely low risk, and not worth the negative consequence: it’s stopping people from getting vaccinated.
In the Modern vaccine trial, they randomized 15,210 people to the vaccine and 15,210 people to placebo. Of those who got the placebo, 185 developed COVID-19. Therefore, 1.2% got COVID-19. Thirty of those became very ill. Of those who got the vaccine, 11 developed COVID-19. None of them got very ill. Therefore, 0.07% got COVID-19. So, the vaccine was effective: it prevented illness and it prevented serious illness. Additionally, the efficacy of the vaccine is quoted as 94%.
It is also known that the spread of COVID-19 is greater when patients are sicker, when they are sneezing and coughing, and have evidence of a stronger infection. Those with mild or asymptomatic disease are less likely to spread the illness. Therefore, by reducing symptoms, that vaccine reduces viral spread, though perhaps not completely.
Another way to approach this issue of whether the vaccine prevents spread is to consider what happens with other vaccines. When we give the flu vaccine, do we find that those who get the vaccine contract the flu and pass it on to others at a clinically significant rate? The answer is no. Can it happen? The answer is yes. The flu vaccine, like the COVID-19 vaccine, is not perfect. But it is highly effective. Therefore, to harp on the rare possibility of spreading COVID-19 after vaccination is to focus on what is unlikely to happen rather than to focus on what is likely to happen — that it will work very well.
Although it is very unlikely that two weeks after a person receives the second COVID-19 vaccine that he or she will spread the virus, it is still a rare possibility. There were those 11 people out of 15,210 who developed COVID-19. Therefore, wearing masks after getting the vaccine is justified. But what is not justified is spreading the word that spread of the virus after vaccination is a serious threat. What is not justified is giving people a talking point which is used to say that the vaccine does not work.
https://www.medpagetoday.com/infectiousdisease/vaccines/91298
Image Source: https://www.bbc.com/news/world-asia-china-54982910
25. Does Pfizer’s COVID Vaccine Protect Against Asymptomatic Infection? (Feb.24/21)
Pfizer/BioNTech’s COVID-19 vaccine appeared to prevent not only symptomatic disease, but asymptomatic infection as well, a real-world review of Israeli health records showed.
A large case-control study comprising over one million people found that the estimated vaccine effectiveness for “documented infection” was 46% at days 14-20 following one dose, and 92% at least 7 days following the second dose, reported Ran Balicer, MD, PhD, of Clalit Health Services in Tel Aviv, and colleagues. They also found that vaccine effectiveness may be “slightly lower” among individuals with multiple comorbidities.
Using a proxy for asymptomatic infection, they estimated 29% vaccine efficacy at days 14-20 following the first dose and 90% at 7 or more days after the second dose, as noted in the New England Journal of Medicine. Study authors defined asymptomatic infection as “a PCR-confirmed infection with no report of symptoms during referral and initial physician questioning.” They included these data in a supplemental appendix, with a caveat: “In the absence of systematic periodic testing of SARS-CoV-2 among asymptomatic people in Israel, documented asymptomatic infections do not account for all asymptomatic infections, and likely cannot capture vaccine effectiveness for this outcome,” Balicer and colleagues wrote.
https://www.medpagetoday.com/infectiousdisease/covid19/91350
26. Moderna COVID-19 Vaccine Side Effects: How Long They Last (Mar.11/21)
Pain at the injection site, chills, headache, and fever are the most common symptoms people experience after receiving the Moderna vaccine. All of these reactions — which are temporary and nonthreatening — indicate the vaccine is doing its job and they typically clear up within a few days. “As the vaccine works to ‘train’ your immune system to start developing antibodies, the pain is a sign of the inflammation that occurs as part of this process,” said Dr. Shobha Swaminathan, an associate professor of medicine at Rutgers New Jersey Medical School and clinical research site leader for the Rutgers Moderna trial.
Like other vaccines, every person’s response could be somewhat different. In general, older adults are less likely to experience side effects after vaccination. Recent data suggest women tend to experience more side effects after vaccination, yet it is unclear why. Anaphylaxis, a severe allergic reaction, appears to be rare. Anaphylaxis also appears to be more common in women.
The first dose is considered “the prime” and trains your body to recognize the virus, according to Swaminathan. “Since that is the first exposure, reactions tend to be mild,” Swaminathan said. The second dose, the “booster,” further cements the immune response. “Since the patients have already ‘seen’ the vaccine from the first shot, the second booster is an exaggerated response to the same,” Swaminathan said. Research also suggests reactions are more intense in people who previously had COVID-19 since they likely have some level of preexisting immunity.
27. How Do COVID-19 Vaccines Compare? (Mar.05/21)
While direct comparisons cannot be made because head-to-head trials don’t exist, people are questioning how the three COVID-19 vaccines authorized in the U.S. stack up. Below are the key characteristics of each of those vaccines. This list will be updated as additional vaccines become available.
Side Effects
Pfizer/BioNTech: Most common were fatigue and headache after both doses, with both being more prominent after the second dose. These were milder for participants over 55 compared with those age 16 to 55. In this latter group, the rates of fatigue and headache were 59% and 52%, respectively, after dose 2.
Moderna: Overall systemic adverse events including fever, chills, headache, and myalgia were recorded in 60% of participants after the first dose and in 80% of participants after the second dose.
Johnson & Johnson/Janssen: Most common systemic reactions were headache (39%), fatigue (38%), myalgia (33%), nausea (14%), and fever (9%).
Variants
Pfizer/BioNTech: No clinical data; lab studies have shown that the South African (B.1.351) variant may reduce antibody titers by two-thirds. Pfizer is studying a third “booster” dose of the original vaccine against this variant, as well as evaluating a variant-specific vaccine with a modified mRNA sequence.
Moderna: No clinical data; lab studies found no significant impact on neutralizing antibodies with the U.K. variant (B.1.1.7) but a six-fold reduction in neutralizing antibodies with the South African variant (B.1.351). Moderna plans to test a variant-specific booster candidate, a multivalent booster candidate, and a third dose of the original vaccine at 50 μg.
Johnson & Johnson/Janssen: 57% efficacy in South Africa; 66% efficacy in South America (Brazil was among the countries studied, but there were no sequenced cases of the P.1 variant)
https://www.medpagetoday.com/special-reports/exclusives/91489
28. 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.
https://www.who.int/news-room/q-a-detail/q-acoronaviruses)
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.
https://www.who.int/news-room/q-adetail/q-a-coronaviruses
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!
Source: https://www.who.int/news-room/q-a-detail/q-acoronaviruses
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.
https://www.cancer.gov/contact/emergencypreparedness/coronavirus
Should you wish to contact your local public health agency, please see below.
Alberta
COVID-19 info for Albertans
Social media: Instagram @albertahealthservices, Facebook @albertahealthservices, Twitter @GoAHealth
Phone number: 811
British Columbia
British Columbia COVID-19
Social media: Facebook @ImmunizeBC, Twitter @CDCofBC
Phone number: 811
Manitoba
Manitoba COVID-19
Social media: Facebook @manitobagovernment, Twitter @mbgov
Phone number: 1-888-315-9257
New Brunswick
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
Northwest Territories coronavirus disease (COVID-19)
Social media: Facebook @NTHSSA
Phone number: 811
Nova Scotia
Nova Scotia novel coronavirus (COVID-19)
Social media: Facebook @NovaScotiaHealthAuthority , Twitter @healthns, Instagram @novascotiahealthauthority
Phone number: 811
Nunavut
Nunavut COVID-19 (novel coronavirus)
Social media: Facebook @GovofNunavut , Twitter @GovofNunavut, Instagram @governmentofnunavut
Phone number: 1-888-975-8601
Ontario
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,
Quebec
Coronavirus disease (COVID-19) in Québec
Social media: Facebook @GouvQc, Twitter @sante_qc
Phone number: 1-877-644-4545
Saskatchewan
Saskatchewan COVID-19
Social media: Facebook @SKGov, Twitter @SKGov
Phone number: 811
Yukon
Yukon: Find information about coronavirus (COVID-19)
Social media: Facebook @yukonhss, Twitter @hssyukon
Phone number: 811
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