A PATIENT-FOCUSED ORGANIZATION
COLORECTAL CANCER TREATMENT & CLINICAL RESEARCH UPDATES
Month Ending May 13th, 2021
The following colorectal cancer treatment and research updates extend from April 28th, 2021 to May 13th, 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. 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. Vitrakvi’s Positive Tumor-Agnostic Recommendation from CADTH
6. Novel Late-Stage CRC Treatment Proves Effective in Preclinical Models
7. First-line Pembrolizumab Monotherapy Improves HRQOL Versus Chemotherapy for mCRC
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. CRC Deaths Rising Among Young People
13. Patients at Average Risk of CRC May Prefer Stool-Based Screenings
14. CRC Screening: One of The Best Weapons in Your Health Toolbox
15. Intestinal Polyps in Close Relatives can Increase Risk of CRC
16. Study Finds Disparities in CRC Screenings
17. Young Adult CRC Clinic Available at Sunnybrook Hospital
18. Registration is Now Open For CCRAN’s Early Age Onset CRC Virtual Symposium
19. Natera to Present New CRC and Multiple Myeloma Data at the 2021 Annual ASCO Meeting
20. CRC: Simple Lifestyle Modifications to Keep you Safe
21. Early-Onset CRC — Are Sugary Drinks to Blame?
22. Diet and CRC Risk: Yes to Dairy, No to Alcohol
23. Look for These Symptoms in the Months After COVID-19 Recovery
24. Moderna Announces Positive Initial Booster Data Against SARS-CoV-2 Variants of Concern
25. Cancer Patient Advocacy Groups Urge the Prime Minister and Premiers to Help Our Cancer Patients Complete the Vaccine Series within the Clinical Trial Recommended Timeline!
26. 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.
- Vitrakvi’s Positive Tumor-Agnostic Recommendation from CADTH (May.07/21)
Vitrakvi (Larotrectinib) received a conditional, positive tumour-agnostic recommendation from CADTH on Friday, May 7th, 2021!! The CADTH pCODR Expert Review Committee (pERC) recommended that VITRAKVI should be reimbursed for the treatment of adult and pediatric patients with metastatic or locally advanced solid tumours who have a Neurotrophic Tyrosine Receptor Kinase (NTRK) gene fusion with conditions. You can read the full draft recommendation on the CADTH website ( https://cadth.ca/sites/default/files/cdr/complete/PC0221%20Vitrakvi%20-%20Draft%20CADTH%20Recommendation_For%20Posting%20May%207,%202021.pdf ) . This recommendation recognizes and responds to our evolving understanding of the causes of cancer, in this case a rare genomic alteration that results in TRK fusion cancer in pediatric and adult patients, and is a step forward in offering patients effective, innovative therapies. It is great news for Canadian TRK fusion cancer patients and a critical milestone in achieving public coverage of VITRAVKI.
- Novel Late-Stage CRC Treatment Proves Effective in Preclinical Models (Apr.28/21)
In a recent discovery by University of Minnesota Medical School, researchers uncovered a new way to potentially target and treat late-stage colorectal cancer (CRC). In partnership with Xianda Zhao, MD, PhD, a postdoctoral fellow in Subramanian’s laboratory, the duo set out to investigate how CRC becomes resistant to available immunotherapies. What they found was recently published in Gastroenterology, including:
CRC cells secrete exosomes that carry immunosuppressive microRNAs (miR-424) that prevent T cell and dendritic cell function because they block key proteins (CD28 and CD80) on these immune cell types, respectively. In the absence of these proteins, the T cells, which would normally kill the cancer cells, become ineffective and are eliminated from tumors, allowing tumors to grow.
By blocking these immunosuppressive microRNAs in cancer cells, the team observed an enhanced anti-tumor immune response and discovered that cancer cell-secreted exosomes also contain tumor-specific antigens that can stimulate the tumor-specific T cell response.
The researchers tested tumor-secreted exosomes without immunosuppressive microRNAs, in combination with immune checkpoint inhibitors, as a novel combination therapy in preclinical models with advanced-stage colorectal cancer, which proved effective.
“Our studies indicate that disrupting specific immunosuppressive factors in tumor cells helps unleash the immune system to effectively control tumor growth and metastasis in preclinical models with late-stage CRC,“ said Subramanian, who is also a member of the Masonic Cancer Center. “Eliminating the immune suppressive effects of those exosomes is now the focus of a new treatment option for patients with this deadly disease.”
7. First line Pembrolizumab Monotherapy Improves HRQOL Versus Chemotherapy for mCRC (May.03/21)
Patients with previously untreated microsatellite instability–high (MSI-H) or mismatch repair–deficient (MMR-d) metastatic colorectal cancer (mCRC) saw clinically significant improvements in their health-related quality of life (HRQOL) when receiving pembrolizumab (Keytruda) monotherapy compared with chemotherapy, according to a study published in Lancet Oncology. These results from the open-label, randomized, phase 3 KEYNOTE-177 trial (NCT02563002), when combined with previously reported positive clinical data, support the use of pembrolizumab as a first-line therapeutic option for this cohort of patients with mCRC.
The research enrolled 307 patients and randomly assigned them to either pembrolizumab (n = 153) or investigators choice of chemotherapy (n = 154), which included leucovorin, fluorouracil, and either irinotecan or oxaliplatin, with or without bevacizumab (Avastin) or cetuximab (Erbitux). Of this population, 294 patients were included in the HRQOL analysis, with the median time from randomization to data cutoff recorded at 32.4 months as of February 19, 2020.
Results displayed a clinically meaningful improvement in the scores with the EORTC QLQ-C30 global health status/quality of life (GHS/QOL) for patients in the pembrolizumab arm compared with patients in the chemotherapy arm. For GHS/QOL, the median time to deterioration was increased for patients in the pembrolizumab arm versus those in the chemotherapy arm. The same was also true for physical functioning, social functioning, and fatigue scores for patients in the pembrolizumab arm.
“The observed improvements in health-related quality of life with pembrolizumab over chemotherapy (with or without bevacizumab or cetuximab) complement the efficacy and safety results of KEYNOTE-177, which showed superior progression-free survival and fewer treatment-related adverse events with pembrolizumab compared with standard-of-care chemotherapy,” wrote the investigators.
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.
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:
11. Trends in the Incidence of Young-Onset CRC with a Focus on Years Approaching Screening Age (Apr.10/21)
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.
12. CRC Deaths Rising Among Young People (Apr.27/21)
It is estimated one out of every 20 people will develop colorectal cancer (CRC) in their lifetime. If that number isn’t startling enough, a new study finds this may become the number one cancer-related death for younger people. The problem? The disease often goes undiagnosed until it’s too late.
Danielle Ripley-Burgess hid her symptoms for a long time. “I was probably in eighth grade when I started seeing blood in the stool, and it got worse and worse.” She finally spoke up at 17, and despite her age, her doctor didn’t rule out colorectal cancer. “I showed up, 17 years old, with rectal bleeding, and my GI didn’t hesitate to say, ‘Well, she needs a colonoscopy ASAP,’” she said. “I look back and think his decision helped save my life.” Most young colorectal patients aren’t so fortunate – and the delay can be deadly.
New research finds youth is no longer something doctors should overlook when it comes to CRC.“It’s often misdiagnosed for so long, a lot of early age onset patients are diagnosed at a later stage when the disease is much more difficult to treat,” said Molly McDonnell, Fight Colorectal Cancer’s director of advocacy. A study in the Journal of the American Medical Association predicts it will be the leading cause of cancer-related deaths for people ages 20 to 49 in less than a decade. McDonnel said research regarding why this is happening and how to stop it needs funding now.
13. Patients at Average Risk of CRC May Prefer Stool-Based Screenings (Apr.30/21)
Most individuals with an average risk of colorectal cancer (CRC) said they would prefer a stool-based screening test for CRC over colonoscopy, the method most often recommended by health care providers, according to a study published in Cancer Prevention Research. The 3 most common tests are an annual fecal immunochemical test or fecal occult blood test (FIT/FOBT), which detects blood in the stool, the multitarget stool DNA (mt-sDNA) test, which is completed every 3 years and detects altered DNA from cancer cells, precancerous polyps, or blood in the stool, and a colonoscopy every 10 years. Researchers evaluated patient preferences through a survey, which included short descriptions of FIT/FOBT, mt-sDNA, and colonoscopy, and asked a nationally representative sample of adults 40 to 75 years of age to choose between 2 options presented at a time.
The survey results showed that 66% of respondents preferred mt-sDNA over colonoscopy and 61% said they preferred FIT/FOBT over colonoscopy. When presented with a choice between the 2 stool-based options, 67% indicated a preference for mt-sDNA over FIT/FOBT. Examining demographic differences, the researchers found that although mt-sDNA was preferred over colonoscopy for all age groups examined, a larger proportion of older adults (ages 65 to 75 years) said they preferred colonoscopy compared to those in younger age groups (ages 45 to 54 years). Additionally, half of Hispanic and non-Hispanic Black respondents preferred stool-based tests over colonoscopy, with a preference for mt-sDNA over FIT/FOBT. Respondents without insurance were 2.5 times more likely to prefer less expensive stool-based tests over colonoscopy.
The overall awareness of stool-based tests was about 60%, compared to 90% for colonoscopy. According to the researchers, this indicates that there is an opportunity to improve patient education about stool-based options. Participants who were aware of stool-based tests were twice as likely to prefer mt-sDNA over FIT/FOBT, and those who had previously had a stool-based test were 2.8 times more likely to choose FIT/FOBT over colonoscopy. In contrast, respondents who had previously had a colonoscopy were less than half as likely to prefer a stool-based test over colonoscopy and those who had a provider recommend colonoscopy in the past 12 months were 40% less likely to prefer mt-sDNA over colonoscopy.
14. CRC Screening: One of The Best Weapons in Your Health Toolbox (Apr.30/21)
Regular colorectal cancer (CRC) screening through colonoscopy is one of the most powerful tools against CRC. A colonoscopy is the examination of the large bowel and part of the small bowel. Utilizing a small camera on a flexible tube, doctors screen for polyps or bowel cancer and help diagnose symptoms such as unexplained diarrhea, abdominal pain or blood in the stool.
This screening can help find cancer or pre-cancer (polyps) in those who have no signs or symptoms. Given that polyps can take 10 years or more to develop into cancer, regular screenings can help prevent the disease. If you are 45 years or older and at average risk of colon cancer (no colon cancer risk factors other than age), your doctor may recommend a colonoscopy every 10 years or sometimes sooner.
“Prevention through CRC screening is the best thing we can do, since some people who have CRC have no signs or symptoms,” says Christina Wu, gastroenterologist and medical oncologist at Winship Cancer Institute. “If you are over 45 years old or have a family member who has had CRC, reach out to your primary care physician to see if a screening is right for you.”
- Intestinal Polyps in Close Relatives can Increase Risk of CRC (May.04/21)
In the largest registry study to date, researchers at Karolinska Institutet in Sweden and Harvard University in the USA demonstrate the relationship between colorectal cancer (CRC), and having a first-degree relative (i.e. parents and siblings) with a colorectal polyp. The study, which is published in the British Medical Journal, is of potential consequence for different countries’ screening procedures.
They found that approximately 8.4% of the participants with CRC had a sibling or parent with colorectal polyps, as opposed to 5.7% of the control group. The results show that heredity for colorectal polyps had a 40% increased risk of CRC. The researchers found what appear to be several hereditary risk relationships. “The risk was double in people with at least two first-degree relatives with polyps or a first-degree relative who had a colorectal polyp diagnosed before the age of 60.” says the study’s first author Mingyang Song, researcher at Harvard University.
“If additional studies reveal a link between a family history of polyps and the risk of CRC, it is something to take into account in the screening recommendations, especially for younger adults,” says Jonas F. Ludvigsson, paediatrician at Orebro University Hospital and professor at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet.
16. Study Finds Disparities in CRC Screenings (May.03/21)
Patients with one or more health conditions are more likely to be screened for colorectal cancer (CRC) than those without comorbidities, according to new research in the Journal of Osteopathic Medicine. However, patients with five or more health conditions are also less likely to be screened than patients with two to four health conditions. The study found patients with diabetes, hypertension, skin cancer, chronic obstructive pulmonary disease (COPD), arthritis, depression, and chronic kidney disease were significantly more likely to be screened than those without these health conditions. It also found that an increase in screening adherence of roughly 40% corresponded with a 52% reduction in cancer mortality.
“It may be that the treating physician or a patient suffering from five or more additional disease states is fatigued by more pressing treatment needs and therefore not prioritizing important screenings,” said Dr. Greiner. “I also worry about the person who has no other health conditions and is either not seeing their doctor on a regular basis or, because of their otherwise clean bill of health, not following the screening recommendation.” According to the American Cancer Society (ACS), the lifetime risk of developing colorectal cancer is about 1 in 23 (4.3%) for men and 1 in 25 (4.0%) for women. The ACS guidelines recommend that all patients aged 45 or older be screened.
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
- 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.
18. Registration is Now Open For CCRAN’s Early Age Onset CRC Virtual Symposium (Apr.27/21)
The incidence of colorectal cancer has been declining in Canadians over 50 years of age, largely due to population-based screening programs. Rates, however, are on the rise in adults younger than 50 years. There is considerable evidence that “the increased incidence of colorectal cancer among younger adults in Canada is not only continuing but possibly accelerating.” In response to the findings and the growing number of young patients seeking support, education, and advocacy for advanced colorectal cancer, CCRAN is hosting its first of three complimentary symposia to be held virtually on June 17, 2021. Over the course of these three symposia, CCRAN will educate on, strategize, and implement a response to the rise in early age onset colorectal cancer (EAOCRC). We encourage all stakeholders, including patients and caregivers, to participate in our symposium on June 17, 2121. Please see graphic appearing below for registration details.
19. Natera to Present New CRC and Multiple Myeloma Data at the 2021 Annual ASCO Meeting (May.03/21)
Natera, Inc. (NASDAQ: NTRA), a pioneer and global leader in cell-free DNA testing, announced it will present 4 posters at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting, taking place June 4-8, 2021. These presentations will highlight the unique applications of the Signatera molecular residual disease (MRD) test in colorectal cancer (CRC) and multiple myeloma.
This comes on top of two new studies that were recently presented at the American Association for Cancer Research (AACR) annual meeting. One study reported superior performance by Signatera compared to standard of care CA-125, in detection of cancer recurrence with 100% sensitivity and specificity on average 10 months ahead of radiological findings, among 25 patients with early-stage ovarian cancer who were tested serially after surgical resection. The other study at AACR reported a stronger clinical benefit when using Natera’s method for quantifying ctDNA levels using an absolute measure of mean tumor molecules per milliliter of plasma (MTM/mL); instead of the more common variant allele frequency (VAF) used by other ctDNA tests, which can be confounded by significant changes in the background cell-free DNA caused by biological factors unrelated to the cancer.
Signatera is a custom-built circulating tumor DNA (ctDNA) test for treatment monitoring and molecular residual disease (MRD) assessment in patients previously diagnosed with cancer. The test is available for both clinical and research use, and has been granted three Breakthrough Device Designations by the FDA for multiple cancer types and indications. The Signatera test is personalized and tumor-informed, providing each individual with a customized blood test tailored to fit the unique signature of clonal mutations found in that individual’s tumor. This maximizes accuracy for detecting the presence or absence of residual disease in a blood sample, even at levels down to a single tumor molecule in a tube of blood. Signatera is intended to detect and quantify how much cancer is left in the body, to detect recurrence earlier and to help optimize treatment decisions.
The ASCO abstract titles are as follows:
- Abstract # 3540: Serial circulating tumor DNA analysis for assessment of recurrence risk, benefit of adjuvant therapy, growth rate and early relapse detection in patients with stage III CRC
- Abstract # 8029: Personalized, ctDNA analysis to detect minimal residual disease and identify patients at high risk of relapse with multiple myeloma
- Abstract # 3608: Minimal Residual Disease by Circulating Tumor DNA Analysis for CRC Patients Receiving Radical Surgery: An Initial Report form CIRCULATE-Japan
- Abstract # 4103: Tumor-informed assessment of circulating tumor DNA and its incorporation into practice for patients with hepatobiliary cancers
20. CRC: Simple Lifestyle Modifications to Keep you Safe (Apr.30/21)
Most diseases stem from — and get aggravated by — poor lifestyle choices. Ever since the pandemic began, people have tried to give more attention to their overall health, so as to stay disease-free. Many people around the country continue to seek treatment for cancer, and among them, colorectal cancer (CRC) is one which needs urgent attention. Dr Rahulkumar Chavan, consultant surgical oncologist, Hiranandani Hospital Vashi — A Fortis Network Hospital — says that CRC is a disease which can be attributed to the “negative impact of changing lifestyle and food habits”. “It is often called a ‘western lifestyle disease’. Consumption of tobacco, alcohol, a diet high in processed meat and low in fibre, obesity, and low physical activity are common causes of colon cancers,” he says.
Lifestyle modification for prevention:
- Avoid smoking and alcohol consumption which are carcinogenic.
- Studies suggest avoiding high-calorie foods, red and processed meat also reduce the risk of CRC.
- Perform regular exercise with moderate intensity (for at least 30 minutes).
- Maintain healthy body weight to minimize the chances of CRC.
- Eat a diet rich in vegetables, fruits and whole grains which are high in fibre. High-fibre diet not only reduces the risk of CRC, but also of heart diseases.
- Early-Onset CRC — Are Sugary Drinks to Blame? (May.07/21)
High consumption of sugar-sweetened beverages (SSB) in adolescence and young adulthood could partially explain the recent rapid rise in early-onset colorectal cancer (EO-CRC) — at least in women, according to the authors of a new analysis.
This analysis prospectively investigated the association of SSB intake among 95,464 female registered nurses who were aged between 25 and 42 years at enrollment and followed them for the development of EO-CRC, defined as onset before the age of 50 years. The nurses filled out food frequency questionnaires every 4 years, which asked about SSBs, defined as soft drinks, fruit drinks, sports drinks, and sweetened tea beverages. Information on potential CRC risk factors was also collected, including family history of bowel cancer, lifestyle, regular use of aspirin or non-steroidal anti-inflammatory drugs and vitamin supplements, and colonoscopy/sigmoidoscopy.
Over a maximum follow-up of 24 years (average, about 14 years), the study documented 109 cases of incident EO-CRC, and suggested a 2.2-fold higher risk among women who reported drinking two or more SSB per day, compared to those who reported drinking less than one 12-ounce SSB per week. Each additional serving of SSB was associated with further risk: 16% in young adults and 32% in adolescents. The researchers also investigated the impact of substituting SSBs with artificially sweetened beverages (ASBs), as well as coffee, reduced fat milk, or total milk and found a 17% – 36% lower risk of EO-CRC. The findings “reinforce the public health importance of limiting SSB intake for better health outcomes,” noted senior author Yin Cao, MD, from Washington University School of Medicine in St. Louis, Missouri.
However, experts reacting to this study on the UK Science Media Centre were less convinced by the research. “Overall, these findings should be considered as preliminary and exploratory until larger studies are done in other populations,” said Carmen Piernas, MSC, PhD, university research lecturer and nutrition scientist at Nuffield Department of Primary Care Health Sciences, University of Oxford, England.
Image Source: https://www.eatthis.com/sugary-drinks/
- Diet and CRC Risk: Yes to Dairy, No to Alcohol (May.02/21)
Several foods are associated with the risk of colorectal cancer (CRC), with alcohol bearing a risk increase while dairy products and calcium showing a protective effect, among others, according to a study.
The researchers assessed 92 food and nutrient intakes in 386,792 participants, among whom 5,069 developed CRC. They found that consuming high amounts of alcohol, liquor/spirits, wine, beer/cider, soft drinks, and pork was associated with an increased risk of CRC. Conversely, increased intake of milk, cheese, calcium, phosphorus, magnesium, potassium, riboflavin, vitamin B6, beta-carotene, fruit, fibre, nonwhite bread, banana, and total protein had a protective benefit.
24. Look for These Symptoms in the Months After COVID-19 Recovery (Apr.28/21)
Through analysis of the U.S. Department of Veterans Affairs database, Dr. Ziyad Al-Aly, an assistant professor in the school of medicine at Washington University in Saint Louis, examined the health outcomes of individuals 6 months after having COVID-19. They found that those who had the virus had a higher risk of several conditions, including heart disease, diabetes, and kidney complications, long into the future. Globally there have been more than 149 million cases of COVID-19, and research suggests that approximately 10% (14.9 million people) will be considered “long-haulers,” those who experience symptoms more than 4 weeks after the onset of COVID-19.
While the exact cause and link between COVID-19 and long-term complications isn’t currently known, some experts suggest it could be a result of inflammation from the virus, or possibly a revelation of an underlying condition. “There are several ways to interpret these findings,” said Dr. Michael Goyfman, director of clinical cardiology at Long Island Jewish Forest Hills in Queens, New York. “One is that COVID-19 directly resulted in these various health consequences due to either the inflammation caused by the virus, the body’s response to the infection via the immune system, etc.,” Goyfman explained. “Another view is that these patients were somewhat sicker to begin with, so people who had a worse outcome with COVID were those who already had these conditions, and perhaps their hospitalization with COVID was merely the first sign of their underlying issues,” Goyfman said.
Symptoms to look for:
25. Moderna Announces Positive Initial Booster Data Against SARS-CoV-2 Variants of Concern (May.05/21)
Moderna, Inc., a biotechnology company pioneering messenger RNA (mRNA) therapeutics and vaccines, announced initial data from its Phase 2 study showing that a single 50 μg dose of mRNA-1273 or mRNA-1273.351 given as a booster to previously vaccinated individuals increased neutralizing antibody titer responses against SARS-CoV-2 and two variants of concern, B.1.351 (first identified in South Africa) and P.1 (first identified in Brazil).
“As we seek to defeat the ongoing pandemic, we remain committed to being proactive as the virus evolves. We are encouraged by these new data, which reinforce our confidence that our booster strategy should be protective against these newly detected variants. The strong and rapid boost in titers to levels above primary vaccination also clearly demonstrates the ability of mRNA-1273 to induce immune memory,” said Stéphane Bancel, Chief Executive Officer of Moderna. “Our mRNA platform allows for rapid design of vaccine candidates that incorporate key virus mutations, potentially allowing for faster development of future alternative variant-matched vaccines should they be needed. We look forward to sharing data on our multivalent booster candidate, mRNA-1273.211, which combines mRNA-1273 and mRNA-1273.351 in a single vaccine, when available. We will continue to make as many updates to our COVID-19 vaccine as necessary to control the pandemic.”
26. 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