A PATIENT-FOCUSED ORGANIZATION
COLORECTAL CANCER TREATMENT & CLINICAL RESEARCH UPDATES
Month Ending July 15th, 2021
The following colorectal cancer treatment and research updates extend from June 26th, 2021 to July 15th, 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. The COC Protocol in CRC
6. Treatment of HER2+ CRC with Precision Cancer Medicines
7. Aspirin and Ibuprofen Use May Help Prevent CRC and Advanced Colorectal Adenoma Incidence
8. EC green Light for Opdivo Plus Yervoy in mCRC
9. Can KRAS Positive Colorectal and Lung Cancer Finally be Targeted?
10. Hepatic Artery Infusion Pump (HAIP) Chemotherapy Program – Sunnybrook Hospital
11. Living Donor Liver Transplantation for Unresectable Colorectal Cancer Liver Metastases
12. Preoperative ctDNA Levels Are Detectable in the Majority of Patients with Resectable CRC
13. Study Offered at the Odette Cancer Centre to Treat Recurrent Rectal Cancer
14. Trends in the Incidence of Young-Onset CRC with a Focus on Years Approaching Screening Age
15. Cancer-detecting blood test accurate enough to be used as early screening tool: study
16. CRC Patients Diagnosed Before 50 Have Better Survival Odds
17. Olympus Supports New Recommendation to Begin CRC Screenings at Age 45
18. Young Adult CRC Clinic Available at Sunnybrook Hospital
19. Association of Cumulative Social Risk and Social Support with Receipt of Chemotherapy Among Patients with Advanced CRC
20. Are Antibiotics Linked to Early-Onset CRC?
21. Many Early Onset Colon Cancers are Caused by Genetic Mutations Through Families
22. CRC Survivors Ask: What Can I Do Now?
23. ’Mounting’ Data Link Red Meat Consumption to CRC Risk, Mortality
24. CRC Risk May Be Increased by Low Exposure to UVB Light
25. What to Know About the Coronavirus Lambda Variant
26. Pfizer to Ask Regulators to Authorize Covid-19 Vaccine Booster
27. Even with New Variants, Experts Say We May Not Need COVID-19 Booster Shots
28. COVID-19 Treatments: What’s In, What’s Out
29. 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.
2. TRK Fusion Cancer And How to Test For It (Feb.16/21)
3. 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.
4. 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.
5. The COC Protocol in CRC
The COC Protocol is a combination of four commonly prescribed medications (atorvastatin, metformin, mebendazole, and doxycycline) with the potential to target colorectal cancer (CRC) and help improve the effectiveness of standard anticancer therapies.
A number of observational studies in patients taking metformin or statins to treat diabetes or cardiovascular conditions have linked the use of these medications to improved outcomes in CRC. The strongest clinical evidence so far comes from a series of trials investigating the potential of metformin in patients who have either very early CRC, or a very high risk of developing CRC. In the first small pilot trial, just one month of low-dose metformin significantly reduced the number of potentially pre-cancerous cellular changes (called ‘aberrant crypt foci’) in patients, while patients who had no metformin treatment showed no change. A subsequent larger and better controlled Phase 3 trial in patients at high-risk of developing CRC who had recently had surgery to remove colorectal polyps found that metformin reduced the chance of polyps reoccurring within the year. Just 38.0% of patients who took metformin had polyps after 1 year, compared to 56.5% of patients who took placebo.
Numerous larger studies investigating the benefits of taking metformin alongside, or immediately following standard cancer treatments are now underway. More clinical trials are needed to investigate the individual and combined use of these medications in cancer.
6. Treatment of HER2+ CRC with Precision Cancer Medicines (Jun.29/21)
Precision cancer medicines that target the HER2 receptor in breast, colon and other cancers represent an effective treatment option for individuals with HER2-positive (HER2+) disease. Researchers are evaluating various drug combinations that target the HER2 receptor in colorectal cancers (CRCs) because HER2 directed therapy is effective and can avoid the complications of chemotherapy.
Herceptin (trastuzumab) and Tykerb (lapatinib) are two precision cancer medicines that bind along the HER pathway at different points, both producing anti-cancer effects in HER2+ breast cancer. When evaluated in advanced HER2+ wild type KRAS patients with advanced colon cancer the combination is also active and well tolerated in treatment-refractory patients with HER2+ disease.
Tukysa (tucatinib) is a tyrosine kinase inhibitor drug that is highly selective for HER2 without significant inhibition of EGFR (epidermal growth factor receptor). EGFR inhibition is associated with significant side effects including skin rash and diarrhea. The MOUNTAINEER clinical trial evaluated the effectiveness of combination HER2 therapy with Herceptin combined with Tukysa in HER2+ advanced CRC in 26 patients with HER2+ RAS wild-type metastatic CRC (mCRC) after treatment with first- and second-line standard-of-care therapies. The combined regimen demonstrated encouraging activity and was well tolerated. Overall, 52% of patients responded to treatment with a median duration of response of 10.4 months and an average overall survival of 18.7 months.
The combination of Herceptin-Perjeta also has demonstrated promising activity in patients with metastatic CRC with RAS wild-type and HER2 amplification in the TRIUMPH clinical trial. Overall ~35% of 19 patients with RAS wild-type and HER2-amplified metastatic CRC that were refractory to standard chemotherapy responded to treatment.
7. Aspirin and Ibuprofen Use May Help Prevent CRC and Advanced Colorectal Adenoma Incidence (Jul.02/21)
As colorectal cancer (CRC) continues to be the second highest cause of cancer-related deaths in the U.S., researchers have had a growing interest in prevention strategies. One potential preventative strategy may be the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and ibuprofen, which were associated with reduced risk of advanced recurrent adenoma (a benign tumor that could progress to cancer) and CRC. “Chronic inflammation has been implicated in the process of colorectal tumorigenesis, and NSAIDs have been identified in preclinical and clinical studies to have a protective effect against colorectal tumors,” the study authors wrote.
Although prior studies have shown reduction in colorectal cancer risk with aspirin use, few evaluated non-aspirin NSAIDs such as ibuprofen and most have grouped all NSAIDs together, the authors noted. The long-term benefit has also been unclear. Researchers of this study saw a decrease in the overall risk of CRC incidence with increased use of aspirin, ibuprofen and combined use of both. There was a significant inverse association between both aspirin use alone and combined use of aspirin and ibuprofen with cancers in the proximal and distal colon. Ibuprofen use alone was associated with a decreased risk of cancer in the proximal colon but not the distal colon. To conclude, authors noted that further research is necessary to balance the potential for medication-related side effects and life expectancy when assessing the use of NSAIDs for chemoprevention recommendations.
8. EC green Light For Opdivo Plus Yervoy in mCRC (Jun.30/21)
The European Commission (EC) has cleared Opdivo (nivolumab) plus Yervoy (ipilimumab) for the treatment of adult patients with mismatch repair deficient (MMR-D) or microsatellite instability-high (MSI-high) metastatic colorectal cancer (mCRC), after prior fluoropyrimidine-based combination chemotherapy.
The approval is based on the positive results from BMS’ Phase II CheckMate-142 trial, which demonstrated a clinically meaningful improvement in objective response rate (ORR) for MSI-high/MMR-D mCRC patients who had received prior treatment with fluoropyridine, oxaliplatin and irinotecan. Specifically, 64.7% of patients responded to treatment with Opdivo plus Yervoy, with 12.6% achieving a complete response.
“With this approval, patients in the EU with MMR-D or MSI-high mCRC will now have the first dual immunotherapy treatment available to them, and we look forward to working with stakeholders to advance this rational combination,” said Ian Waxman, development lead, gastrointestinal cancers, BMS.
9. Can KRAS Positive Colorectal and Lung Cancer Finally be Targeted? (Mar.26/21)
The investigational KRAS G12C inhibitor drug Adagrasib (MRTX849) yielded clinical responses in patients with non-small cell lung cancer (NSCLC) and colorectal cancer (CRC), and other solid tumors harboring KRAS G12C mutations, according to the results from the phase I – II Krystal clinical trials.
Adagrasib is an investigational, orally available small molecule that is designed to potently and selectively inhibit a form of KRAS which harbors a substitution mutation (G12C). Adagrasib works by irreversibly and selectively binding to KRAS G12C in its inactive state, blocking its signaling to other cells and preventing cancer cell growth and proliferation; this leads to cancer cell death.
The phase 1/2 KRYSTAL-1 clinical trial evaluated adagrasib in 18 CRC patients. Three (17%) had a confirmed objective response and two of them continue to receive treatment. Disease control was seen in 17 of the patients (94%) and 12 of these patients continue to be treated. Side effects included nausea (54%), diarrhea (51%), vomiting (35%), fatigue (32%) and increased levels of an enzyme that indicates minor liver irritation (20%). The only serious adverse side effect to occur in more than one patient was low sodium in the blood.
10. Hepatic Artery Infusion Pump (HAIP) Chemotherapy Program — Sunnybrook Odette Cancer Centre (April 15/21)
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.
11. Living Donor Liver Transplantation for Unresectable Colorectal Cancer Liver Metastases (April 1/21)
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.”
12. Preoperative ctDNA Levels Are Detectable in the Majority of Patients with Resectable CRC (July.05/21)
A team of investigators in Japan used a personalised assay for circulating tumour DNA (ctDNA) levels in plasma to monitor minimal residual disease following surgery in patients with resectable colorectal cancer (CRC). Their subgroup analysis found statistically significant associations between ctDNA levels and the pathological disease stage.
As of 28 February 2021, the GALAXY study enrolled 1,236 patients with 808 patients being included in this analysis. Preoperative baseline ctDNA was detected in 799 patients. ctDNA was available in 797 patients 4 weeks after operation, in 531 patients 12 weeks after operation, and in 263 patients 24 weeks after operation. Stage I-III CRC had 654 patients and 154 patients had stage IV cancer. Among 65, 280, and 301 patients with pathological stages I, II, and III, preoperative ctDNA was detected in 50 (77%), 267 (95%), and 288 (96%) patients, respectively.
Longitudinal ctDNA positivity at postoperative week 4, 12 and 24 was significantly associated with inferior disease-free survival (DFS). Sensitivity of relapse detection was 93.1%. Six-months DFS rate in ctDNA negative patients in overall and pathologic stage I-III were ≥99%, showing unprecedented, good prognosis. Researchers concluded that further investigation whether ctDNA status could become new surrogate endpoint beyond DFS is warranted.
Circulating tumor DNA (ctDNA) are circulating tumor cells that are shed by tumors into the blood. Finding ctDNA in the blood means that there is very likely some small amounts of cancer remaining after surgery. However, this cancer, if detected, cannot be found on other tests usually used to find cancer, such as CT Scans, as it may be too small to measure. Testing for ctDNA levels may help identify patients with colon cancer after surgery.
ctDNA may help guide precision medicine in patients with cancer in the following settings:
- Detection of minimal residual disease (‘MRD’) following colorectal 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.
RADIATION THERAPIES/INTERVENTIONAL RADIOLOGY
13. 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:
14. 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.
15. Cancer-detecting blood test accurate enough to be used as early screening tool: cfDNA study (Jun.25/21)
Results from a study of a blood test that can detect more than 50 types of cancer suggest that it is accurate enough to be used as a screening tool among people at higher risk of the disease, including those who are not symptomatic.
The test accurately detected cancer, often before any symptoms were present, and delivered a very low false-positive rate. It also successfully predicted where in the body the cancer is located with a high degree of accuracy (88.7% of cases) – a development researchers say can help doctors narrow down diagnostic testing and confirm a diagnosis sooner. The test, developed by U.S.-based company Grail, detects chemical changes in fragments of genetic code – known as cell-free DNA (cfDNA) – that leak from tumours and other cells into the bloodstream. The company promises results will be made available within 10 business days from the time the sample reaches the lab.
Speed aside, the latest study of the test suggests an impressively high level of accuracy, correctly identifying the presence of cancer in 51.5% of cases across all stages of the disease. During the study, scientists analyzed 2,823 people with the disease and 1,254 people without. The test wrongly detected cancer in only 0.5% of cases. In solid tumours that do not have any screening options, like those associated with oesophageal, liver and pancreatic cancers, the ability to generate a positive test result was twice as high (65.6%) as cancers with solid tumours that do have screening options, such as breast, bowel, cervical or prostate cancers. The test’s ability to detect cancer in the blood such as lymphoma and myeloma, however, was 55.1%.
This isn’t the first cancer-detecting blood test to perform well in studies. However, in a study published in July 2020, the authors studying the test cautioned that large-scale studies across long time periods are needed to confirm the potential of the test for early cancer detection.
16. CRC Patients Diagnosed Before 50 Have Better Survival Odds (Jun.23/21)
New research has found that younger patients who are diagnosed with colorectal cancer (CRC) have high rates of survival if they’re diagnosed with the disease early. The study analyzed data from 769,871 people diagnosed with colorectal cancer. The results showed that the people diagnosed with CRC when they were younger than 50 had a “survival advantage” over the people who were diagnosed between the ages of 51 and 55. Additionally, people who were diagnosed at ages 35 through 39, and with stages I and II, had the best outcomes.
The authors concluded that the study’s findings clearly showed the potentially life-saving benefit of early screening for CRC. The study’s findings are timely, coming just a month after the United States Preventive Services Task Force (USPSTF) lowered the recommended age to start colorectal cancer screenings from 50 to 45. “What this study suggests is that, if you present at a younger age, if it’s detected at an early stage, your survival is actually better,” says Anton Bilchik, MD, PhD, adding that this finding “reinforces the need to screen at a younger age.”
17. Olympus Supports New Recommendation to Begin CRC Screenings at Age 45 (Jul.01/21)
Olympus announced its support of the new recommendation issued by the United States Preventive Services Task Force (USPSTF) to begin colorectal cancer (CRC) screenings for all individuals beginning at age 45. Lowering the recommended screening age will allow more people to be screened, especially those among whom CRC rates are increasing most quickly. The Multi-Society Taskforce, which includes the American College of Gastroenterology (ACG), the American Gastroenterological Association (AGA), and the American Society for Gastrointestinal Endoscopy (ASGE), is in full support of this new recommendation.
When screening is done via colonoscopy, colorectal cancer prevention is possible through the detection and removal of precancerous and cancerous polyps. “Now more than ever it is important to not only support but advocate for people to be screened for CRC starting at the age of 45,” said Ross D. Segan, MD, MBA, FACS, Chief Medical Officer for Olympus Corporation. Since the start of the COVID-19 pandemic in 2020, screening rates for colorectal cancer have declined by 84.5%.
18. Young Adult CRC Clinic Available at Sunnybrook (Apr.12/21)
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.
19. Association of Cumulative Social Risk and Social Support with Receipt of Chemotherapy Among Patients with Advanced CRC (Jun.09/21)
Researchers conducted a cross-sectional, population-based survey study to determine whether cumulative social risk (ie, multiple co-occurring sociodemographic risk factors) is associated with lower receipt of chemotherapy among patients with advanced colorectal cancer (CRC) and whether social support would moderate this association.
Results showed participants with 3 or more risk factors were less likely to receive chemotherapy than participants with 0 risk factors. Participants with 2 or more support sources had higher odds of undergoing chemotherapy than those without social support. Within each social support level, participants were less likely to receive chemotherapy as cumulative social risk increased.
Thus, the study found that cumulative social risk was associated with reduced receipt of chemotherapy. These associations were mitigated by social support. Assessing cumulative social risk may identify patients with CRC who are at higher risk for omitting chemotherapy who can be targeted for support programs to address social disadvantage and increase social support.
20. Are Antibiotics Linked to Early-Onset CRC? (Jul.03/21)
The use of antibiotics may lead to an increased risk of colon cancer at all ages, an analysis of a large Scottish primary care database suggested. During a presentation at the virtual World Congress on Gastrointestinal Cancer, Sarah Perrott, of the University of Aberdeen in Scotland, pointed out that the incidence of early-onset colorectal cancer (CRC) has been increasing globally, while at the same time there has been an increase in antibiotic consumption.
Researchers identified 7,903 CRC cases (5,281 colon cancers and 2,622 rectal cancers) diagnosed from 1999 to 2011 and matched them with 30,418 controls. Of the patients with CRC, 445 were under the age of 50, and 45% were prescribed antibiotics during the exposure period. Perrott and colleagues also found that antibiotic use was associated with an increased risk of proximal colon cancer in patients under 50, but not among those in the older age group. “No association was observed with rectal cancer,” Perrott pointed out, “which we find interesting, in that rectal cancer is a common cancer site in early-onset CRC compared to later onset.” Most classes of antibiotics were not significantly associated with colon, rectal, or distal colon cancers, the authors reported. However, quinolones and sulfonamides/trimethoprim were associated with proximal colon cancer in the early-onset group.
“More epidemiological and translational studies are required to evaluate the true role of antibiotics in the development of colorectal cancer and also to evaluate the long-term effects of antibiotics on gut health,” Perrott said.
21. Many Early Onset Colon Cancers are Caused by Genetic Mutations Through Families (Apr.15/21)
One in every six colorectal cancer (CRC) patients (16 percent) diagnosed under age 50 has at least one inherited genetic mutation that increases his or her cancer risk and many of these mutations could go undetected with the current screening approach, according to initial data from a statewide CRC screening study conducted at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James).
In this new analysis, the OSUCCC – James team offers the first detailed report of the prevalence and spectrum of specific mutations in 25 genes associated with inherited (passed down through families) cancer syndromes in an unselected series of CRC patients.
For this study, researchers recruited 450 patients who had undergone surgery for newly diagnosed, invasive colorectal cancer on or after Jan. 1, 2013. Blood and tumor samples were collected from each patient and tumor pathology characteristics were verified prior to testing. All tumors were screened for microsatellite instability and/or abnormal immunohistochemistry, characteristics that are found in cancers from individuals with Lynch syndrome. All colorectal cancer patients diagnosed under age 50 underwent genetic testing for 25 cancer susceptibility genes [including the genes that cause Lynch syndrome (MLH1, MSH2, EPCAM, PMS2 and MSH6)] using a multi-gene panel.
Overall, 75 cancer susceptibility gene mutations were identified in 72 patients. Eight percent (36 patients) had Lynch syndrome only, 0.4 percent (2 patients) had Lynch syndrome plus another hereditary cancer syndrome, 7.6 percent (34 patients) had a different hereditary cancer syndrome (including a third patient with two syndromes).
Researchers of the study believe this data offers additional support for complete genetic testing for all early-onset colorectal patients. This could save lives by identifying at-risk families so that they can benefit from intensive cancer surveillance and prevention options.
22. CRC Survivors Ask: What Can I Do Now? (Apr.29/21)
Benefits of Exercise
Clinical trials have evaluated the benefit of exercise in cancer patients, and most have found an association with improved quality of life, reduced risk of cancer recurrence and prolonged survival. In a meta-analysis of 49,000 survivors of colorectal cancer (CRC) physical activity had a dose-related effect on survival. A reduction in mortality risk was observed with increasing exercise and physical activity. Similarly, a 16-year longitudinal study found that more physical activity before and after a diagnosis of CRC was associated with lower mortality, whereas more sedentary time was associated with a higher risk.
Nutrition and Weight Management
The National Surgical and Adjuvant Bowel Project evaluated the association between Body Mass Index (BMI) and outcomes in two clinical trials of adjuvant chemotherapy involving 4,288 individuals with colon cancer. When compared with normal-weight people (BMI, 18.5-24.9 kg/m2), very obese patients (BMI =35 kg/m2) had a 38% greater risk for colon cancer recurrence or development of a second primary cancer, a 36% increased risk for CRC-related mortality, and a 28% increased risk for death from any cause.
In addition to obesity, certain diets appear to contribute to poor survivorship following treatment for colon cancer. In a study involving 1,000 patients with stage II/III colon cancer patients in the highest quintile of a Western diet (red meat, fat, refined foods, desserts) versus lowest had double or triple the risk for CRC recurrence and CRC-related death. Patients whose diets reflected a high glycemic index also had worse disease-free survival, recurrence-free survival and overall survival.
23. ’Mounting’ Data Link Red Meat Consumption to CRC Risk, Mortality (Jun.28/21)
Researchers have identified a possible molecular link between high consumption of both processed and unprocessed red meat and increased colorectal cancer (CRC) risk and mortality. “We have known for quite a while now that environmental factors, including diet, can impact colorectal cancer incidence. What was missing were data demonstrating whether we could see an impact of these environmental carcinogens in cancer specimens of patients,” Marios Giannakis, MD, PhD, oncologist at Dana-Farber Cancer Institute and assistant professor of medicine at Harvard Medical School, said during an interview with Healio.
By examining sequencing data of 900 patients with CRC, Giannakis and colleagues identified a previously un-described pattern of mutations — a “mutational signature” — that exists in CRC. They attributed this signature to alkylating damage and next investigated for possible culprits. One of the known risk factors for CRC is red meat, and it is known to contain chemicals that potentially can cause alkylation. They essentially found that patients who were consuming the most red meat overall, including both processed and unprocessed red meat, had cancers with increased alkylating damage. Giannakis noted that one of the next steps is to further investigate the mechanism by which increased red meat consumption can causes these mutations and explore what other factors modify this risk.
24. CRC Risk May Be Increased by Low Exposure to UVB Light (Jul.05/21)
Researchers from the University of California San Diego, USA, discovered a strong association between low exposure to UVB light from the sun and higher rates of colorectal cancer (CRC) across all age groups and countries surveyed.
The authors suggest that lower UVB exposure may reduce levels of vitamin D. Vitamin D deficiency has previously been associated with an increased risk of CRC. Raphael Cuomo, Co-author of the study, said: “Differences in UVB light accounted for a large amount of the variation we saw in colorectal cancer rates, especially for people over age 45. Although this is still preliminary evidence, it may be that older individuals, in particular, may reduce their risk of colorectal cancer by correcting deficiencies in vitamin D.” The researchers recommend that future studies should look directly at the potential benefits on CRC of correcting vitamin D deficiencies. However, researchers warn that the observational nature of the study does not allow for conclusions about cause and effect and more work is needed to understand the relationship between UVB and vitamin D with CRC in more detail.
25. What to Know About the Coronavirus Lambda Variant (July.06/21)
The lambda variant was first identified in Peru in December 2020. In June, the World Health Organization (WHO) labeled lambda a “variant of interest” based on the presence of several concerning genetic changes. “Lambda carries a number of mutations with suspected phenotypic implications, such as a potential increased transmissibility or possible increased resistance to neutralizing antibodies,” the WHO wrote in its Weekly Epidemiological Update published on June 15. Lambda is now in 31 countries, according to data from GISAID, including the United States, United Kingdom, and Canada.
Variants of interest differ from “variants of concern” — like alpha, beta, delta, and gamma — which have strong evidence showing they’re more dangerous to people. Although lambda isn’t a variant of concern right now, this could change over time. Currently, we don’t know for sure whether lambda can evade the immune protection offered by COVID-19 vaccines, but scientists are trying to figure that out.
As with any coronavirus variant, though, you should be cautious of it. But right now, the delta variant is much more of a concern in the United States. With delta and other variants of concern, people who are fully vaccinated have a much lower risk of severe illness and death, even if they contract an infection. Vaccination offers high protection against the coronavirus, but it’s not the only line of defense. Wearing face masks in crowded places and practicing physical distancing when possible are also effective ways to protect yourself and others.
26. Pfizer to Ask Regulators to Authorize Covid-19 Vaccine Booster (Jul.08/21)
Pfizer Inc. will seek clearance from U.S. regulators in coming weeks to distribute a booster shot of its Covid-19 vaccine to heighten protection against infections, as new virus strains rise.
Pfizer and partner BioNTech SE said Thursday that they will seek authorization for the third shot, based on encouraging initial study data. The companies said the data showed that a booster shot given at least six months after the second dose produced antibodies protective against the original strain of the virus and a more recent strain, Beta. The companies also noted that the antibody levels were 5-10x higher than after two doses.
Pfizer also said it plans to start clinical trials in August of an updated version of its vaccine that would better protect against the Delta variant. However, the companies do not think they will need to replace the current version of their highly successful shot.
27. Even with New Variants, Experts Say We May Not Need COVID-19 Booster Shots (Jul.08/21)
As coronavirus variants emerge and spread, speculation is increasing about whether we’ll eventually need booster shots to maintain our protection against COVID-19. All viruses mutate. The coronavirus that causes COVID-19, SARS-CoV-2, has already gone through many mutations and will continue to evolve over time. But that doesn’t necessarily mean our vaccines will lose their power to protect us, or that we’ll need a booster shot.
Growing evidence suggests the shots will provide long lasting immunity, even against new variants. In addition to antibodies that act fast and attack the coronavirus spike protein, our bodies have the cell-mediated immune response, which includes T cells and memory B cells. “Vaccines induce much more than antibodies. T-cell immunity is a critical component of immunity that the press often ignores when reporting on vaccination studies,” Dr. Amesh Adalja, an infectious disease specialist and a senior scholar at the Johns Hopkins University Center for Health Security, told Healthline. T cells are crucial for long lasting immunity and protection against severe disease. All the major vaccine clinical trials looked at T-cell production and concluded that the shots produce a strong and durable T-cell response, according to Dr. Monica Gandhi, an infectious disease specialist with the University of California, San Francisco.
Scientists have yet to discover just how long protection from our T cells and memory B cells will last, but research on other viruses show they can, in certain cases, last for years. Scientists will continue observing people over time to understand how long protection against severe disease lasts.
28. COVID-19 Treatments: What’s In, What’s Out (Mar.17/21)
Below is a live list of currently authorized and/or validated therapies — noting the stage of disease for which they work best — as well as some others that didn’t pan out or are still under evaluation. To read more about each treatment method listed, follow the link below.
Treatments in Use:
- Remdesivir (Veklury)
- Tocilizumab (Actemra)
- Convalescent plasma
- Monoclonal Antibodies: bamlanivimab/etesevimab, casirivimab/imdevimab, and sotrovimab
- Budesonide (Pulmicort)
Failed or Debated Therapies:
- Vitamin C
- Vitamin D
- Protease Inhibitors
29. 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