A PATIENT-FOCUSED ORGANIZATION
COLORECTAL CANCER TREATMENT & CLINICAL RESEARCH UPDATES
Month Ending August 12th, 2021
The following colorectal cancer treatment and research updates extend from July 15th, 2021 to August 12th, 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. Dose Capping May Explain Reduced Survival in Patients with CRC and High BMI
6. Bayer is Committed to Working with Cancer Agencies and Drug Plans to Bring Innovative Tumour Agnostic Treatment to Canadian Patients
7. Long-Term Aspirin Use Before Diagnosis May Reduce Risk of Death From CRC
8. Integrative Medicine and Cancer Care
9. Roche to Study Syros’ CDK7 Inhibitor with Tecentriq in BRAF-Mutated CRC Patients
10. Hepatic Artery Infusion Pump (HAIP) Chemotherapy Program – Sunnybrook Hospital
11. Living Donor Liver Transplantation for Unresectable Colorectal Cancer Liver Metastases
12. In Vivo Lung Perfusion (IVLP) as an Adjuvant Treatment for Patients with Resectable Pulmonary Metastases of Colorectal Carcinomas
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. What is a FIT, and which ones are best to use?
16. What Is a Liquid Biopsy?
17. Clinical Trial Aims to Improve Outcomes for Patients with CRC After Surgery
18. Evidence for a CRC Screening Benefit After Age 75 Years
19. Young Adult CRC Clinic Available at Sunnybrook Hospital
20. Antibiotic Use Linked to Increased Risk of CRC
21. CRC Vaccine Successful in Mice
22. Ask the Experts About Circulating Tumor DNA in the Management of Cancer
23. KRAS Mutation Predicts Response to HAI Pump in Unresectable Colorectal Liver Metastases
24. Lower Vitamin D Levels May Increase CRC Risk
25. Multiple Lifestyle Exposures May Be the ‘Smoking Gun’ to Early Onset CRC
26. Risk of Early-Onset CRC Reduced by Higher Intake of Vitamin D
27. These Surprising Foods May Lower Your CRC Risk, New Study Says
28. No, Most COVID Infections Are Not Occurring in Vaccinated People
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. Dose Capping May Explain Reduced Survival in Patients With CRC and High BMI (Jul.16/21)
Capping doses of adjuvant chemotherapy may worsen survival outcomes in colorectal cancer (CRC) patients with a high body mass index (BMI), new research suggests.
Dr Slawinski, MBBS, of the University of Manchester in the United Kingdom, noted that adjuvant chemotherapy is often capped at a body surface area of 2.2m2, potentially reducing the average cumulative relative dose (ACRD) and average relative dose intensity (ARDI) in patients with high BMIs.
Dr Slawinski and colleagues evaluated data from 4 randomized trials including 7271 patients. Both ACRD and ARDI were determined as percentage values of actual versus expected dose, averaged across the number of drugs in the regimen. The results showed no significant relationship between ARDI and survival, including disease-free survival, overall survival, and cancer-specific survival. However, there was a significant relationship between ACRD and survival outcomes. Each 5% ACRD increment increase was linked with:
- A 5% reduction in mortality for disease-free survival
- A 7% reduction in mortality for overall survival
- A 6% reduction in mortality for cancer-specific survival
In addition, each 5 kg/m2 increment increase of BMI was associated with reductions in ACRD and ARDI.
These results suggest that dose capping might explain some of the poorer survival outcomes seen in CRC patients with obesity, but more research is needed, Dr Slawinski said.
Slawinski CGV, Malcomson L, Barriuso J, et al. Average cumulative relative dose of adjuvant chemotherapy is more important than average relative dose intensity for colorectal cancer survival, with implications for treating obese patients: The OCTOPUS consortium. Presented at: ESMO World Congress on Gastrointestinal Cancer; June 30-July 3, 2021. Abstract O-4.
6. Bayer is Committed to Working with Cancer Agencies and Drug Plans to Bring Innovative Tumour Agnostic Treatment to Canadian Patients (Jul.22/21)
Bayer Inc. (Bayer) received the draft, positive tumour-agnostic reimbursement recommendation for VITRAKVI® (larotrectinib) issued by the Canadian Agency for Drugs and Technologies in Health (CADTH), pan-Canadian Oncology Drug Review (pCODR) and Expert Review Committee (pERC) in May 2021. The draft recommendation is great news for pediatric and adult TRK fusion cancer patients with metastatic or locally advanced solid tumors that have a Neurotrophic Tyrosine Receptor Kinase (NTRK) gene fusion and currently have no satisfactory treatment options.
Bayer acknowledges the implementation challenges associated with tumour agnostic treatments and is committed to working with payers and healthcare providers. This includes discussing how Bayer’s existing patient support program (TRAKTION) and complimentary NTRK gene fusion testing program (FastTRK) could be supportive so Canadian patients have access to this innovative and effective treatment.
VITRAKVI (larotrectinib) is indicated for the treatment of adult and pediatric patients with solid tumours that:
have a Neurotrophic Tyrosine Receptor Kinase (NTRK) gene fusion without a known, acquired resistance mutation,
are metastatic or where surgical resection is likely to result in severe morbidity, and have no satisfactory treatment options, has been issued marketing authorization with conditions, pending the results of trials to verify its clinical benefit.
7. Long-Term Aspirin Use Before Diagnosis May Reduce Risk of Death From CRC (July 29/21)
Long-term regular aspirin use before a diagnosis of colorectal cancer (CRC) is associated with a lower risk of CRC-specific mortality, according to a study published in the Journal of the National Cancer Institute. The study authors noted that long-term aspirin use has been shown to reduce the incidence of CRC, but there is no evidence on aspirin use and mortality outcomes in CRC patients.
The researchers looked at pre- and postdiagnosis use of aspirin. The pre-diagnosis cohort included 2686 participants, and the postdiagnosis cohort included 1931 participants. Regular aspirin use was defined as taking 15 or more pills per month. Patients were considered short-term aspirin users if they reported regular aspirin use on the pre-diagnosis questionnaire only (submitted a mean of 1.5 years before CRC diagnosis). Patients were considered long-term aspirin users if they reported regular aspirin use on the pre-diagnosis questionnaire and the prior questionnaire.
Results showed that long-term regular aspirin use before CRC diagnosis was significantly associated with a lower risk of CRC-specific mortality, when compared with no aspirin use before diagnosis. Regular aspirin use postdiagnosis was not significantly associated with a lower risk of CRC-specific mortality, when compared with no aspirin use postdiagnosis. However, patients who began taking aspirin regularly after diagnosis had a lower risk of CRC-specific mortality, when compared with patients who did not use aspirin during the pre- and postdiagnosis periods. In addition, long-term regular aspirin use before CRC diagnosis was associated with lower odds of being diagnosed with distant metastases, when compared with no aspirin use before diagnosis.
8. Integrative Medicine and Cancer Care (Jun.17/21)
Integrative medicine refers to the coordinated delivery of both conventional and complementary medical treatment. Research suggests that certain types of complementary therapies may help manage symptoms and side effects and improve a person’s overall sense of well-being. Integrative medicine generally focuses on complementary therapies that have at least some high-quality evidence to support their efficacy and safety.
Integrative medicine takes advantage of complementary therapies such as acupuncture, massage, meditation, yoga, guided imagery, and self-hypnosis. The field especially emphasizes the crucial importance of good nutrition and physical activity. Always along with—not instead of—conventional cancer care, integrative medicine incorporates these and other modalities to manage symptoms that may occur during cancer treatment and remain after its completion.
Integrative therapies reduce both short- and long-term side effects, such as pain and anxiety. They can relieve stress, promote general well-being, and, in some cases, reduce the risk of cancer recurrence. According to the Consortium of Academic Health Centers for Integrative Medicine, there are yet other integrative medicine benefits: it “reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals, and disciplines to achieve optimal health and healing.”
Integrative medicine essentially puts the ball back in your court. It offers a broad array of therapies and lifestyle choices that not only make a real difference for your health and happiness but also give you back a sense and reality of control and confidence. To explore types of complementary and integrative therapies, follow the link below.
9. Roche to Study Syros’ CDK7 Inhibitor with Tecentriq in BRAF-Mutated CRC Patients (Aug.05/21)
Syros Pharmaceuticals has inked an agreement with Roche to supply its CDK7 inhibitor SY-5609 so that it may be studied with Roche’s immune checkpoint inhibitor atezolizumab (Tecentriq) in a molecularly defined colorectal cancer (CRC) patient population.
Under the terms of their agreement, Cambridge, Massachusetts-based Syros will supply SY-5609 for the Phase I/Ib INTRINSIC trial, which is exploring the activity of different targeted drugs or immunotherapies, among them atezolizumab, either as single agents or in combination regimens in CRC patients with molecularly aberrant tumors. Roche will evaluate the safety, tolerability, and preliminary efficacy of SY-5609 and atezolizumab in BRAF-mutated CRC patients.
Roche’s rationale for combining atezolizumab with a SY-5609 is backed by preclinical data showing that CDK7 inhibition leads to DNA replication stress and genomic instability, which triggers an immune response that is further strengthened with the addition of an immune checkpoint inhibitor. Syros also presented preclinical data at the American Society of Clinical Oncology’s annual meeting in June showing that SY-5609 had particularly robust activity in tumor models with BRAF mutations.
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. In Vivo Lung Perfusion (IVLP) as an Adjuvant Treatment for Patients with Resectable Pulmonary Metastases of Colorectal Carcinomas (Aug.10/21)
This study is investigating a new technique for delivering chemotherapy directly into the lungs at the time of surgery. Delivering chemotherapy directly to the lungs could potentially kill any microscopic cancer cells that are present in the lungs at the time of surgery, while sparing other major organs in the body from the side effects of chemotherapy. This technique is called In Vivo Lung Perfusion (IVLP). Patients will be allocated to one of eight groups and will be assigned to the appropriate group based on their date of surgery. There will be at least 30 days between groups. Oxaliplatin will be administered at the time of surgery using the IVLP technique at the following doses, assuming 2000ml perfusate per case:
Group 1: 5mcg/ml perfusate (n=1)
Group 2: 10mcg/ml perfusate (n=1)
Group 3: 15mcg/ml perfusate (n=1)
Group 4: 20mcg/ml perfusate (n=1)
Group 5: 25mcg/ml perfusate (n=1)
Group 6: 30 mcg/ml perfusate (n=1)
Group 7: 35 mcg/ml perfusate (n=1)
Group 8: 40 mcg/ml perfusate (n=3)
The advancement in groups will occur if no major toxicity is seen, and 30 days has lapsed since the previous group was completed. If a major toxicity is observed, the previous dosage group will be expanded to n=3, and the maximum tolerated dose would be established at that level.
After treatment, patients will be followed as per standard of care.
Patients must meet all of the following criteria:
- Diagnosis of Colorectal Carcinoma
- Presence of bilateral pulmonary metastases AND 3 or more lung lesions in total
- Age 70 years or less
- ECOG 0-2
- Absence of extra-pulmonary disease, except liver metastases suitable to curative treatment. No enlarged lymph nodes.
Patients cannot have any of the following:
- Patient has previously received more than 1000 mg of oxaliplatin
- History of significant pulmonary disease or pneumonitis
- Pregnant or lactating females
- Inability to understand the informed consent process
- Hypersenstivity to oxaliplatin
- Patients with Heparin-induced thrombocytopenia (HIT)
- Patients who cannot receive cefazolin or methylprednisolone due to allergy or another reason can be included but will not receive the drug they cannot tolerate
- Current participation in another therapeutic clinical trial
- History of HIV or Hepatitis C
The study is being led by Dr. Marcelo Cypel at the Princess Margaret Cancer Centre and the RESEARCH COORDINATOR is Jennifer Lister: Jennifer.Lister@uhn.ca.
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. What is a FIT, and which ones are best to use? (Jul.14/21)
A fecal immunochemical test (FIT) is a type of colorectal cancer (CRC) screening. The test detects blood in the stool that may not be visible to the naked eye. The presence of blood indicates a need for further evaluation to diagnose the cause of the bleeding (i.e., CRC or other bowel complications). A positive result does not necessarily mean that a person has cancer, but the early detection and treatment of this disease generally improve a person’s outcomes.
A variety of at-home FIT options are available for people to consider. People can perform these non-invasive tests at home, often without the need for a doctor’s visit. A FIT home testing kit will include instructions and a sterile container for the stool sample. Most kits will also include an envelope for mailing the sample to a laboratory. A person does not have to restrict their diet or prepare in any other way before obtaining the sample.
The concept behind a FIT kit is the same regardless of the manufacturer, although individual instructions and processing times may vary. Below are several home testing kits that people can consider using;
- Pinnacle Biolabs
To learn more, follow the link below to find the individual articles for each product.
16. What Is a Liquid Biopsy? (Jul.27/21)
A liquid biopsy is performed by testing a sample of blood for the presence of circulating cancer cells, known as circulating tumor cells. Perhaps more importantly, samples of blood obtained from a liquid biopsy can also be tested for cell-free tumor DNA (cfDNA), which are fragments of DNA shed by cancer cells into a patient’s bloodstream.
Importantly, the bits of cf DNA obtained from a liquid biopsy can provide information to healthcare providers in the following areas:
- If or to what extent the cancer is responding to treatment
- Optimal treatment options specific to the DNA mutations of the cancer cells
- Earlier detection of cancer compared with standard screening measures
- Molecular and genetic real-time changes occurring in a patient’s cancer cells in response to treatment and growth
Liquid biopsies have the potential to detect cancer cells in a patient’s body at an earlier stage than many standard screening methods. This may play an important role in both initial screening measures for early detection of cancer, as well as early detection of a cancer recurrence. To produce the DNA detectable by a liquid biopsy, often fewer cancer cells are required than the number needed for a scan or other laboratory method.
Biopsies that require the removal of tissue samples are often associated with pain during and after the procedure, the potential for infection, the potential for scarring, required medication, anxiety, and the need for extended periods of time in the clinic. Scans used for detection of cancer recurrences sometimes require intravenous medication, dietary changes prior to the test, significant time for the scanning process, and significant financial resources. A liquid biopsy can circumvent many of these issues, as all that is required from the patient is a blood sample.
Research is continuing to standardize liquid biopsies, as well as to expand the understanding of how the information obtained from liquid- biopsy samples can truly guide continuous treatment decisions for those affected by cancer.
17. Clinical Trial Aims to Improve Outcomes for Patients with Stage III CRC After Surgery by using ctDNA (Aug.04/21)
An international clinical trial, run by the Canadian Cancer Trials Group (CCTG) and chaired in Canada by UBC faculty of medicine’s Dr. Jonathan Loree, is examining whether circulating tumour DNA (ctDNA) found in a blood test can be used to better select chemotherapy and improve the outcomes of patients after surgical removal of their colorectal cancer (CRC).
Dr. Jonathan Loree, UBC Faculty of Medicine & GI Medical Oncologist
“This clinical trial will evaluate a new blood test (liquid biopsy) to better predict which patients require additional treatments to increase their chance of cure and which patients do not, allowing us to avoid toxic treatments in patients who have a very low risk of recurrence,” says Canadian co-chair Dr. Loree, an assistant professor in UBC’s department of medicine and medical oncologist at BC Cancer. If surgery was not successful in removing all of the cancer, fragments of cancer DNA (ctDNA) can enter the blood stream. Detecting these fragments after surgery may identify patients most likely to have cancer come back and help determine who should get extra chemotherapy after surgery.
CCTG will oversee conduct of the trial at 35 Canadian centres and Dr. Loree, the CCTG colon cancer chair, will lead the trial in Canada as well as oversee important correlative analyses of tissue samples. The overall goal of the international trial is to change the standard of care for treatment after surgery in people with stage III CRC by reducing unnecessary toxicity due to chemotherapy and improving patient outcomes.
18. Evidence for a CRC Screening Benefit After Age 75 Years (Aug.03/21)
Colorectal cancer (CRC) screening with lower endoscopy may be warranted for people older than 75 years and in good health, a study in JAMA Oncology suggested. The US Preventive Services Task Force currently recommends routine CRC screening until age 75 years, with individualized decision-making for those aged 76 to 85 years based on their screening history and overall health. But because clinical trials have excluded older individuals, it’s unknown whether screening people beyond age 75 years is beneficial.
Screening after age 75 was linked with a 39% reduction in the incidence of CRC and a 40% decrease in the risk of death from the disease. The researchers found similar reductions in the risk of death from CRC, whether or not participants had ever undergone screening before age 75. Among participants who had a history of cardiovascular disease or multiple underlying health conditions, no clear reduction in colorectal cancer–related deaths was seen with screening. However, these findings were less definitive than the overall results, Dr. Umar, D.V.M., Ph.D., of NCI’s Division of Cancer Prevention, said.
19. 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.
20. Antibiotic Use Linked to Increased Risk of CRC (Jul.11/20)
The Centers for Disease Control and Prevention (CDC) note that antibiotics are useful in the treatment of certain types of infection. While doctors use them to treat bacterial infections, they are not effective against infections caused by viruses. Moreover, antibiotics are not always necessary, because sometimes, the body is able to ward off the infection on its own.
Unnecessary use of antibiotics is a growing concern nationally and internationally. In the United States, the CDC is advocating for the careful use of antibiotics to avoid adverse effects. For example, people taking antibiotics are at risk of Clostridioides difficile (C. difficile) infections and other infection types that are resistant to antibiotics. Moreover, the National Institutes of Health (NIH) note that antibiotics can kill off the helpful bacteria in the gastrointestinal tract. In order to balance these risks, healthcare professionals need to avoid prescribing antibiotics that are not a necessary treatment.
Researchers examined the prescription of oral antibiotics and antibiotic exposure period in those with colorectal cancer (CRC) and in the matched control groups. They found a link between antibiotic use and an increased risk of colon cancer in both the early and later onset categories. Risk of colon cancer related to antibiotic use varied between the early onset and later onset groups. According to the study results the researchers shared, people with later onset CRC had an associated risk of 9%. The association was much higher in those with early onset CRC, with an almost 50% increased risk. However, this risk was not associated with every type of antibiotic or every type of CRC. The researchers note that “among both age groups, most classes of antibiotic were not significantly associated with colon, rectal, or distal colon cancer.”
21. CRC Vaccine Successful in Mice (Jul.28/21)
Scientists from the German Cancer Research Center and Heidelberg University Hospital have for the first time been able to delay the development of hereditary colorectal cancer (CRC) with a protective vaccination. Mice with a hereditary predisposition to CRC survived significantly longer after vaccination than unvaccinated animals. Combining the vaccination with an anti-inflammatory drug increased the protective effect.
With their current work, the researchers have shown for the first time in an animal model that protective vaccination with MSI-typical neoantigens can actually protect against cancer. For this purpose, the team studied a mouse strain that develops CRC as a result of a defect in DNA repair enzymes – comparable to humans suffering from Lynch syndrome. The “Lynch mice” develop tumors in the intestine from the age of six months and die a few weeks or months later. The vaccinated mice survived an average of 351 days, whereas unvaccinated animals survived only 263 days. The tumor mass was also significantly lower in the vaccinated animals. If the mice received the drug naproxen in addition to the vaccine, this further increased the preventive effect of the vaccination. Whether this vaccination can actually prevent tumors and prolong patient survival, however, will only become clear in a few years.
22. Ask the Experts About Circulating Tumor DNA (ctDNA) in the Management of Cancer (Jun.28/21)
What is circulating tumor DNA (ctDNA)?
Circulating tumor DNA (ctDNA) is 150–200-base-pair fragments of DNA, which originate from cancer cells and are present in the bloodstream or other body fluids.
How can ctDNA help manage cancer?
There are currently four clinical applications of ctDNA to guide precision medicine in patients with cancer:
- Detection of minimal residual disease (MRD) following surgery.
- Monitoring the treatment response in the metastatic setting.
- Identifying genomic drivers of therapeutic sensitivity and resistance.
- Guiding treatment strategies to overcome resistance to treatment.
How is ctDNA used for the management of early-stage cancers?
Across all stages of surgically removed cancer, detection of ctDNA following surgery is a strong predictor of cancer recurrence. The detection of ctDNA could lead clinicians to intensify therapy in certain situations. Conversely, the absence of ctDNA could provide an opportunity to minimize surveillance or adjuvant treatment.
How is ctDNA used for the management of metastatic cancer?
ctDNA can be used to monitor treatment response, identify genomic drivers of treatment sensitivity or resistance, or identify new therapies that could overcome genomic drivers of treatment resistance.
23. KRAS Mutation Predicts Response to HAI Pump in Unresectable Colorectal Liver Metastases (Aug.02/21)
In patients with unresectable liver metastases from colorectal cancer (CRC), mutated KRAS predicts worse response to hepatic arterial infusion (HAI) pump chemotherapy, according to new research. “Although not practice changing, our results are important when considering whether to offer this particular treatment to potential candidates with KRAS mutation,” said lead study author Hordur Kolbeinsson, MD, a general surgery resident with Spectrum Health/Michigan State University General Surgery Residency, in Grand Rapids. “Additionally, it suggests that KRAS mutation status should be used as a stratification factor in future trials exploring HAI chemotherapy.”
Dr. Kolbeinsson reviewed cases from 25 patients with unresectable liver metastases from CRC who were treated with HAI chemotherapy between August 2017 and May 2019. The researchers observed an overall decrease in liver tumor burden of 63.5% with an objective response rate (ORR) of 80%, and 40% of patients converted to resectable status. Eleven patients (44%) had KRAS mutation. When compared with wild-type, KRAS-mutated tumors had a lower rate and magnitude of response. Fewer patients with KRAS-mutated tumors converted to resectable status during HAI pump chemotherapy.
“It must be noted that even though patients with KRAS mutations had an average smaller tumor burden decrease (58% vs. 70%), their overall response rate was more than acceptable (64%), meaning that patients with KRAS mutations and unresectable liver metastases from CRC are still going to benefit from the treatment,” Dr. Kolbeinsson said.
24. Lower Vitamin D Levels May Increase CRC Risk (Jul.13/21)
A team from the University of California San Diego has conducted a new study that builds on a long-standing hypothesis linking vitamin D deficiency to a greater risk of colorectal cancer (CRC). They found that countries where people experience lower levels of UVB light report higher rates of CRC.
This new study looked at global UVB light exposure levels across 186 countries. The team accounted for various factors, such as smoking and skin pigmentation, while also adjusting for age. They found a distinct age-dependent inverse link between UVB exposure and colorectal cancer. The association was statistically significant for people over the age of 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”, said the study’s co-author.
The authors suggest that lower UVB exposure may reduce levels of vitamin D, which has previously been associated with an increased risk of CRC. The UC San Diego team concluded that this study supports the need for adequate public health programs to avoid vitamin D inadequacy at national and global levels, whether through screening those at risk, through selective supplementation or through population-based measures. In addition, future studies can aim at identifying the cancer types which show significant improvement with vitamin D supplementation.
25. Multiple Lifestyle Exposures May Be the ‘Smoking Gun’ to Early Onset CRC (Jul.29/21)
“A change in the typical age of onset of cancers, for something like colon cancer, which is so much linked to lifestyle, diet an activity, … makes it likely that there’s something in the environment, something that we’re being exposed to, that’s increased the risk,” commented Dr. Richard Boland, professor of medicine at the University of California San Diego School of Medicine, in response to the study.
This comment is in response to a recent study published in the Annals of Oncology, which determined that antibiotics may have a role in the increased rates of colorectal cancer (CRC) for all age groups, but especially in those younger than 50. Researchers in the study analyzed Scottish primary care data from 7,903 patients with CRC (445 younger than 50 years). Patients without early-onset CRC were analyzed separately. Of all the patients in the study, 45% had previously been prescribed antibiotics.
According to Boland, while the data may show this association, it doesn’t prove causation. He uses an example from a previous study which linked obesity with an increased risk of-early onset CRC. “It must be more complicated than that,” he said. “It turned out that the people who were obese and had metabolic syndrome were more likely to smoke, more likely to drink alcohol, more likely to eat meat, less likely to be vegetarian, less active … all of the things that we think of as part of the healthy lifestyle. They’re all there in the same bucket.”
Boland added that we may never find out the exact lifestyle exposure that increases the risk for early-onset CRC, as there could be other lifestyle exposures at play. “My bottom line really is that all of the things that we are suspicious of, whether it’s obesity, high fat diets or lack of activity, … we may never really get the smoking gun here,” Boland explained. Because of this, Boland emphasizes the importance of living a healthy lifestyle and using a limited amount of antibiotics, if needed.
26. Risk of Early-Onset CRC Reduced by Higher Intake of Vitamin D (Aug.03/21)
One potential protective factor against colorectal cancer (CRC) is vitamin D and there is evidence of a strong inverse relationship between vitamin D levels and the risk of CRC. Nevertheless, whether reduced plasma levels of vitamin D are also associated with the development of early-onset CRC is uncertain. In trying to ascertain the relationship between these two factors, a team from the Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, US, turned to the Nurses’ Health Study II which is a prospective cohort study of 116,429 female nurses aged between 25 and 42 years and which began in 1989.
A total of 94,205 women were included in the analysis and there were 111 documented cases of early-onset CRC detected between 1991 and 2015. The median vitamin D intake was 372 IU/day and vitamin D levels > 450 IU/day were associated with a reduced risk of developing early-onset CRC compared to intakes < 300 IU/day. Interestingly, the researchers also found that the HR for dietary vitamin D intake had a stronger inverse association with the development of EOCRC per 400 IU/day increase than among supplement users.
The authors concluded that given the association between higher vitamin D intake and early-onset colorectal cancer, strategies to ensure adequate intake of the vitamin could serve as an important preventative measure in younger adults.
27. These Surprising Foods May Lower Your CRC Risk, New Study Says (Aug.05/21)
Research that was just published in the journal Nature Communications evaluated 860 past studies to understand the association between food intake and individuals’ risk for developing or dying from 11 types of cancer, including: colorectal cancer (CRC), cancers of the mouth, pharynx, larynx, esophageal cancer, stomach cancer, liver cancer, gallbladder cancer, lung cancer, skin cancers, female breast cancer, kidney, and bladder cancer. Similar to another recent study, alcohol was strongly associated with most of these cancers, while red meat, in particular, was shown to increase the risk of CRC.
When it came to reducing the risk of CRC, the researchers found that dairy and whole grains were inversely correlated with incidences of the disease. That is, the more regularly individuals consumed these two foods, the less likely they were to develop CRC. Specifically, the researchers note that eating approximately 14 ounces of dairy (possibly including an average of seven ounces of milk) and three ounces of whole grains per day was associated with lower colorectal risk.
28. No, Most COVID Infections Are Not Occurring in Vaccinated People (Aug.06/21)
Misinformation and misunderstanding about vaccine efficacy have abounded recently, potentially sparked by what seemed to be worrying data out of Provincetown, Massachusetts, reported last week by the CDC. The agency’s investigation revealed that 74% of the 469 COVID-19 cases in that outbreak occurred in fully vaccinated people. But that doesn’t by any stretch of the imagination mean that three-quarters of vaccinated people are getting COVID. In addition to this being one particular outbreak, as vaccination rates increase overall, a larger proportion of cases will occur in the vaccinated — it’s just simple math.
“The more vaccinated a population, the more we’ll hear of the vaccinated getting infected,” Katelyn Jetelina, PhD, MPH, an epidemiologist at the University of Texas Health Science Center at Houston, wrote. If there were four COVID cases out of 100 people, for example, with two occurring in vaccinated people and two occurring in unvaccinated people, that would be 50% of cases occurring in vaccinated people.
Yes, researchers have acknowledged that breakthrough infections are likely to be under-reported, so the CDC recently estimated that 35,000 fully vaccinated people each week develop symptomatic COVID-19. Even at that rate, vaccination confers an eightfold reduction in the risk of getting infected in the first place; a 25-fold reduction in risk of getting hospitalized; and a 25-fold reduction in the risk for death. “We need to make it clear that vaccination reduces your chance of getting infected with COVID-19 and thus of transmitting it,” tweeted Leana Wen, MD, MPH, of George Washington University in Washington, D.C.
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