
A PATIENT-FOCUSED ORGANIZATION
COLORECTAL CANCER TREATMENT & CLINICAL RESEARCH UPDATES
Month Ending September 16th, 2021
The following colorectal cancer treatment and research updates extend from August 12th, 2021 to September 16th, 2021, inclusive and are intended for informational purposes only.
This content is not intended to be a substitute for professional medical advice. Always consult your treating physician or guidance of a qualified health professional with any questions you may have regarding your health or a medical condition. Never disregard the advice of a medical professional or delay in seeking it because of something you have read on this website.

CONTENT
1. Phase II LEAP Clinical Trial to Treat mCRC.
2. TRK Fusion Cancer and How to Test For It
3. A Phase II, Open-Label, Multicentre, Study of an Immunotherapeutic Treatment for the MSI High Colorectal Cancer Metastatic Population
4. Phase III Study at the Odette Cancer Centre Comparing Arfolitixorin vs. Leucovorin: Both in Combination with 5FU, Oxaliplatin, and Bevacizumab in Patients with Advanced Colorectal Cancer
5. Larotrectinib (Vitrakvi) Finally Receives Its Positive, Conditional Funding Recommendation
6. Immunotherapy May Be Effective in Certain Patients With mCRC
7. Turning Point Therapeutics Initiates TRIDENT-2 Clinical Study Investigating Repotrectinib-Trametinib Combination in KRAS G12D Mutated Advanced Solid Tumors
8. A Study of Select Drug Combinations in Adult Patients With Advanced/Metastatic BRAF V600 CRC
9. Antihypertensives May Improve Survival for Patients with CRC
10. Onvansertib Added to SOC Improves Responses and Survival in KRAS-Mutant mCRC

11. Hepatic Artery Infusion Pump (HAIP) Chemotherapy Program – Sunnybrook Hospital
12. Living Donor Liver Transplantation for Unresectable Colorectal Cancer Liver Metastases
13. Canadian Guidelines on the Management of Colorectal Peritoneal Metastases

14. Study Offered at the Odette Cancer Centre to Treat Recurrent Rectal Cancer

15. Trends in the Incidence of Young-Onset CRC with a Focus on Years Approaching Screening Age
16. Early Colon Cancer Screening: A 30-Minute Checkup Could Save Your Life
17. Check Your Health: Age 45 is the New 50 for Colon Cancer Screening

18. Young Adult CRC Clinic Available at Sunnybrook Hospital
19. CCRAN’s Partnership with Count Me In
20. The Importance of Getting a Second Opinion
21. Key Immune Cells Maintain Healthy Gut Bacteria to Protect Against CRC
22. Are Early-Onset CRCs More Aggressive?
23. Factors Prognostic for Brain Metastases from CRC: A Single-Center Experience in China
24. Maternal Health May Play a Big Role in Who Gets CRC
25. Simple, Non-Invasive Tool Obviates Unnecessary Surgery in Patients with CRC

26. Vitamin D May Protect Against Young-Onset CRC
27. Association between Coffee Consumption and Risk of CRC in a Korean Population

28. COVID-19 Vaccines and Cancer
29. If You Received the Pfizer or Moderna Vaccines, Expect to Get a Booster Starting This Fall
30. English Study Finds Long COVID Affects Up To 1 in 7 Children Months After Infection
31. WHO Monitoring New Coronavirus Variant Named Mu
32. Biden Administration Likely to Approve Covid-19 Boosters at 6 Months
33. Moderna Makes Twice as Many Antibodies as Pfizer, Study Says
34. COVID-19 Updates: U.K. to Offer Booster Shots for Everyone Over 50
35. Risk Factors and Disease Profile of Post-Vaccination SARS-CoV-2 Infection in UK Users of the COVID Symptom Study App
36. Reopening and Vaccination Policies
37. Pandemic Lockdown Tied to Worse Outcomes in mCRC
38. Can Intranasal COVID Vaccines Help Stop the Spread?
39. Frequently Asked Questions for COVID-19
DRUGS / SYSTEMIC THERAPIES
1. Phase II LEAP Clinical Trial For mCRC (Sept 10/21)
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)
https://www.bayer.ca/en/media/news/?dt=TmpBPQ==&st=1
3. A Phase 2, Open-label, Multicenter, Study of an Immunotherapeutic Treatment for the MSI High CRC Metastatic Population (Sept.16/21)
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 (Sept.16/21)
The purpose of this study is to look at the effectiveness of the drug Arfolitixorin in combination with 5-fluorouracil (5FU), oxaliplatin, and bevacizumab in patients with colorectal cancer (CRC). Patients with advanced/metastatic CRC who meet certain criteria may be able to participate. There will be two groups of patients participating in this study;
- one group will receive Arfolitixorin in combination with 5FU), oxaliplatin, and bevacizumab,
- while the other group will receive the drug Leucovorin in combination with 5FU, oxaliplatin, and bevacizumab (standard of care).
The doctor and study staff will not know which group a patient is in. Patients will be randomized to receive one treatment or the other.
About Arfolitixorin:
Arfolitixorin is Isofol’s proprietary drug candidate being developed to increase the efficacy of standard of care chemotherapy for advanced CRC. The drug candidate is currently being studied in a global Phase 3 clinical trial. As the key active metabolite of the widely used folate-based drugs, arfolitixorin can potentially benefit all patients with advanced CRC, as it does not require complicated metabolic activation to become effective.
Treating cancer patients with arfolitixorin – The goals:
- When treating CRC, for example, arfolitixorin is administered in combination with 5-FU to increase cell mortality in circulating cancer cells and in cancerous tumours.
- Arfolitixorin is administered in conjunction with rescue therapy after high-dose treatment with the cytotoxic agent, methotrexate, in order to suppress the cytotoxic effect in surrounding healthy tissue. The treatment is used for certain types of cancer, such as osteosarcoma, a type of bone cancer. This involves administering arfolitixorin separately, 24 hours after the chemotherapy.
https://sunnybrook.ca/trials/item/?i=293&page=49335 and https://clinicaltrials.gov/ct2/show/NCT03750786
(https://isofolmedical.com/arfolitixorin/ )
5. Larotrectinib (Vitrakvi) Finally Receives Its Positive, Conditional Funding Recommendation (Sept.14/21)
Larotrectinib (Vitrakvi) finally received the much-awaited positive funding recommendation today from the expert committee (CADTH) in Canada that we have all been waiting for monthsl! CADTH issued the final, condition positive tumour-agnostic recommendation for VITRAKVI® (larotrectinib). The CADTH’s pCODR Expert Review Committee (pERC) retained it’s draft recommendation from May 2021 and provided a final recommendation that VITRAKVI should be reimbursed for the treatment of adult and pediatric patients with metastatic or locally advanced solid tumours who have a Neurotrophic Tyrosine Receptor Kinase (NTRK) gene fusion with conditions. The full final recommendation can be accessed on the CADTH website at: https://www.cadth.ca/larotrectinib
This final, positive recommendation is excellent news for Canadian TRK fusion cancer patients, which includes colorectal cancer, and brings us closer to realizing public coverage of VITRAKVI for eligible patients.
The manufacturer of the drug therapy, Bayer, looks forward to engaging with the provinces in discussion on how they can collaborate and bring access to publicly funded VITRAKVI as quickly as possible, in addition to publicly funded NTRK gene fusion testing. They hope these discussions proceed in an expeditious manner recognizing the high unmet need for TRK fusion cancer patients and noting that the VITRAKVI file has already spent 2.5 years undergoing HTA review. Bayer continues to support the existing patient support program (TRAKTION) and complimentary NTRK gene fusion testing program (FastTRK) for Canadian patients in the interim before provincial listings.
6. Immunotherapy May Be Effective in Certain Patients With mCRC (Aug.12/21)
Patients with microsatellite stable colorectal cancer (MSS-CRC), which represents 95% of all metastatic CRC (mCRC) cases, are more responsive to checkpoint blockade immunotherapy if the patient’s tumors have not spread to the liver, according to a study published in JAMA Network Open. Checkpoint blockade immunotherapy is an innovative treatment that helps the immune system recognize and attack cancerous cells.
The study analyzed data from 95 patients with MSS mCRC who received immune checkpoint inhibitor programmed cell-death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) targeted therapy when their disease became resistant to chemotherapy. “When we stratified the patients by the presence or absence of liver metastases, we noted that about 20% of patients without liver metastases had a major response to anti-PD-1 or anti-PD-L1 therapy, while none of the patients with liver metastases experienced a positive response,” said Marwan Fakih, MD, co-director of the Gastrointestinal Cancer Program and the Judy & Bernard Briskin Distinguished Director of Clinical Research at City of Hope, in a press release. “CRC patients without liver metastases could benefit from immunotherapy considerably more than patients with liver metastases.”
Immunotherapy in patients with MSS colorectal cancer has traditionally been seen as ineffective, according to the investigators, which leaves these patients with few treatment options. “For patients without liver metastatic disease, PD-1/PD-L1-based therapies, particularly those combining these agents with tyrosine kinase inhibitors (TKI), hold significant promise,” Fakih said.
7. Turning Point Therapeutics Initiates TRIDENT-2 Clinical Study Investigating Repotrectinib-Trametinib Combination in KRAS G12D Mutated Advanced Solid Tumors (Aug.16/21)
A precision oncology company developing next-generation therapies that target genetic drivers of cancer, today announced initiation of the first cohort of its Phase 1b/2 TRIDENT-2 combination study of lead investigational drug repotrectinib. The initial cohort will investigate repotrectinib in combination with MEK-inhibitor trametinib in KRAS G12D mutated advanced solid tumors.
“We are pleased to initiate the TRIDENT-2 study and explore a potential new treatment option for patients with KRAS-driven solid tumors,” said Mohammad Hirmand, executive vice president and chief medical officer. “With preclinical studies demonstrating repotrectinib’s ability to inhibit JAK2, SRC and FAK, our goal is to help improve the effectiveness of KRAS-targeting agents by suppressing known pathways of tumor resistance.”
Results from preclinical studies presented at the 2021 American Association for Cancer Research annual meeting found that repotrectinib in combination with trametinib was more effective than single-agent trametinib in patient-derived KRAS mutant G12D lung cancer models. The repotrectinib-trametinib combination suppressed a broad range of downstream mutant KRAS G12D signaling, increased cell cycle arrest and induction of apoptosis, and was more active in multiple KRAS G12D dependent models compared to either single-agent treatment. The frequently mutated Kirsten Rat Sarcoma (KRAS) viral oncogene is associated with a broad range of human cancers, including approximately 30% of non-small cell lung, 40% of colorectal and more than 90% of pancreatic cancers.
8. A Study of Select Drug Combinations in Adult Patients with Advanced/Metastatic BRAF V600 CRC (Jun.23/21)
This is a phase Ib, multi-center, open-label study with multiple treatment arms in adult patients with advanced or metastatic BRAF V600 (E, D, or K) colorectal cancer (CRC) in order to characterize safety and tolerability of each treatment arm tested and to identify recommended doses and regimens for future studies. The open platform design of this study is adaptive to allow removal of combination treatment arm(s) based on emerging data and facilitate introduction of new candidate combinations. The study is comprised of a dose escalation part and may be followed by a dose expansion part for any combination treatment arm.
The study is estimated to have an enrolment of 395 participants / adult patients with advanced or metastatic BRAF V600 CRC. Each arm will be treated with a unique combination of Dabrafenib, LTT462, Trametinib, LXH254, TNO155, and Spartalizumab. The estimated primary completion date is August 17, 2023. Primary outcome measures include;
- Incidence and nature of dose limiting toxicities (DLTs) in the first cycle [ Time Frame: 30 months ]
- Incidence and severity of adverse events (AEs) and serious adverse events (SAEs), including changes in laboratory values, vital signs, and ECGs [ Time Frame: 34 months ]
- Frequency of dose interruptions [ Time Frame: 30 months ]
- Frequency of dose reductions [ Time Frame: 30 months ]
- Dose intensity [ Time Frame: 30 months ]
https://clinicaltrials.gov/ct2/show/NCT04294160
9. Antihypertensives May Improve Survival for Patients with CRC (Aug.19/21)
After reviewing outcomes of almost 14,000 patients with colorectal cancer (CRC), researchers determined that ACE inhibitors, beta-blockers and thiazide diuretics were all associated with decreased mortality. They also found that patients who took their blood-pressure drugs consistently were less likely to die from their cancer.
Patients’ adherence to their blood-pressure regimen also appears important: “Our results show an association between increased adherence to [blood-pressure] medications and reduced … mortality in patients starting these medications after stage I, II or III CRC diagnosis relative to those who did not,” the researchers write in a new scientific paper outlining their findings. “Although further analysis is necessary, this increment of survival may be associated with a higher dose exposure, as a long-term/high-dose exposure to ACE-Is/ARBs was associated with a decreased incidence of CRC mortality.”
The scientists are uncertain if the apparent benefits from the blood-pressure drugs stem from the drugs themselves or from controlling patients’ high blood pressure. The researchers note that there have been several recent clinical trials testing blood-pressure drugs’ potential usefulness against other cancers. More research is warranted into the drugs’ application for CRC, as well as their potential benefits in gastric and bladder cancer, they conclude.
10. Onvansertib Added to SOC Improves Responses and Survival in KRAS-Mutant mCRC (Sept.09/21)
In patients with KRAS-mutated metastatic colorectal cancer (mCRC), treatment with onvansertib showed improved efficacy compared with the current standard-of-care (SOC) irinotecan, fluorouracil (5-FU), and folinic acid (leucovorin; FOLFIRI) in combination with bevacizumab (Avastin), according to a press release from Cardiff Oncology.
Onvansertib is a PLK1 inhibitor that has demonstrated the ability to regulate cell-cycle progression, causes mitotic arrest leading to cell death, and regulates tumor growth. The phase 1b/2 study included 44 patients with mCRC of whom 38 were evaluable for response. Patients treated at the recommended phase 2 dose (RP2D) of onvansertib of 15 mg/m2 were dosed orally on days 1 through 5 every 14 days. With the accompanying FOLFIRI regimen, patients received irinotecan 180 mg/m2, leucovorin 400 mg/m2, bolus 5-fluorouracil (5-FU) 400 mg/m2, and continuous intravenous infusion 5-FU at 24 mg/m2 in combination with bevacizumab 5 mg/kg.
Partial responses (PRs) were achieved in 42% of the 19 patients who were treated with the RP2D of onvansertib in the study. This percentage was an improvement from the 5% to 13% objective response rate (ORR) that was historically observed with the SOC. Looking at the outcomes of onvansertib across all dose levels (12 mg/m2, 15 mg/m2, and 18 mg/m2), the ORR was 38%, which consisted completely of PRs. PRs also carried over to the different KRAS mutant variants seen in the study subjects including KRAS G12D, KRAS G12V, and KRAS G13D, which are commonly observed in mCRC. Following 1 cycle of onvansertib, achievement of a PR demonstrated the highest decreases in plasma KRAS mutant allelic frequency.
Treatment with onvansertib and FOLFIRI in combination with bevacizumab in the study was well-tolerated. Only 10% of patients experienced grade 3 or 4 treatment-emergent adverse events (TEAEs). The majority of the TEAEs observed were manageable and reversible with supportive care.
SURGICAL THERAPIES
11. 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.
http://sunnybrook.ca/content/?page=colorectal-colon-bowel-haip-chemotherapy
12. 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.”
https://clinicaltrials.gov/ct2/show/NCT02864485
13. Canadian Guidelines on the Management of Colorectal Peritoneal Metastases (Sept.15/21)
Modern management of colorectal cancer (CRC) with peritoneal metastasis (PM) is based on a combination of cytoreductive surgery (CRS), systemic chemotherapy, and hyperthermic intraperitoneal chemotherapy (HIPEC). Although the role of HIPEC has recently been questioned with respect to results from the prodige 7 trial, the role and benefit of a complete CRS were confirmed, as observed with a 41-month gain in median survival in that study, and 15% of patients remaining disease-free at 5 years. Still, CRC with PM is associated with a poor prognosis, and good patient selection is essential. Many questions about the optimal management approach for such patients remain, but all patients with PM from CRC should be referred to, or discussed with, a PM surgical oncologist, because cure is possible. The objective of the present guideline is to offer a practical approach to the management of PM from CRC and to reflect on the new practice standards set by recent publications on the topic.
RADIATION THERAPIES/INTERVENTIONAL RADIOLOGY
14. Study Offered at the Odette Cancer Centre to Treat Recurrent Rectal Cancer (Sept.9/21)
Magnetic resonance-guided focused ultrasound (MRg-FU) is a lessinvasive, outpatient modality being investigated for the thermal treatment of cancer. In MRg-FU, a specially designed transducer is used to focus a beam of low-intensity ultrasound energy into a small volume at a specific target site in the body. MR is used to identify and delineate the tumour, focus the ultrasound beam on the target, and provide a real-time thermal mapping to ensure accurate heating of the designated target with minimal effect to the adjacent healthy tissue. The focused ultrasound beam produces therapeutic hyperthermia (40-42°C) in the target field, causing protein denaturation and cell damage. Currently, there is no prospective clinical data reported on the use of MRg-FU in the setting of recurrent rectal cancer. Recurrent rectal cancer is a vexing clinical problem. Current retreatment protocols have limited efficacy. The addition of hyperthermia to radiation and chemotherapy may enhance the therapeutic response. With recent advances in technology, the investigators hypothesize that MRg-FU is technically feasible and can be safely used in combination with concurrent reirradiation and chemotherapy for the treatment of recurrent rectal cancer without increased side-effects. The study is being offered at the Odette Cancer Centre. Here is the link to the study protocol:
SCREENING
15. 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.
16. Early Colon Cancer Screening: A 30-Minute Checkup Could Save Your Life (Aug.07/21)
The overall incidence of, and death rates associated with, colorectal cancers (CRCs) have been on the decline for more than a decade, thanks in large part to effective colonoscopy screenings that can detect the disease in its early stages.
There are several methods available for colon cancer screening, including colonoscopies. Colonoscopies are vital to improving our ability to find colorectal cancer quickly and early, which makes the disease much easier to treat. This simple procedure also aids in prevention, as we have the ability to identify and remove colorectal polyps before they become cancerous in the first place. Another reason that colonoscopies are so important is that the early stages of colon cancer often do not come with symptoms. Still, you should see your doctor if you have any of these warning signs:
- Bleeding from the rectum
- Blood in the stool or in the toilet after a bowel movement
- Change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool
- Persistent cramping or discomfort in the lower abdomen
- An urge to have a bowel movement when the bowel is empty
- Constipation or diarrhea that lasts for more than a few days
- Decreased appetite
- Nausea or vomiting
- Unintentional weight loss
You can also be proactive when it comes to prevention in other ways. Living a healthy lifestyle that includes daily exercise, a healthy diet, maintaining a healthy weight, limiting your alcohol intake, and eliminating smoking can reduce your risk for colorectal and many other forms of cancer. Knowing your family’s medical history is also important, as a history of the disease in your immediate family puts you at a higher risk.
Image Source: https://www.istockphoto.com/illustrations/colon-cancer-screening
17. Check Your Health: Age 45 is the New 50 for Colon Cancer Screening (Aug.30/21)
The United States Preventive Services Task Force has established new colon cancer screening guidelines as a result of a dramatic increase in colorectal cancer (CRC) among young people. The official recommendation for people with average risk to have their first colonoscopy or other screening is now at age 45, rather than 50.
Statistics and Facts:
- The Colorectal Cancer Alliance reports about 11 percent of CRCs are diagnosed in those younger than 50 years. Based on these findings the age for screening has been lowered to 45 for average-risk adults.
- CRC is still a leading cause of cancer death for men and women. Each year, almost 53,000 people die in the United States and 145,000 Americans are diagnosed with CRC.
- CRC is preventable, detectable and if found early, treatable.
- According to the American Cancer Society, 9 out of 10 times early treatment saves lives and the five-year survival rate for colon cancer if caught early is 90%.
OTHER
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
- Psychologists
- Geneticists
- Nurse navigator
Should a patient wish to be referred to Sunnybrook, they may have their primary care physician, or their specialist refer them to Sunnybrook via the e-referral form, which can be accessed through the link appearing below. Once the referral is received, the Young Adult Colorectal Cancer Clinic will be notified if the patient is under the age of 50. An appointment will then be issued wherein the patient will meet with various members of the team to address their specific set of concerns.
http://sunnybrook.ca/content/?page=young-adult-colorectal-cancer-clinic
19. CCRAN’s Partnership with Count Me In (Sept.14/21)
CCRAN is proud to partner with Count Me In, a nonprofit research initiative, on The Colorectal Cancer Project. This new project is open to anyone in the United States or Canada who has ever been diagnosed with colorectal cancer (CRC). Patients can find out more and join at JoinCountMeIn.org/Colorectal.
Through the project, patients are asked to complete surveys to share information about their experience with CRC, to share biological sample(s), and to allow for the research team to request copies of their medical records. The project team then de-identifies and shares data from these with the entire research community.
Every patient’s story holds a piece of the puzzle that can help us better understand CRC. By discovering more about what drives cancer and sharing this data, CCRAN and the Colorectal Cancer Project believe insights can be gained to develop more effective therapies. One of the aims of the project is to reach populations that have been understudied, including individuals who are diagnosed with CRC at a young age, individuals from marginalized communities who have historically been excluded from research, and patients with metastatic CRC. Together, we can accelerate our understanding of CRC. To learn more or sign up to participate, visit JoinCountMeIn.org/Colorectal.
20. The Importance of Getting a Second Opinion (Apr.27/21)
A second opinion is an important part of becoming educated about your cancer and your treatment options. The more you can learn about your diagnosis and your treatment options, the better chance you have of receiving the most appropriate treatment. The treatment of cancer has evolved tremendously in the recent past. As a result, many cancers are now more treatable than they once were, especially if the appropriate initial treatment is selected.
Usually, patients obtain a second opinion after being referred to a second physician or to a special team of experts in a cancer center, called a multidisciplinary team. This doctor or team of doctors will review the following:
- Pathology report (how the cancer looks under the microscope),
- The extent of cancer
- The physical condition of the patient
- The proposed treatment
The doctor(s) then communicate their opinion regarding treatment to both the patient and the primary physician. Second opinions are more likely to be comprehensive, or inclusive of every possible perspective, when performed in a cancer center with a multidisciplinary team, which usually includes surgeons, oncologists, radiation therapists, and sub-specialist oncologists. In addition to getting a second opinion consider joining a cancer focused social community. Interacting and learning from other cancer patients in your situation can be very informative and provide needed support.
21. Key Immune Cells Maintain Healthy Gut Bacteria to Protect Against CRC (Aug.17/21)
An immune cell subset called innate lymphoid cells (ILC3s) protects against colorectal cancer (CRC), in part by helping to maintain a healthy dialogue between the immune system and gut microbes, according to a new study led by researchers at Weill Cornell Medicine and New York-Presbyterian.
In the new study, Dr. Sonnenberg and colleagues, including lead author Dr. Jeremy Goc, a research associate in Dr. Sonnenberg’s laboratory, examined the role of ILC3s, which reside in the intestines and are known to help mediate the relationship between the immune system and gut microbes. Group 3 innate lymphoid cells normally play a key role in maintaining a healthy dialogue between the microbiome and the immune environment in the lower gut. The researchers showed that ILC3s tend to be drastically reduced and functionally altered in people with CRC. Further, they demonstrate that experimentally disrupting the functions of ILC3s in mice leads to aggressive colon cancer and greatly reduces the effectiveness of cancer immunotherapies.
“These findings suggest new possibilities for the clinical approach to CRC, and also help explain why this type of cancer often fails to respond to immunotherapies,” said senior author Dr. Gregory Sonnenberg, an associate professor of microbiology and immunology in medicine in the Division of Gastroenterology and Hepatology and a member of the Jill Roberts Institute for Research in Inflammatory Bowel Disease at Weill Cornell Medicine.
22. Are Early-Onset CRCs More Aggressive? (Aug.19/21)
Early-onset colorectal cancer (EO-CRC) is not biologically different from, or more aggressive than, average-onset CRC (AO-CRC), according to a comparative analysis. “EO-CRCs are more commonly left-sided and present with rectal bleeding and abdominal pain but are otherwise clinically and genomically indistinguishable from AO-CRCs,” wrote Andrea Cercek, MD, of Memorial Sloan Kettering Cancer Center in New York City, and colleagues in the Journal of the National Cancer Institute. More aggressive treatment based on age is not necessary or effective, they added.
Cercek and team compared clinical, somatic, and germline characteristics of 687 AO-CRC patients (ages 50+) with 759 EO-CRC patients (ages 35-49), all of whom were treated during the same time frame (2014-2019) at Memorial Sloan Kettering. The EO-CRC cohort was further stratified by age at diagnosis (151 at ≤35 years, and 608 at 36-49 years). Among patients with microsatellite stable (MSS) tumors with metastatic disease, the use and type of chemotherapy was comparable among the three cohorts, with the majority of patients in each receiving fluoropyrimidine plus oxaliplatin with or without bevacizumab (Avastin) as first-line therapy. Radiographic response to first-line chemotherapy was 71.9% for patients ≤35 years, 61.8% for those ages 36-49, and 66.5% for AO-CRC patients. There was no statistically significant difference in median overall survival between the groups — 46.9 months for patients ≤35 years, 56.4 months for patients 36-49 years, and 54.5 months for patients with AO-CRC.
This study highlights the importance of the lack of genomic and biological differences in the disease, Cercek and colleagues suggested, particularly since initial reports described EO-CRC as a potentially different and more aggressive entity and led many physicians to pursue more intense treatments. “Our results demonstrate that clinical outcomes and response to chemotherapy are the same and that aggressive treatment regimens based solely on age at CRC diagnosis are not warranted,” they concluded.
https://www.medpagetoday.com/oncology/coloncancer/94134
23. Factors Prognostic for Brain Metastases from CRC: A Single-Center Experience in China (Aug.19/21)
This study aimed to analyze clinicopathological, survival, prognostic factors, as well as the timing of brain metastases (BM) in colorectal cancer (CRC). Data of 65 CRC patients with BM were collected from a single institution in China. The time from primary tumor surgery to the occurrence of BM was calculated. Kaplan-Meier analysis was used to evaluate cumulative survival of patients. Factors associated with prognosis of overall survival (OS) were explored using Cox’s proportional hazard regression models.
The median time interval from CRC surgery to the diagnosis of BM was 24 months. After diagnosis of BM, median OS values for patients were 11 months. Extracranial metastases occurred in 45 cases (69.2%) when BM was diagnosed. Analysis of predictors using Kaplan-Meier method showed that time of BMs, presence of extracranial metastases, treatment, CA199, CA125, CA242, and CA211 were significantly associated with OS. However, sex, primary cancer, location of BM, or the number of brain lesions were not correlated with survival time. Multivariate analysis using a Cox regression model showed that only treatment was an independent predictor for OS. Surgical treatment of metastatic lesions may be an alternative choice for CRC patients with BM. Identifying the timing of brain metastases can help to detect this disease early, leading to a better survival outcome.
24. Maternal Health May Play a Big Role in Who Gets CRC (Sept.10/21)
To determine why colorectal cancer (CRC) patients are being diagnosed more frequently and at a young age, Caitlin Murphy, associate professor at the UTHealth School of Public Health, studied maternal obesity of pregnant women in the 1950s and what the current health is of the people born to those mothers.
“It’s people who are born in about generation X that seem to have the highest rate of CRC and when we see those generational effects, it tells us that factors in early life so think of things like childhood, infancy, even things that might happen in the womb are really important risk factors for developing the disease. So, we wanted to take a look and see what kind of early life factors might be associated with CRC and we started with maternal obesity,” Murphy explained. Right away, she was able to make the connection between a mother’s weight at the beginning of pregnancy and how often the unborn baby would grow up to develop colon cancer.
The guidelines to get screened for colon cancer recently dropped from 50 to 45-years-old. Murphy said the illness is successfully treated if caught early, and this research tells us that people need to be screened as early as recommended.
Image Source: https://medcitynews.com/2021/05/providers-payers-startups-are-all-looking-for-key-pieces-to-solve-the-maternal-care-puzzle/
25. Simple, Non-Invasive Tool Obviates Unnecessary Surgery in Patients with CRC (Sept.06/21)
A blood RNA test predicts whether residual tumor cells remain in early-stage colon cancer patients and obviates unnecessary surgery. “Osakidetza [the Basque Public Health Service] has an early detection programme for colorectal cancer (CRC). Its aim is to spot lesions and cancer at an early stage in order to increase the likelihood of cure. It is based on a test that detects tiny amounts of blood in the stool, which apparently are not visible. If the result is positive, a colonoscopy is performed to detect and even cure the disease by removing the cancer through colonoscopy,” said Luis Bujanda-Fernández de Piérola, Professor of Medicine, UPV/EHU.
“This work, which has made it to the cover and an editorial in the prestigious journal Gastroenterology, has involved the development of a non-invasive tool, a simple blood test, to obviate unnecessary surgery,” said the author of the paper. “The presence of five microRNAs in the blood has been found to correlate very directly with the presence or absence of cancer cells in the lymph nodes or in the colon wall. That way we are able to obviate unnecessary surgery in colon cancer patients,” stressed Bujanda.
Reliability is significantly increased through this new technique, and almost 90 % certainty is offered in predicting the risk of residual tumor cells remaining in the patient’s body. Consequently, this novel technique gives us the certainty of knowing whether or not the patient is going to be operated on. “This is a significant finding verified in a sample of 188 patients with endoscopically removed colon cancer. Right now, the next step would be for other research groups to obtain the same results, validate the findings and for hospitals to incorporate them,” said Luis Bujanda.
NUTRITION/HEALTHY LIFESTYLE
26. Vitamin D May Protect Against Young-Onset CRC (Aug.25/21)
Consuming higher amounts of Vitamin D – mainly from dietary sources – may help protect against developing young-onset colorectal cancer (CRC) or precancerous colon polyps, according to the first study to show such an association. The study, recently published online in the journal Gastroenterology, by scientists from Dana-Farber Cancer Institute, the Harvard T.H. Chan School of Public Health, and other institutions, could potentially lead to recommendations for higher vitamin D intake as an inexpensive complement to screening tests as a CRC prevention strategy for adults younger than age 50.
The authors of the study noted that vitamin D intake from food sources such as fish, mushrooms, eggs, and milk has decreased in the past several decades. There is growing evidence of an association between vitamin D and risk of CRC mortality. However, prior to the current study, no research has examined whether total vitamin D intake is associated with the risk of young-onset CRC.
This prospective cohort study of nurses aged 25 to 42 years began in 1989 and the women were followed every two years by questionnaires on demographics, diet and lifestyle factors, and medical and other health-related information. During the period from 1991 to 2015 the researchers documented 111 cases of young-onset CRC and 3,317 colorectal polyps. Analysis showed that higher total vitamin D intake was associated with a significantly reduced risk of early-onset CRC. The same link was found between higher vitamin D intake and risk of colon polyps detected before age 50. Senior co-author Kimmie Ng, MD, MPH, of Dana-Farber mentioned “[they] found that total vitamin D intake of 300 IU per day or more – roughly equivalent to three 8-oz. glasses of milk – was associated with an approximately 50% lower risk of developing young-onset CRC”.
https://www.cancerhealth.com/article/vitamin-d-may-protect-youngonset-colorectal-cancer
Image Source: https://www.healtheuropa.eu/65-of-brits-lack-vitamin-d/96785/
27. Association between Coffee Consumption and Risk of CRC in a Korean Population (Aug.11/21)
This study was performed to investigate the association between coffee consumption and risk of colorectal cancer (CRC) in a Korean population and examine whether the association can be altered by adjustment for intake of coffee additives. The study involved 923 CRC cases and 1846 controls matched by sex and age (within 5 years). A semi-quantitative food frequency questionnaire was used to assess coffee intakes.
High coffee consumption was associated with lower odds of developing CRC (_3 cups/day vs. no drinks). When the researchers additionally controlled for consumption of coffee additives including sugar and cream, the inverse association became stronger (_3 cups/day vs. no drinks), and a significant inverse linear trend was shown. The inverse associations were observed for proximal colon cancer, and rectal cancer in the stratified analysis by anatomical sub-sites. Regarding sex, inverse associations between coffee consumption and CRC were found for men and women. In the stratified analysis by obese status of subjects, inverse linear trends were observed in both non-obese and obese people.
High coffee consumption may be associated with a lower risk of CRC in the Korean population and the degree of decrease in the odds of developing CRC changes by adjustment for intake of coffee additives.
https://res.mdpi.com/d_attachment/nutrients/nutrients-13-02753/article_deploy/nutrients-13-02753.pdf
COVID-19 UPDATES
28. COVID-19 Vaccines and Cancer (Aug.13/21)
The two-dose Pfizer-BioNTech COVID-19 vaccine provides an effective immune response and is safe in people undergoing treatment for certain types of cancer, according to a study published in the June 2021, JAMA Oncology. Compared to individuals without cancer however, people with breast, colon and lung cancers, appear to have a “lagging” immune response to the vaccine.
Israeli researchers compared antibody responses after vaccination with the Pfizer-BioNTech vaccine in 232 adults receiving chemotherapy or radiation treatment for cancer with those of 220 healthy adults. After the first dose, 29% of the cancer patients had detectable antibodies in their blood, compared with 84% of those without the disease and 86% had detectable levels in their blood after the second dose.
Having cancer regardless of treatment status is a risk factor for worse outcome from infections including influenza and COVID-19. Thus, doctors are recommending vaccination to all cancer patients. For newly diagnosed cancer patients, it is best to vaccinate before treatment as the immune response to the vaccine may be impaired in patients receiving chemotherapy. The vaccine is optimally administered at least two weeks before chemotherapy starts. The question of how soon vaccination should occur after completion of chemotherapy or immunotherapy is still being investigated.
29. If You Received the Pfizer or Moderna Vaccines, Expect to Get a Booster Starting This Fall (Aug.22/21)
With the surging Delta variant battling whatever gains that months of vaccinations made against COVID-19, federal health officials are sending reinforcements in the form of booster shots. These should become available next month.
“The first part that is already happening is a third dose of vaccine recommended for those who are immunocompromised,” Dr. Mark Sawyer, an infectious disease specialist at UC-San Diego and Rady Children’s Hospital in San Diego, told Healthline. “It’s not considered so much a booster, but another chance to respond to the whole vaccination series, since some people with immunocompromising conditions don’t respond,” he explained. “The next part we will see is a true booster dose for those who have already had either one dose of Johnson & Johnson, or two doses of one of the mRNA vaccines,” Sawyer said. “The purpose of this dose is to boost the immune levels that may have worn off. This is especially important for protection from the Delta variant. This is expected to start mid to late September.”
According to the Centers for Disease Control and Prevention (CDC) guidelines updated August 20, individuals will be eligible for a booster 8 months after their final dose, once authorized by the Food and Drug Administration (FDA). On August 20, the CDC said the most at-risk people will be first in line for boosters, including healthcare professionals, residents of long-term care facilities, and other older adults. People who received the one-shot Johnson & Johnson vaccine can expect to need a booster as well. However, because it became available later than the other two-shot vaccines, the CDC is still compiling the necessary data to move forward with details.
30. English Study Finds Long COVID Affects Up To 1 in 7 Children Months After Infection (Sept.01/21)
The authors of an English study led by University College London and Public Health England, claim that as many as 1 in 7 children may have symptoms linked to the coronavirus months after testing positive for COVID-19. Even though children infrequently become severely ill with Covid-19, they can suffer lingering symptoms. The study found that 11 to 17 year-olds who tested positive for the virus were twice as likely to report three or more symptoms 15 weeks later than those who had tested negative.
The study observed 3,065 11 to 17 year-olds in England who tested positive in a PCR test between January and March of which 14% reported three or more symptoms such as unusual tiredness or headaches 15 weeks later, compared to 7% of the 3,739 who had tested negative over the same period. The researchers saw that in spite of the findings suggesting as many as 32,000 teenagers might have multiple symptoms linked to COVID-19 after 15 weeks, the prevalence of long COVID in the age group was lower than some had feared in 2020.
31. WHO Monitoring New Coronavirus Variant Named Mu (Sept.01/21)
On August 30th the World Health Organization added another version of coronavirus, the Mu variant (also known as B.1.621) to it’s list of “variants of interest” given the concerns that it may partially evade the immunity people have developed from past infection or vaccination. The Mu variant has been detected in 39 countries and according to the WHO “has a constellation of mutations that indicate potential properties of immune escape”.
In January 2021 the Mu variant was first identified in Colombia and since then sporadic cases and larger outbreaks have been recorded around the world including in the UK, Europe, the US and Hong Kong. The variant maybe gaining ground in Colombia and Ecuador where it accounts for 39% and 13% of Covid cases respectively, while it makes up less than 0.1% of Covid infections globally.
Of interest to scientists and public health officials is whether the Mu variant is more transmissible, or causes more serious disease, than the Delta variant that is dominant in much of the world. The WHO bulletin states ‘The epidemiology of the MU variant in South America, particularly with the co-circulation of the Delta variant, will be monitored for changes.’
In the UK, at least 32 cases of the Mu variant have been detected most of which were in people in theirs 20s. The pattern of infection suggests it was brought in by travelers. Some positive results were found among those with one or two doses of Covid vaccine.
https://www.theguardian.com/world/2021/sep/01/who-monitoring-new-coronavirus-variant-named-mu
32. Biden Administration Likely to Approve Covid-19 Boosters at Six Months (Aug.26/21)
President Joe Biden’s administration is planning to issue updated guidance recommending a third dose of Pfizer or Moderna’s vaccine be given to Americans 6 months after their second dose instead of 8 months as most vaccinated Americans say they’re ready for the next shot.
The administration announced the long-anticipated plans for boosters last week, recommending a third dose be given at least 8 months after the second. But federal regulators are now likely to decide a 6 month waiting period is preferable after reviewing information from vaccine manufacturers and other countries. A final plan will need to be approved by the CDC’s vaccine advisory committee and the FDA. Thus, distribution of the booster shots is expected to begin Sept. 20, pending final signoff by the FDA clearance and CDC. The Biden administration and vaccine manufacturers have indicated that there should be enough doses for any fully vaccinated adult seeking a third dose. Approval for a plan, which is also expected to include information on a Johnson & Johnson booster shot, is expected by mid-September.
33. Moderna Makes Twice as Many Antibodies as Pfizer, Study Says (Aug.31/21)
A study showed that Moderna Inc.’s Covid vaccine generated more than double the antibodies of a similar shot made by Pfizer and BioNTech SE. The study compared the levels of antibodies produced by the two vaccines which are believed to be one of the important components of the immune response. It did not look at whether the difference in antibodies led to a difference in efficacy over time between the two shots, both of which were more than 90% effective in final-stage clinical trials.
The study was conducted among 1,600 workers at a major Belgium hospital system looking at the antibody levels against the coronavirus spike protein in blood samples 6 to 10 weeks after vaccination. The participants had not been infected with the coronavirus before getting vaccinated. Results showed that the antibody levels among those who got two doses of the Moderna vaccine averaged 2,881 units per milliliter, compared with 1,108 units per milliliter among those who received two Pfizer doses. Such results propose the differences might be due to the higher amount of active ingredient in the Moderna vaccine which has 100 micrograms versus 30 micrograms in the Pfizer-BioNTech or the slightly longer interval between the doses of the Moderna vaccine at 4 weeks, versus three weeks for the Pfizer-BioNTech.
David Benkeser, a biostatistician at Emory University advised “I would urge caution in making the conclusion that because Moderna demonstrated a slightly higher peak on average that its efficacy will be slower to wane.” “Such a conclusion requires a host of assumptions that have not yet been evaluated.” He also noted both vaccines produce high levels of antibodies and other studies have shown even relatively low levels of antibodies are protective.
34. COVID-19 Updates: U.K. to Offer Booster Shots for Everyone Over 50 (Sept.14/21)
The United Kingdom will start giving COVID-19 booster shots to everyone over age 50, according to The Associated Press. The AP reported that a U.K. medical panel on vaccinations and immunizations advised that people over age 50 be allowed to get COVID-19 booster shots, as immunity may wane over the winter months. Healthcare workers and people who are immunocompromised will also be able to get COVID-19 vaccine boosters.
As more people return to the workplace after months working remotely, vaccination status is becoming a condition of employment, according to CNBC. Job postings requiring vaccination have spiked since the Food and Drug Administration (FDA) granted full approval to the Pfizer-BioNTech COVID-19 vaccine, according to jobs site Indeed, showing increasing numbers of employers requiring candidates be vaccinated, reported CNBC.
Image Source: https://www.health.com/condition/infectious-diseases/coronavirus/covid-19-booster-shot-side-effects
35. Risk Factors and Disease Profile of Post-Vaccination SARS-CoV-2 Infection in UK Users of the COVID Symptom Study App (Sept.01/21)
This study aimed to identify risk factors for post-vaccination SARS-CoV-2 infection and describe the characteristics of post-vaccination illness. Findings showed that frailty was associated with post-vaccination infection in older adults (≥60 years) after their first vaccine dose, and individuals living in highly deprived areas had increased odds of post-vaccination infection following their first vaccine dose. Individuals without obesity (BMI <30 kg/m2) had lower odds of infection following their first vaccine dose. Vaccination (compared with no vaccination) was associated with reduced odds of hospitalization or having more than five symptoms in the first week of illness following the first or second dose, and long-duration (≥28 days) symptoms following the second dose. Almost all symptoms were reported less frequently in infected vaccinated individuals than in infected unvaccinated individuals, and vaccinated participants were more likely to be completely asymptomatic, especially if they were 60 years or older.
To minimize SARS-CoV-2 infection, at-risk populations must be targeted in efforts to boost vaccine effectiveness and infection control measures. The study findings might support caution around relaxing physical distancing and other personal protective measures in the post-vaccination era, particularly around frail older adults and individuals living in more deprived areas, even if these individuals are vaccinated, and might have implications for strategies such as booster vaccinations.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00460-6/fulltext
36. Reopening and Vaccination Policies (Sept.09/21)
Canada is now firmly in the midst of a fourth wave of the COVID-19 pandemic. This is primarily due to the highly contagious delta variant, which now makes up nearly 90% of all reported cases of COVID-19 across the country. While these challenges are not new, a key difference in this wave is the role of vaccinations. According to the COVID-19 Vaccination Tracker, 78% of the eligible population – Canadians age 12+ – are fully vaccinated, while 85% of those eligible have received at least one dose. This translates to 68% of the overall Canadian population having received both doses of a vaccination and 74% having one. Additionally, there remains a large swath of the population – those age under 12 years of age – who are not yet eligible to receive a vaccine, and likely will remain ineligible until early next year.
A key, evolving conversation is the role of vaccination passports. In early August, the federal Liberal government committed to a national vaccine passport. However, timelines around this continue to be fluid and will likely continue to be, particularly in light of the current federal election. At the time of the announcement the federal government called on other jurisdictions to implement similar systems or use the emerging federal system. In the weeks since, provinces have taken a range of approaches. For instance, Quebec, B.C., Ontario, Newfoundland and Labrador are all in varying stages of introducing their own proof of vaccination systems – notably all are being referred to as vaccination cards, not passports. Additionally, these jurisdictions are implementing associated policies that articulate when and where proof of vaccination is required ie: for accessing restaurants, clubs, ticketed sporting events and organized social gatherings such as weddings.
To help make sense of the continually fluid landscape as it relates to the COVID-19 pandemic, Global Public Affairs is re-instating our COVID-19 tracking tools. Below you will find an overview of the current pandemic landscape across the country. Attached are an updated set of documents that provide highlights on where Canadian jurisdictions fall on key policy conversations, how they are evolving across governments and across the private sector, and steps each jurisdiction is taking in light of the evolving COVID pandemic.
Re-entry and Vaccination Status Policies
37. Pandemic Lockdown Tied to Worse Outcomes in mCRC (Sept.08/21)
One of the most pressing questions during the coronavirus pandemic has been its impact on cancer detection, diagnosis, and treatment. During the first Covid-19 surge, swamped health-care systems suspended cancer screenings and some in-person care while some people stayed away for fear of Covid-19 infection. A small new study from France is one of the first to show how diagnostic delays could lead to worse outcomes.
The paper, published Wednesday in JAMA Network Open, compared people newly diagnosed with metastatic colorectal cancer (mCRC) before and after the country’s 55-day pandemic lockdown in 2020. It found that 40 people diagnosed with mCRC after the lockdown had a tumor burden nearly 7x higher than 40 people diagnosed before the pandemic. For people with a higher tumor burden, their median survival decreased from 20 months to just under 15 months.
The researchers didn’t set out to study the pandemic’s impact on cancer. They were working on a large clinical trial using blood tests that measure circulating DNA to see if patients with metastatic colorectal cancer had certain genetic mutations that might respond to a targeted therapy. The researchers, led by Alain Thierry, director of research at INSERM and Institut de Recherche en Cancérologie de Montpellier, noticed significantly higher levels of circulating tumor DNA in most of the patients diagnosed after screening resumed on May 11, 2020, compared to 228 patients diagnosed before lockdown began on March 9, 2020. In their previous work, circulating DNA analysis had shown strong prognostic value.
Thierry said CRC should be a major target for any intervention to minimize Covid-related diagnostic delays. “Our data points first, to the crucial importance of early detection; second, to [the need] to maintain screening programs and diagnostic services during a pandemic; and third, to the need … to minimize patient’s fears by ensuring [better] communication,” he said.
Image Source: https://www.endsreport.com/article/1711151/pandemic-lockdown-slashed-carbon-emissions
38. Can Intranasal COVID Vaccines Help Stop the Spread? (Sept.05/21)
High on the list for reducing viral load and reducing the chance of people spreading the virus should be intranasal vaccines, which would stimulate nasal tissue immune factors (mucosal immunity) including local mucosal IgA.
Daniel Oran, MA, and Eric Topol, MD, from the Scripps Institute published an opinion piece in Scientific American in March highlighting reasons for pursuing intranasal vaccines and for providing financial incentives. As they discuss, these vaccines offer ease of administration and eliminate the issue of “needle phobia.” But these vaccines still need to demonstrate efficacy and safety in clinical trials. For some, there is concern about using an attenuated, live COVID-19 virus and the theoretical risk that the vaccine itself can cause the infection. However, this wouldn’t be the first vaccine of its kind.
Unfortunately, just a few intranasal vaccines are in necessary clinical trials with one recently being withdrawn (Altimmune’s AdCOVID, due to insufficient immune response).The leading contender among clinical trials is Bharat Biotech in India that has started phase II/III trials using a chimpanzee adenovirus which encodes the COVID-19 spike protein.
39. Frequently Asked Questions for COVID-19
Q: What is COVID-19 (or novel Coronavirus Disease – 19)?
A: Coronaviruses are a large family of viruses that can cause illnesses in humans and animals. Coronaviruses can cause illnesses that range in severity from the common cold, to more severe diseases such as Severe Acute Respiratory Syndrome (SARS) and most recently, COVID-19. COVID-19 or novel coronavirus originated from an outbreak in Wuhan, China in December 2019. The most common symptoms associated with COVID-19 can include fever, fatigue, and a dry cough. Though additional symptoms have now been linked with the disease, which may include aches and pains, nasal congestion, runny nose, sore throat, diarrhea, skin rash and vomiting. It is also possible to become infected with COVID-19 and not experience any symptoms or feeling ill. The spread of COVID-19 is mainly through the transmission of droplets from the nose or mouth when a person coughs, exhales or sneezes. These droplets land on surfaces around a nearby person. COVID-19 can be transmitted to that nearby person who may end up touching the surface contaminated with COVID-19 and then end up touching their nose, mouth, or eyes. A person can also contract COVID-19 through inhaling these droplets from someone with COVID-19. Although research is still ongoing, it is important to note that older populations (over the age of 65), those with a compromised immune system and those with pre-existing conditions including heart disease, high blood pressure, lung disease, diabetes or cancer may be at a higher risk of severe illness due to COVID-19.
https://www.who.int/news-room/q-a-detail/q-acoronaviruses)
Q: What can I do to avoid getting Coronavirus?
A: There are various ways in which we can reduce our risk of contracting COVID-19. Below are some measures suggested by the World Health Organization
- Keep at least 2 metres (or 6 feet) between yourself and other people. This will reduce the risk of inhaling droplets from those infected with COVID-19.
- Regularly clean your hands for at least 20 seconds with warm water and soap, or an alcohol-based hand rub. This will kill any viruses on your hands.
- Avoid touching your eyes, nose and mouth. If the virus is on your hands, it can enter the body through these areas.
- Follow good respiratory hygiene by covering your mouth and nose with a tissue or elbow when you cough and sneeze. This prevents the droplets from settling on surfaces or being released into the air around you.
- Stay home as much as possible, especially if you are feeling unwell. If you think you may have the Coronavirus, please see “What should I do if I think I have Coronavirus?” section.
- Please wear a face covering or mask in public when physical distancing is not possible.
https://www.who.int/news-room/q-adetail/q-a-coronaviruses
Q: Are there any treatments available for Coronavirus?
A: People with cancer are at a higher risk of severe illness due to COVID-19 as cancer is considered a pre-existing health issue. Some cancer treatments including chemotherapy, radiation and surgery can weaken the immune system, making it harder for the body to fight infections and viruses, such as Coronavirus. It is important to diligently follow the World Health Organization’s recommendations above to reduce the risk of contracting COVID-19. If you have any concerns about your risk, it is best to contact your doctor or healthcare team.
There are currently no treatments available for COVID-19 but trials are underway to determine how to best treat and manage those afflicted with the virus. Vaccine candidates are being vigorously tested in a number of countries around the world, Canada included. The US government is funding 3 major phase 3 trials on potential COVID-19 vaccines and all 3 trials are being conducted by 3 different pharmaceutical companies looking at different vaccine candidates. The hope is to have a vaccine by the end of the year!
Source: https://www.who.int/news-room/q-a-detail/q-acoronaviruses
Q: Are there special precautions that people with cancer can take?
A: People with cancer (and other chronic ailments such as heart disease, diabetes, high blood pressure and lung disease) are at a higher risk of severe illness due to COVID-19 as cancer is considered a pre-existing health issue. Some cancer treatments including chemotherapy, radiation and surgery can weaken the immune system, making it harder for the body to fight infections and viruses, such as Coronavirus. It is important to diligently follow the World Health Organization’s recommendations above to reduce the risk of contracting COVID-19. If you have any concerns about your risk, it is best to contact your doctor or healthcare team.
Will anything change with regards to my cancer related medical visits? As each patient and treatment plan is unique, it is always best to contact your health care provider for updated information about your treatment plan. In some cases, it is safe to delay cancer treatment until after the pandemic risk has decreased. In other cases, it may be safe to attend a clinic that is separate from where COVID-19 patients are being treated. Oral treatment options could be prescribed by your care provider virtually, without the need to attend the clinic. Finally, some follow-up appointments or discussions could be held virtually (via skype or zoom for example) or over the phone to minimize your risk. As we know, conditions and protocols are changing daily due to the nature of the COVID-19 outbreak, and vary based on location, therefore, the best first step is to reach out to your care provider for guidance.
https://www.cancer.gov/contact/emergencypreparedness/coronavirus
Should you wish to contact your local public health agency, please see below.
Alberta
COVID-19 info for Albertans
Social media: Instagram @albertahealthservices, Facebook @albertahealthservices, Twitter @GoAHealth
Phone number: 811
British Columbia
British Columbia COVID-19
Social media: Facebook @ImmunizeBC, Twitter @CDCofBC
Phone number: 811
Manitoba
Manitoba COVID-19
Social media: Facebook @manitobagovernment, Twitter @mbgov
Phone number: 1-888-315-9257
New Brunswick
New Brunswick Coronavirus
Social media: Facebook @GovNB, Twitter @Gov_NB, Instagram @gnbca
Phone number: 811
Newfoundland and Labrador
Newfoundland and Labrador COVID-19 information
Social media: Facebook @GovNL, Twitter @GovNL, Instagram @govnlsocial
Phone number: 811 or 1-888-709-2929
Northwest Territories
Northwest Territories coronavirus disease (COVID-19)
Social media: Facebook @NTHSSA
Phone number: 811
Nova Scotia
Nova Scotia novel coronavirus (COVID-19)
Social media: Facebook @NovaScotiaHealthAuthority , Twitter @healthns, Instagram @novascotiahealthauthority
Phone number: 811
Nunavut
Nunavut COVID-19 (novel coronavirus)
Social media: Facebook @GovofNunavut , Twitter @GovofNunavut, Instagram @governmentofnunavut
Phone number: 1-888-975-8601
Ontario
Ontario: The 2019 Novel Coronavirus (COVID-19)
Social media: Facebook @ONThealth, Twitter @ONThealth , Instagram @ongov
Phone number: 1-866-797-0000
Prince Edward Island
Prince Edward Island COVID-19
Social media: Facebook @GovPe, Twitter @InfoPEI,
Quebec
Coronavirus disease (COVID-19) in Québec
Social media: Facebook @GouvQc, Twitter @sante_qc
Phone number: 1-877-644-4545
Saskatchewan
Saskatchewan COVID-19
Social media: Facebook @SKGov, Twitter @SKGov
Phone number: 811
Yukon
Yukon: Find information about coronavirus (COVID-19)
Social media: Facebook @yukonhss, Twitter @hssyukon
Phone number: 811