A PATIENT-FOCUSED ORGANIZATION
COLORECTAL CANCER TREATMENT & CLINICAL RESEARCH UPDATES
Month Ending October 14th, 2021
The following colorectal cancer treatment and research updates extend from September 16th, 2021 to October 14th, 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. LUMAKRAS™ (Sotorasib) Combined with Vectibix® (Panitumumab) Showed Encouraging Efficacy and Safety in Patients with KRAS G12C-Mutated CRC
6. Adavosertib for RAS-/TP53-Mutant mCRC Reduced Risk of Progression, Death
7. Active Monitoring Compared to Maintenance Capecitabine is a Viable Alternative for Stable mCRC
8. HER2 Expression Level Associated With Antitumor Activity of Trastuzumab Deruxtecan for HER2-Positive mCRC
9. FDA Approves Erbitux Plus Braftovi for Pretreated CRC Subtype
10. Hepatic Artery Infusion Pump (HAIP) Chemotherapy Program – Sunnybrook Hospital
11. Living Donor Liver Transplantation for Unresectable Colorectal Cancer Liver Metastases
12. Hepatectomy With or Without Adjuvant mFOLFOX6 for Liver-Only mCRC: Disease-Free and Overall Survival
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. Young Adult CRC Clinic Available at Sunnybrook Hospital
16. CCRAN’s Partnership with Count Me In
17. Hereditary Cancer Online Survey
18. Cleveland Clinic Launches Center for Young-Onset CRC
19. Clinical Trials Are an Integral Part of Cancer Treatment and Should be Considered
20. Research Finds Possible Connection Between Bacteria and Bowel Cancer
21. Having a Cousin or Grandparent With Colon Cancer Raises Your Risk
22. NRG Oncology Launches Highly Anticipated CRC Prevention Study
23. Six Ways to Reduce Your Risk of Colon Cancer
24. Physical Activity after CRC Diagnosis and Mortality in a Nationwide Retrospective Cohort Study
25. Vitamin D May Protect Against CRC, New Research Finds
26. Spinach Reduces Colon Cancer Risk: Study Explores How
27. Began Exercising While Working Remotely? How to Maintain After Returning to the Office
28. COVID-19 Vaccines and Cancer
29. Third COVID Vaccine Dose Boosts Protection in Solid Tumor Patients
30. Yes, You’re Fully Vaccinated Even if You Haven’t Had a Booster Shot
31. Why Black, Native American, and Latino Communities Experience Higher COVID-19 Death Rates
32. Reopening and Vaccination Policies
33. 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. LUMAKRAS™ (Sotorasib) Combined with Vectibix® (Panitumumab) Showed Encouraging Efficacy and Safety in Patients with KRAS G12C-Mutated CRC (Sept.16/21)
Data from the Phase 1b/2 CodeBreaK 101 study show that combining LUMAKRAS™ (sotorasib) with Vectibix® (panitumumab), Amgen’s monoclonal antibody epidermal growth factor receptor (EGFR) inhibitor, demonstrated encouraging efficacy and safety in patients with KRAS G12C-mutated advanced colorectal cancer (CRC). Overall, the objective response rate (ORR) was 27% (confirmed and unconfirmed) among 26 patients in the efficacy analysis set (which included 5 patients who had progressed with prior sotorasib monotherapy). The disease control rate (DCR) was 81%. In the expansion cohort of sotorasib-naïve patients with refractory CRC, 33% of patients experienced a response (confirmed and unconfirmed). “With treatment response rates being as low as 2% in patients with colorectal cancer who progress in advanced stages, developing new treatment approaches for these patients is of critical interest,” said Marwan G. Fakih, M.D., primary study investigator and co-director of the Gastrointestinal Cancer Program, City of Hope, Duarte, California.
https://www.biopharmadive.com/news/amgen-lumakras-colorectal-cancer-combination/606700/
6. Adavosertib for RAS-/TP53-Mutant mCRC Reduced Risk of Progression, Death (Sept.21/21)
For patients with TP53-/RAS-mutant metastatic colorectal cancer (mCRC) following first-line chemotherapy, adavosertib resulted in a 65% reduction in the risk of disease progression or death when compared with active monitoring, according to results of the phase 2 FOCUS4-C trial. Findings, which were also published in the Journal of Clinical Oncology, showed that the median progression-free survival (PFS) was nearly doubled with adavosertib, at 3.61 months compared with 1.87 months for active monitoring. Additional data showed that the median overall survival (OS) was 13.1 months with adavosertib and 11.3 months with active monitoring, which was not found to be statistically significant. However, lead study author Jenny F. Seligmann, , noted that these data are immature.
“Although these results are provocative, we would consider them exploratory, and ongoing translational work shall investigate possible mechanistic explanations for these interesting results,” Seligmann said. Regarding safety, most adverse effects (AEs) reported with adavosertib were grade 1 or 2; a grade 3 or higher AE that occurred in more than 5% of patients on the 200-mg dose was fatigue (9%). On the 300-mg dose, grade 3 or higher AEs (≥5%) included diarrhea (14%), fatigue (14%), and nausea (5%).
7. Active Monitoring Compared to Maintenance Capecitabine is a Viable Alternative for Stable mCRC (Sept.20/21)
This study conducted in the United Kingdom compared outcomes of progression-free survival (PFS), overall survival (OS), toxicity, and safety in either maintenance therapy with capecitabine or active monitoring in a randomized trial of 254 adult patients with metastatic colorectal cancer (mCRC). A total of 254 patients were randomized, with 127 to each of the study arms [capecitabine (a pro-drug that is activated by tumour cells) versus active monitoring (AM)]. Patients in the first treatment arm were requested to take capecitabine until disease progression, intolerable toxicity, or death.
PFS was increased in the treatment arm, but no significant improvement in OS was seen. Toxicity was greater in the treatment arm, while quality of life (QoL) was similar between study arms. Assessment of QoL included measures such as usual activities, self-care, anxiety/depression, or mobility. Pain/discomfort was somewhat less in the treatment arm though not statistically significant, and the authors suggested this may be because of the progression rates in the active monitoring study arm.
Image Source: https://www.ccalliance.org/colorectal-cancer-information/managing-the-disease/monitoring-for-colorectal-cancer
8. HER2 Expression Level Associated With Antitumor Activity of Trastuzumab Deruxtecan for HER2-Positive mCRC (Sept.22/21)
“This exploratory biomarker analysis suggests an association between baseline HER2 expression level or amplification and the antitumor activity of the drug fam-trastuzumab deruxtecan-nxki (T-DXd). The multicenter, open-label trial enrolled patients with unresectable or metastatic HER2-expressing, RAS/BRAF V600E wild-type CRC who had received at least 2 prior regimens. Prior HER2-directed treatment was allowed. Patients were divided into 1 of 3 cohorts: A, B, or C.
As of the December 28, 2020, cutoff, in cohort A, the objective response rate (ORR) was 45.3%, which consisted of all partial responses (PRs). A total of 37.7% (n = 20) of patients experienced stable disease, 9.4% (n = 5) of patients experienced progressive disease, and 7.5% (n = 4) of patients were not evaluable. The median progression-free survival (PFS) was 6.9 months, and the median overall survival (OS) was 15.5 months. The median duration of response (DOR) was 7.0 months, and the disease control rate (DCR) was 83.0%. The median treatment duration was 5.1 months. By HER2 status, the ORR was 7.7% in the IHC2+/ISH+ group vs 57.5% in the IHC3+ group.
“Interpretation is limited by the small sample size; therefore, further investigation into potential mechanisms of resistance and response to and patient selection for T-DXd in HER2-positive mCRC is warranted,” concluded Salvatore Siena, MD, a professor of medical oncology at the Universita degli Studi di Milano and director of the Niguarda Cancer Center at Grande Ospedale Metropolitano Niguarda in Milan, Italy.
9. FDA Approves Erbitux Plus Braftovi (Encorafenib) for Pretreated CRC Subtype (Sept.29/21)
The Food and Drug Administration (FDA) approved a new indication for Erbitux (cetuximab) plus Braftovi (encorafenib) for pretreated BRAF V600E-mutant metastatic colorectal cancer (mCRC), according to Lilly, the manufacturer of Erbitux. The approval is based on findings from the phase 3 BEACON CRC trial, which demonstrated that the drug combination led to an average overall survival (time that a patient with cancer is still alive after starting treatment) rate of 8.4 months compared with 5.4 months in patients in the control group who received irinotecan with Erbitux or FOLFIRI (a chemotherapy combination to treat metastatic colorectal cancer) with Erbitux. A total of 20% of patients who received Erbitux and Braftovi responded to treatment, while only 2% did in the control group. Average progression-free survival — defined as time patients lived without their disease getting worse — was 4.2 months and 1.5 months in the combination and control groups, respectively.
“The BEACON study showed that the combination of Erbitux and (Braftovi) significantly improved overall survival in patients with mCRC with a BRAF V600E mutation — a subtype that typically has worse outcomes compared to those without the mutation,” said Dr. David Hyman, chief medical officer of oncology at Lilly, in a statement.
SURGICAL THERAPIES
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.
http://sunnybrook.ca/content/?page=colorectal-colon-bowel-haip-chemotherapy
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.”
https://clinicaltrials.gov/ct2/show/NCT02864485
12. Hepatectomy with or Without Adjuvant mFOLFOX6 for Liver-Only mCRC: Disease-Free and Overall Survival (Sept.28/21)
In the Japanese phase II/III JCOG0603 trial reported in the Journal of Clinical Oncology, 300 patients with any number of liver metastases were randomly assigned between March 2007 and January 2019 to hepatectomy followed by 12 cycles of mFOLFOX6 (fluorouracil, leucovorin, and oxaliplatin) (n = 151) or hepatectomy alone (n = 149).
At the third interim analysis, with a median follow-up of 53.6 months, the trial was terminated early according to protocol on the basis of significantly prolonged disease-free survival in the hepatectomy/chemotherapy group vs the hepatectomy group. Disease-free survival was 52.1% vs 41.5% at 3 years and 50.1% vs 37.3% at 5 years. At an updated analysis with a median follow-up of 59.2 months, 5-year disease-free survival was 49.8% vs 38.7%. At the updated analysis, overall survival was 87.2% vs 91.8% at 3 years and 71.2% vs 83.1% at 5 years.
The investigators concluded, “Disease-free survival did not correlate with overall survival for liver-only metastatic colorectal cancer (mCRC). Adjuvant chemotherapy with mFOLFOX6 improves disease-free survival among patients treated with hepatectomy for CRC liver metastasis. It remains unclear whether chemotherapy improves overall survival.”
RADIATION THERAPIES/INTERVENTIONAL RADIOLOGY
13. 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
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.
OTHER
15. 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
16. 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.
“Count Me In”, a nonprofit cancer research initiative, is inviting all patients across the United States and Canada who have ever been diagnosed with colorectal cancer (CRC) to participate in research and help drive new discoveries related to this disease. The Colorectal Cancer Project will enable patients to easily share their samples, health information and personal lived experiences directly with researchers in order to accelerate the pace of research.
Patients who have been diagnosed with CRC at any point in their lives can join the project by visiting JoinCountMeIn.org/colorectal. From there, patients will be invited to share information about their experience through surveys and to provide access to medical records as well as saliva samples and optional blood, stool, and/or stored tissue samples for study and analysis. Researchers from the Broad Institute of MIT and Harvard and Dana-Farber Cancer Institute use this information to generate databases of clinical, genomic, molecular, and patient-reported data that is then de-identified and shared with researchers everywhere. To date, more than 9,000 patients with different cancers have joined Count Me In and shared their data.
“We still do not know why there is an alarming rise in CRC in young adults”, said Andrea Cercek, MD Co-Director, Center for Young Onset Colorectal and Gastrointestinal Cancers Memorial Sloan Kettering Cancer Center and co-scientific leader of the Colorectal Cancer Project. “What we do know is that this is a global phenomenon that affects otherwise healthy individuals with no known risk factors. The Colorectal Cancer Project will provide researchers important information that will lead to a better understanding of this disease.”
17. Hereditary Cancer Online Survey (Oct.07/21)
Researchers at Memorial University are conducting an online survey study about how patients at risk for hereditary cancer share risk information with their families. Studies have shown that approximately 50% of the relatives of probands who carry BRCA1/2 or Lynch mutations attend genetic counselling and testing. This means a large percentage of those at risk for these hereditary cancers are not accessing genetic testing and risk-reducing management options.
We are interested in whether methods of outreach beyond sharing a family letter might be preferred by these families, including direct contact by a healthcare provider or genetics service. Ultimately, we hope to collect information on preferences for receiving and sharing information on hereditary cancer predisposition and the factors that may influence these preferences.
Your help would be appreciated with advertising the survey. It takes 15-20 minutes to complete and is relevant to all families with an identified BRCA or Lynch syndrome mutation which can cause colorectal cancer. Please complete or share this survey link widely through your network(s): Qualtrics Survey | Qualtrics Experience Management
If you have questions regarding your rights as a research participant, please contact the Health Research Ethics Authority at (709) 777-6974 or info@hrea.ca.
18. Cleveland Clinic Launches Center for Young-Onset CRC (Sept.21/21)
“More research is needed to better understand what is causing the rise of colorectal cancer (CRC) cases in young adults,” said David Liska, M.D., colorectal surgeon and director of the Center for Young-Onset CRC. “We now have a center dedicated to early-onset CRC, with a specific focus on treatment, care, and research.”
Younger patients often have diagnostic and treatment considerations that are specific to their age. A CRC diagnosis can interrupt their most productive years. To provide a personalized care plan, the center brings together a multidisciplinary team that includes specialists in surgery, oncology, radiation therapy, genetics, gastroenterology, fertility, psychology, and lifestyle medicine. “The new center will allow us to take a comprehensive approach to the research, diagnosis and treatment of early-onset CRC,” said Scott Steele, M.D., MBA, chair of Cleveland Clinic’s Department of Colorectal Surgery.
Dr. Liska added that a “worrying trend that I have seen with patients under 50 is that they get diagnosed with colorectal cancer after having experienced symptoms for quite some time. It is important to know what factors can increase the risk of developing CRC, what symptoms to be vigilant about, and when to get screened.”
19. Clinical Trials Are an Integral Part of Cancer Treatment and Should be Considered (Jul.02/21)
Cancer clinical trials are studies that evaluate the effectiveness and safety of new cancer drugs or cancer treatment strategies. The development of more effective cancer treatment requires that new and innovative therapies be evaluated with cancer patients. Each clinical trial is designed to find new or better ways to treat cancer patients. In oncology, clinical trials are especially important because, in the absence of high cure rates, nearly all cancer treatment approaches are developmental in nature. Many medical professionals encourage those diagnosed with cancer to at least consider participating in a clinical trial in addition to other treatment options.
Is a clinical trial right for you?
Pros of Clinical Trials:
- Participating patients are treated with carefully designed cancer treatment regimens that are either the best standard treatments available or approaches that may become standard treatments.
- Participation is an integral part of the research process.
- In some cases the best cancer treatment may be available only in a clinical trial.
- Participants receive correct dosages as a result of carefully designed regimens and strict protocol, and correct dosage often contributes to the effectiveness of a cancer treatment regimen.
- The medical community gains knowledge about the treatment of cancer that can be used to treat other cancer patients and to develop newer cancer treatments.
The Cons of Clinical Trials:
- Clinical trials are not available for all cancers or all patients.
- Patients in Phase III clinical trials are assigned at random to either the experimental or control group—a
- process that makes some people uncomfortable.
- Participation in a clinical trial may offer no benefit.
Image Source: https://www.spectrumnews.org/news/sponsors-of-clinical-trials-may-report-data-late-or-never/
20. Research Finds Possible Connection Between Bacteria and Bowel Cancer (Oct.01/21)
Published in the leading gastroenterology journal Gut, findings of new research can help clinicians to identify patients at risk of poorer outcomes and make decisions on treatment options for patients with bowel cancer whose tumors are infected with the bacterium Fusobacterium nucleatum.
Using genomic sequencing, researchers are now able to detect traces of an infection with bacteria or other microbes in patients’ tumors that previously would have been undetectable. The research found that a collection of bacteria that normally lives in the oral cavity infects bowel tumors, changes how tumor cells behave, and may trigger the spread of the tumor to other organs. The study suggests that there is a direct relationship between the presence of a bacteria called Fusobacterium nucleatum and the spread of bowel cancer resulting in poorer outcomes for a subset of patients. Lead researcher, Jochen Prehn, Professor of Physiology and Director of the Centre for Systems Medicine at RCSI said: “An effective tool to help oncologists to personalize colorectal cancer (CRC) treatment is urgently needed.”
21. Having a Cousin or Grandparent With Colon Cancer Raises Your Risk (Sept.15/21)
A new study conducted by the University of Buffalo found that colon cancer risk goes beyond a parent or siblings having had the disease. The odds of having the disease increases substantially if one has a second- or third degree relative who had colon cancer at an early age (defined as before 50). First-degree relatives include parents, children and siblings. Second-degree relatives include aunts, uncles, grandparents, grandchildren, nieces and nephews. Third-degree relatives include first cousins, great-grandparents and great-grandchildren. The study found that first-degree relatives of someone with early-onset colon cancer are 6x more likely to develop colon cancer before age 50; second-degree relatives 3x more likely and third-degree 1.5x more likely.
22. NRG Oncology Launches Highly Anticipated CRC Prevention Study (Oct.06/21)
On October 6th, 2021, NRG Oncology activated the highly anticipated colorectal cancer (CRC) prevention trial, FORTE, NRG-CC005. FORTE is a large, randomized trial of surveillance colonoscopy for participants with a first-time diagnosis of 1 or 2 small benign polyps, called adenomas. Participants in the study will be assigned to having their next colonoscopy exam at 5 years and at 10 years or their next colonoscopy exam at 10 years. The study is expected to enroll 9,500 participants (about 4,750 people in each study group).
The primary objective of the study is to determine whether people who had 1 or 2 small benign polyps removed during colonoscopy should have their repeat colonoscopy exam at 10 years or at both 5 years and at 10 years. Participants in FORTE are also being asked to submit blood, stool, and tissues from polyps as part of the research.
NUTRITION/HEALTHY LIFESTYLE
23. Six Ways to Reduce Your Risk of Colon Cancer (Sept.20/21)
Here are some recommendations to reduce your risk of developing colon cancer:
- Eat more plant-based foods
- A 2015 study found that a plant-based diet decreased the risk of colon cancer by 49%, compared with a typical American diet that includes high meat consumption.
- Another 2015 study concluded that a plant-based diet “provides robust benefits against a multitude of cancers while presenting virtually no threat of unwanted side effects.”
- Eat less red meat and processed meats
- A 2005 European study that followed 478,000 men and women found that those who ate the most red meat, approximately 5 ounces or more per day, were more likely to develop colon cancer than those who ate the least red meat, less than 1 ounce a day.
- A 2015 meta-analysis also concluded that eating red meat and processed meat “convincingly increases the risk of colon cancer by 20-30%.”
- Reduce or avoid alcohol consumption
- A 2018 study on alcohol consumption and colorectal cancer found that alcohol is one of the largest contributors to the development of colorectal cancer (CRC).
- A new 2021 study from the World Health Organization also confirmed a link between alcohol and a higher risk of colon cancer.
- If you smoke, try to quit
- A 12-year study of over 180,000 people found an association between cigarette smoking and the risk of colon cancer. According to the study, the risk was greatest among current, long-time smokers. The risk decreased for former smokers who stopped smoking before the age of 40 or who had not smoked for more than 31 years.
- Manage your weight
- According to the National Cancer Institute, people with overweight or obesity are about 30% more likely to develop colon cancer than those without the conditions. In addition, a high body mass index (BMI) is linked to increased risks of colon and rectal cancers, particularly in men.
- Get daily physical activity
- A 2019 study found that physical activity may not only prevent approximately 15% of colon cancers, but may also decrease the mortality risk and recurrence of colon cancer before and after diagnosis.
https://www.healthline.com/health/colorectal-cancer/colon-cancer-prevention#importance-of-screening
24.Physical Activity after CRC Diagnosis and Mortality in a Nationwide Retrospective Cohort Study (Sept.25/21)
Physical activity can help to prevent colorectal cancer (CRC), but its importance after cancer diagnosis remains unclear. In this nationwide insurance data-based study of 43,596 CRC patients, subgroup analyses were performed by treatment group. In the surgically treated group, a high level of activity (the weighted sum of the frequencies for walking, moderate, and vigorous activity greater than or equal to 3 times/week) was inversely associated with all-cause mortality and CRC specific mortality. No significant results were shown for cardiovascular disease-specific mortality. No association was shown in patients who received chemoradiotherapy without surgery. The present study may provide evidence for post-diagnosis physical activity as a prognostic factor in colorectal cancer, particularly in surgically treated early-stage patients.
https://www.mdpi.com/2072-6694/13/19/4804
Image Source: https://www.hhmglobal.com/knowledge-bank/news/why-is-physical-activity-so-important-for-health-and-wellbeing
25.Physical Activity after CRC Diagnosis and Mortality in a Nationwide Retrospective Cohort Study (Sept.25/21)
According to new research in the journal of Gastroenterology, Vitamin D has been linked to reducing your risk of colorectal cancer (CRC). Foods high in Vitamin D include salmon, cheese, fortified dairy products, beef liver and egg yolks.
The study was based on data from approx. 95,000 women who participated in the Nurses’ Health Study II over a 24-year timespan. The study showed that those who consumed foods with higher vitamin D content had a 50% lower risk of developing CRC especially when they were younger. Study co-author Kimmie Ng M.D. stated that previous research also showed the correlation between anti-cancer activity and Vitamin D consumption, however this recent study is a big deal as it found the correlation exists for young people both men and women where we are seeing a spike in CRC cases.
https://www.runnersworld.com/news/a37503014/vitamin-d-may-protect-against-colorectal-cancer-study
Image Source: https://www.shutterstock.com/search/vitamin+d?image_type=illustration
26.Spinach Reduces Colon Cancer Risk: Study Explores How (Oct.01/21)
Prior research has concluded that eating spinach can reduce the risk of colon cancer by as much as 50%.
A new study conducted by the TAMU (Texas A&M University) Health Science Center reaffirms that spinach can actually slow polyp growth in people with either genetic or nongenetic colon cancer. The study looked specifically at the benefit of spinach for individuals with a genetic form of colorectal cancer called familial adenomatous polyposis. Most patients with this form of colorectal cancer will eventually require surgery to remove the colon due to the growth of multiple, sometimes hundreds of noncancerous colon polyps, followed by nonsteroidal anti-inflammatory drugs (NSAIDS) to prevent polyps from growing in the duodenum. After feeding freeze-dried spinach to rats with familial adenomatous polyposis for 26 weeks, the study confirmed that eating spinach slows down polyp growth and could delay the need for that intensive treatment.
To understand why spinach was so effective in slowing polyp growth, the researchers utilized a data-driven methodology called multi-omics. They discovered that the anti-polyp effect of spinach stems from metabolic interactions between fatty acids and linoleic acid derivatives. Senior investigator Dr. Roderick Dashwood advises that people should start to consume spinach as a preventive measure against the development of colorectal cancer, he stated “the sooner, the better”.
https://www.medicalnewstoday.com/articles/spinach-reduces-colon-cancer-risk-study-explores-how
Image Source: https://www.everydayhealth.com/cancer-photos/top-foods-to-fight-cancer.aspx
27. Began Exercising While Working Remotely? How to Maintain After Returning to the Office (Oct.05/21)
A survey found that almost 60% of non-exercisers pre-pandemic are now actively exercising an average of 2.64x a week since returning to the office. Those who exercised one to two times each week increased their exercise frequency by 126%, those who exercised up to three times each week increased to 4x while those who exercised the most- four or more times each week had dropped by 14.16 % when they returned to traditional schedules.
Experts say the key to maintaining a regular fitness routine is to start low with less strenuous activities and progress gradually. If possible try to build in movement in regular routines, like walk to store instead of driving. It’s important to make sure you enjoy the type of exercise you’re doing in order to help you stick to new routines and maintain a higher level of fitness. Having a workout buddy can also be a motivator to maintain a new exercise routine. Exercise can be the perfect way to improve one’s sense of well-being, mood, energy, and cognitive functioning.
COVID-19 UPDATES
28. COVID-19 Vaccines and Cancer (Oct.06/21)
The VOICE study measured responses to Moderna’s two-dose mRNA-1273 vaccine. The study enrolled 791 patients with solid tumors from hospitals throughout the Netherlands and placed them in four cohorts: individuals without cancer; patients with cancer treated with immunotherapy; patients treated with chemotherapy; and patients treated with a chemo-immunotherapy combination. The patients received antibody tests 28 days after the second shot. Adequate antibody levels – by the researchers’ own definition – were found in 84% of patients receiving chemotherapy, 93% receiving immunotherapy, and 89% receiving a chemo-immunotherapy combination, compared to 99.6% of individuals without cancer.
The relative risk of developing COVID-19 was 21.5x higher for unvaccinated patients with cancer than for vaccinated patients with cancer, according to findings from a real-world study in over 1000 patients presented at the European Society for Medical Oncology Congress 2021. Most vaccinated patients reported no side effects (39%) or mild ones (43%) and 2.4% reported severe side effects typically lasted 1 to 3 days. The most common were sore arm, headache, fatigue, and increased temperature. Less common were swollen lymph nodes (0.7%) and allergic reactions (0.7%). Thus, most experts recommend vaccination as long as the vaccine is safe for use, even if the expected protection rate is lower than the general population because the risks of getting COVID-19 infection in patients with cancer is significant.
29. Third COVID Vaccine Dose Boosts Protection in Solid Tumor Patients (Oct.01/21)
One week after the administration of a third vaccine dose, neutralizing antibody responses improved in 80% of solid tumor patients undergoing chemotherapy, with adverse events that were mild in nature, reported Rachna T. Shroff, MD, MS, of the University of Arizona Cancer Center in Tucson, and colleagues. “These results suggest that a third dose of BNT162b2 is safe, improves humoral immunity against SARS-CoV-2, and could be immunologically beneficial for patients with cancer on active chemotherapy,” the team wrote in the study online in Nature Medicine.
The study was designed to evaluate immune responses after the two-dose Pfizer COVID-19 vaccine in patients with solid tumors on active immunosuppressive cancer therapy (n=53), compared with healthy controls (n=50). This was followed by a phase I trial of a third vaccine dose initiated in the cancer cohort based on the two-dose results. Of the 53 cancer patients, 20 participated in the phase I interventional trial to determine if immunity could be improved with a third vaccine dose. After the third vaccine dose, neutralizing antibody levels improved in 16 of the 20 patients, with titers reaching 180 or higher in 15 of the patients who improved. No improvements were observed in T-cell responses.
Image Source: https://healthblog.uofmhealth.org/wellness-prevention/should-you-get-a-third-dose-of-covid-vaccine
30. Yes, You’re Fully Vaccinated Even if You Haven’t Had a Booster Shot (Oct.05/21)
Individuals are considered fully vaccinated in the United States if they have received the Johnson & Johnson shot or both doses of the Pfizer and Moderna shots, even with the Food and Drug Administration’s (FDA) recent authorization of booster doses for select groups. To help increase their immune response against COVID-19, booster shots are available for the various at-risk groups, including older adults, immunocompromised individuals, those with underlying health conditions, and people whose jobs increase their chances of being exposed to the coronavirus. According to the Centers for Disease Control and Prevention, hospitalization rates are 10 to 22 times higher among unvaccinated people than vaccinated people. The vaccines remain highly effective at preventing severe illness along with hospitalization and death.
Image Source: https://www.inquirer.com/philly-tips/cdc-guidelines-vaccinated-20210308.html
31. Why Black, Native American, and Latino Communities Experience Higher COVID-19 Death Rates (Oct.04/21)
Researchers released a study in the journal Annals of Internal Medicine reporting that the death rate from COVID-19 is materially higher in Black, Native American and Latino communities than any other group in the United States. COVID-19 has widened racial and ethnic disparities. Some factors contributing to the higher death rates for those groups are unequal access to healthcare services, underlying medical conditions like high blood pressure and diabetes which result in more severe COVID-19 and jobs that require employees to work closely with the public not allowing for social distancing or remote work. The COVID-19 pandemic and study has been a wake-up call and has put a spot light on areas requiring focus and attention; the need to improve medical services, housing, and job opportunities for Communities of Color.
32. Reopening and Vaccination Policies (Oct.07/21)
Appearing below 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.
33. 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 special precautions that people with cancer can take?
A: People with cancer (and other chronic ailments such as heart disease, diabetes, high blood pressure and lung disease) are at a higher risk of severe illness due to COVID-19 as cancer is considered a pre-existing health issue. Some cancer treatments including chemotherapy, radiation and surgery can weaken the immune system, making it harder for the body to fight infections and viruses, such as Coronavirus. It is important to diligently follow the World Health Organization’s recommendations above to reduce the risk of contracting COVID-19. If you have any concerns about your risk, it is best to contact your doctor or healthcare team.
Will anything change with regards to my cancer related medical visits? As each patient and treatment plan is unique, it is always best to contact your health care provider for updated information about your treatment plan. In some cases, it is safe to delay cancer treatment until after the pandemic risk has decreased. In other cases, it may be safe to attend a clinic that is separate from where COVID-19 patients are being treated. Oral treatment options could be prescribed by your care provider virtually, without the need to attend the clinic. Finally, some follow-up appointments or discussions could be held virtually (via skype or zoom for example) or over the phone to minimize your risk. As we know, conditions and protocols are changing daily due to the nature of the COVID-19 outbreak, and vary based on location, therefore, the best first step is to reach out to your care provider for guidance.
https://www.cancer.gov/contact/emergencypreparedness/coronavirus
Should you wish to contact your local public health agency, please see below.
Alberta
COVID-19 info for Albertans
Social media: Instagram @albertahealthservices, Facebook @albertahealthservices, Twitter @GoAHealth
Phone number: 811
British Columbia
British Columbia COVID-19
Social media: Facebook @ImmunizeBC, Twitter @CDCofBC
Phone number: 811
Manitoba
Manitoba COVID-19
Social media: Facebook @manitobagovernment, Twitter @mbgov
Phone number: 1-888-315-9257
New Brunswick
New Brunswick Coronavirus
Social media: Facebook @GovNB, Twitter @Gov_NB, Instagram @gnbca
Phone number: 811
Newfoundland and Labrador
Newfoundland and Labrador COVID-19 information
Social media: Facebook @GovNL, Twitter @GovNL, Instagram @govnlsocial
Phone number: 811 or 1-888-709-2929
Northwest Territories
Northwest Territories coronavirus disease (COVID-19)
Social media: Facebook @NTHSSA
Phone number: 811
Nova Scotia
Nova Scotia novel coronavirus (COVID-19)
Social media: Facebook @NovaScotiaHealthAuthority , Twitter @healthns, Instagram @novascotiahealthauthority
Phone number: 811
Nunavut
Nunavut COVID-19 (novel coronavirus)
Social media: Facebook @GovofNunavut , Twitter @GovofNunavut, Instagram @governmentofnunavut
Phone number: 1-888-975-8601
Ontario
Ontario: The 2019 Novel Coronavirus (COVID-19)
Social media: Facebook @ONThealth, Twitter @ONThealth , Instagram @ongov
Phone number: 1-866-797-0000
Prince Edward Island
Prince Edward Island COVID-19
Social media: Facebook @GovPe, Twitter @InfoPEI,
Quebec
Coronavirus disease (COVID-19) in Québec
Social media: Facebook @GouvQc, Twitter @sante_qc
Phone number: 1-877-644-4545
Saskatchewan
Saskatchewan COVID-19
Social media: Facebook @SKGov, Twitter @SKGov
Phone number: 811
Yukon
Yukon: Find information about coronavirus (COVID-19)
Social media: Facebook @yukonhss, Twitter @hssyukon
Phone number: 811
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