UNE ORGANISATION CENTRÉE SUR LE PATIENT
TRAITEMENT DU CANCER COLORECTAL ET MISES À JOUR SUR LA RECHERCHE CLINIQUE
Month Ending January 13,, 2022
The following colorectal cancer treatment and research updates extend from November 18,, 2021, to January 13,, 2022, inclusive and are intended for informational purposes only.
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CONTENU
1. Phase II LEAP Clinical Trial to Treat mCRC.
2. TRK Fusion Cancer and How to Test For It
3. Une étude de phase II, ouverte et multicentrique, d'un traitement immunothérapeutique pour la population présentant un cancer colorectal métastatique élevé
4. Étude de phase III au centre de cancérologie Odette comparant l'arfolitixorine et la leucovorine : toutes deux en association avec le 5FU, l'oxaliplatine et le bevacizumab chez des patients atteints d'un cancer colorectal avancé
5. FDA Grants Fast Track Designation to Arfolitixorin for mCRC
6. ERAS-007 will be Evaluated Initially in Combinations That Could Address Over Half of Patients with CRC
7. Sotorasib Shows Activity in Advanced CRC with KRAS. G12C Mutation
8. New Treatment Could Be a Better Option for Patients with Colon Cancer
9. Better Biomarker Choice Could Benefit CRC Patients
10. Trifluridine/Tipiracil Combination Misses Mark in Metastatic Colon Cancer
11. Hepatic Artery Infusion Pump (HAIP) Chemotherapy Program – Sunnybrook Hospital
12. Living Donor Liver Transplantation pour les métastases hépatiques du cancer colorectal non résécable
13. In Vivo Lung Perfusion
14. Study Offered at the Odette Cancer Centre to Treat Recurrent Rectal Cancer
15. Radiotherapy Maximizes Chemotherapy’s Effect in mCRC
16. Trends in the Incidence of Young-Onset CRC with a Focus on Years Approaching Screening Age
17. New Blood Test for CRC Found Effective
18. Primary Care Clinicians Adjust Recommendations for CRC Screening to Accommodate Patient Needs and Preferences
19. CRC ‘No Longer’ Disease of Old Age, Data Supports Lowered Screening Age
20. Younger, Older Patients with mCRC Have Similar Survival Outcomes
21. Young Adult CRC Clinic Available at Sunnybrook Hospital
22. CCRAN’s Partnership with Count Me In
23. Over Half a Million Fewer Surgeries Have Been Performed in Canada Since the Start of The Pandemic
24. Burned-Out Doctors Feel ‘Emotional Sucker Punch’ as More Patients Present with Incurable Cancers
25. Major Financial Hardship Prevalent in mCRC
26. New Discovery Enhances Understanding of CRC
27. Foods to Fight CRC
28. Here’s Who May Need a Fourth COVID-19 Vaccine Dose
29. Frequently Asked Questions for COVID-19
MÉDICAMENTS / THÉRAPIES SYSTÉMIQUES
1. Phase II LEAP Clinical Trial For mCRC (Sept 10/21)
Le but de cette étude est de déterminer la sécurité et l'efficacité de la thérapie combinée avec le pembrolizumab (MK-3475) et la levantine (E7080/MK-7902) chez les patients atteints de cancer du sein triple négatif (TNBC), de cancer des ovaires, de cancer gastrique, de cancer colorectal (CCR), de glioblastome (GBM) ou de cancers des voies biliaires (BTC). Les participants seront inscrits dans des cohortes initiales spécifiques aux tumeurs, qui seront élargies si une efficacité adéquate est déterminée. L'essai est disponible au centre de cancérologie Odette et au centre de cancérologie Princess Margaret à Toronto ainsi que dans les centres suivants au Canada : Abbotsford, BC; Winnipeg, MB; CHU de Québec. Pour plus d'informations, consultez le lien ci-dessous.
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)
L'objectif de cette étude est d'examiner l'efficacité du vaccin DPX-Survivac en combinaison avec les médicaments cyclophosphamide et l'immunothérapie Pembrolizumab chez les patients atteints de cancers solides identifiés comme étant des IMS-E. Tous les patients recevront une thérapie combinée de DPX-Survivac, de cyclophosphamide et de pembrolizumab. Les patients participants sauront quel traitement ils reçoivent. L'essai est actuellement mené au centre de cancérologie Odette, et un nouveau site est en cours d'ouverture à l'hôpital Mont Sinaï.
4. Phase III Study at the centre de cancérologie Odette 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;
- un groupe recevra de l'arfolitixorine en combinaison avec du 5FU), de l'oxaliplatine et du bevacizumab,
- tandis que l'autre groupe recevra le médicament Leucovorin en combinaison avec le 5FU, l'oxaliplatine et le bevacizumab (norme de soins).
Le médecin et le personnel de l'étude ne sauront pas dans quel groupe se trouve un patient. Les patients seront répartis au hasard pour recevoir l'un ou l'autre traitement.
A propos d'Arfolitixorine:
L'arfolitixorine 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.
Traiter les patients atteints de cancer avec de l'arfolitixorine - Les objectifs :
- 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 et https://clinicaltrials.gov/ct2/show/NCT03750786
(https://isofolmedical.com/arfolitixorin/ )
5. FDA Grants Fast Track Designation to Arfolitixorin for mCRC (Nov.29/21)
The FDA granted fast track designation to arfolitixorin for treatment of patients with metastatic colorectal cancer (mCRC). The randomized phase 3 AGENT study is underway to assess the agent, designed to increase the efficacy of standard chemotherapy. Researchers will assign 440 patients to 5-FU, oxaliplatin and bevacizumab (Avastin, Genentech) plus either arfolitixorin or leucovorin as first-line treatment for mCRC. The primary endpoint is overall response rate. Secondary endpoints include PFS, duration of response, OS, number of curative metastasis resections, safety and patient-reported outcomes. Topline data are expected to be available in the first half of 2022.
6. ERAS-007 will be Evaluated Initially in Combinations That Could Address Over Half of Patients with CRC (Sept.22/21)
Erasca, a clinical-stage precision oncology company today announced dosing of the first patient in HERKULES-3, a Phase 1b/2 master protocol clinical trial evaluating ERAS-007 in combination with various agents in patients with gastrointestinal (GI) cancer, with initial focus on patients with advanced colorectal cancer (CRC).
“Initially focused on CRC subtypes with BRAF V600E, KRAS, or NRAS mutations, HERKULES-3 has the potential to address over half of patients with CRC and could be further expanded into other GI cancers with additional combinations” said Jonathan E. Lim, M.D., Erasca’s chairman, CEO, and co-founder. Dr. Lim continued, “Preclinical work by Ryan Corcoran, M.D., Ph.D., at Massachusetts General Hospital Cancer Center indicates that adding an ERK inhibitor has the potential to deepen and prolong responses, as well as delay resistance, forming the scientific basis for exploring ERAS-007 in combination with encorafenib and cetuximab in patients with BRAF V600E-mutant mCRC.”
HERKULES-3 will examine the safety, tolerability, and preliminary efficacy of ERAS-007 in combination with other cancer therapies in study participants with GI malignancies. The dose escalation portions of the first two sub-studies will assess ERAS-007 in combination with the current standard of care, encorafenib (Braftovi®) and cetuximab (Erbitux®), in patients with BRAF V600E-mutant mCRC, and ERAS-007 in combination with the CDK4/6 inhibitor palbociclib (Ibrance®) in patients with KRAS- or NRAS-mutant mCRC.
7. Sotorasib Shows Activity in Advanced CRC with KRAS. G12C Mutation (Dec.17/21)
The ongoing, single-arm CodeBreak 100 trial included 62 patients with KRAS. G12C-mutated colorectal cancer across 33 centers in nine countries who received at least one dose of 960 mg oral sotorasib once daily. All patients had progressed on treatment with fluoropyrimidine, oxaliplatin and irinotecan, and 73% had progressed on at least three prior lines of anticancer therapy.
Results showed an ORR of 9.7%, which fell short of the protocol-specified benchmark. 82% of patients achieved disease control. Researchers reported median PFS of 4 months and median OS of 10.6 months. “The response rate, disease control rate, median PFS and OS in this population of patients with refractory metastatic colorectal cancer is encouraging and clinically significant,” Marwan G. Fakih, MD, co-director of the gastrointestinal cancer program at City of Hope, told Healio.
“This study confirmed the favorable safety profile of sotorasib, with only a few patients experiencing grade 3 or above treatment-related adverse events,” Fakih said. “While sotorasib monotherapy held significant promise based on this study’s results, recent clinical data suggest potential synergy between sotorasib and the anti-EGFR inhibitor panitumumab [Vectibix, Amgen]. A phase 3 clinical trial is currently underway to compare sotorasib plus panitumumab to physicians’ choice of trifluridine [and tipiracil] or regorafenib in patients with the KRAS G12C mutation who progressed on prior fluoropyrimidine, oxaliplatin and irinotecan.”
8. New Treatment Could Be a Better Option for Patients with Colon Cancer (Dec.17/21)
Most patients with colorectal liver metastases (CLM) are poor candidates for resection surgery, so this new treatment could be a better option compared to chemotherapy alone, according to Mary Mulcahy, MD, ’00 GME, professor of Medicine in the Division of Hematology and Oncology and lead author of the study. The standard therapy for colon cancer that has spread outside the colon is chemotherapy. Treatment with chemotherapy is limited by side effects and eventual resistance, according to Mulcahy. “We know systemic chemotherapy will ultimately fail, so we’re looking for non-surgical therapy that can address these patients,” said Mulcahy.
In the current study, investigators combined chemotherapy with transarterial radioembolization (TARE), in which patients are infused with small beads (microspheres) containing a radioactive isotope (Y-90). The microspheres are directed to the hepatic artery and from there travel to the liver, where they embed themselves in the small blood vessels of the tumor and irradiate the cancer. Patients receiving chemotherapy and TARE had longer progression-free survival. Importantly, the addition of TARE did not impact their ability to receive subsequent therapy — something investigators were concerned about. The addition of TARE to chemotherapy did not improve the overall survival. Some subsets of patients had greater benefit from TARE than others. Characteristics which may identify patients who would benefit from the addition of TARE are the location of the original colon tumor, the genetic make-up of the tumor and the amount of tumor in the liver.
Source de l'image : http://www.interventionalradiologyindia.com/liver-tumour-treatment.html
9. Better Biomarker Choice Could Benefit CRC Patients (Dec.15/21)
“Colorectal cancer (CRC) patients who have tried all of the standard treatment options but have still seen their cancer progress are in need of new options. Our study, published in the journal Cell Reports, suggests that one already available targeted therapy could benefit up to 12,000 additional colon cancer patients every year,” said Edward Stites, assistant professor, integrative biology laboratory at the Salk Institute for Biological Sciences. “Our findings are preclinical, and we hope this research will motivate clinicians to develop clinical trials that further examine our results.”
Cetuximab was the first drug to gain FDA approval to block EGFR activity in CRC. Since then, other drugs that target EGFR also have received approval. But from the early development of these drugs, doctors believed that patients with a mutation in any one of the RAS proteins would not respond to EGFR drugs. However, not all RAS mutations are the same. The researchers combined computational and experimental approaches to find more RAS mutations that should not cause resistance to the EGFR drugs. Ultimately, the investigators identified 10 distinct RAS mutations that do not preclude the use of EGFR inhibitors. Many of the drugs that would work for these mutations are already approved by the FDA for other uses, which means that doctors could start prescribing them for their patients “off label” even before clinical trials are conducted.
10. Trifluridine/Tipiracil Combination Misses Mark in Metastatic Colon Cancer (Dec.21/21)
Pairing a novel cytotoxic agent with bevacizumab (Avastin) failed to improve progression-free survival (PFS) versus standard therapy in older patients with metastatic colorectal cancer (mCRC) ineligible for intensive therapy, a randomized trial showed.
“Trifluridine/tipiracil plus bevacizumab did not show statistically significant superiority in terms of PFS assessed by investigator, but there was a trend in favor of trifluridine/tipiracil and bevacizumab with a hazard ratio of 0.87,” said Thierry André, MD, of Sorbonne University and Saint-Antoine Hospital in Paris. “PFS in both arms in the selected population, with a median age of 73, was clinically meaningful, 9.4 versus 9.3 months…Quality-of-life data will be available soon, and data on OS [overall survival] is expected in 2023.” PFS by blinded central review gave trifluridine/tipiracil a small advantage, but the difference did not meet prespecified requirements for statistical significance. Statistical assumptions for the phase III SOLSTICE study included an estimated median PFS of 7.5 months for the control arm.
https://www.medpagetoday.com/hematologyoncology/coloncancer/96332
LES THÉRAPIES CHIRURGICALES
11. Hepatic Artery Infusion Pump (HAIP) Chemotherapy Program – Sunnybrook Odette Cancer Centre (Oct.15/21)
Le programme PPAH est une première au Canada pour les personnes dont le cancer du côlon ou du rectum (cancer colorectal) s'est propagé au foie et ne peut être retiré par une intervention chirurgicale. Le programme implique une approche coordonnée et multidisciplinaire des soins, avec une étroite collaboration entre l'oncologie chirurgicale, l'oncologie médicale (chimiothérapie), la radiologie interventionnelle, la médecine nucléaire et les soins infirmiers en oncologie. La pompe à perfusion de l'artère hépatique (PPAH) est un petit dispositif en forme de disque qui est chirurgicalement implanté juste sous la peau du patient et est relié par un cathéter à l'artère hépatique (principale) du foie. Environ 95 % de la chimiothérapie administrée par cette pompe reste dans le foie, épargnant ainsi le reste du corps des effets secondaires. Les patients reçoivent une chimiothérapie dirigée par PPAH en plus de la chimiothérapie intraveineuse (IV) régulière (chimiothérapie systémique), afin de réduire le nombre et la taille des tumeurs. Drs. Paul Karanicolas and Michael Raphael are the program leads and happy to see patients who may be eligible for the therapy.
Maintenant au centre de cancérologie Odette, le PPAH est utilisé chez les patients atteints d'un cancer colorectal qui s'est propagé au foie et qui ne peut être enlevé chirurgicalement et ne s'est pas propagé à d'autres parties du corps. Les patients qui ont peu (1-5) et de très petites tumeurs dans les poumons peuvent être pris en considération si la maladie pulmonaire est jugée traitable avant le PPAH. Si vous pensez pouvoir bénéficier de cette thérapie et/ou si vous souhaitez en savoir plus sur l'essai clinique, votre oncologue médical ou votre chirurgien peut vous adresser par télécopie au 416-480-6179. Pour plus d'informations sur l'essai clinique PPAH, veuillez cliquer sur le lien fourni ci-dessous
http://sunnybrook.ca/content/?page=colorectal-colon-bowel-haip-chemotherapy
12. Living Donor Liver Transplantation for Unresectable CRC Liver Metastases (Oct.1/21)
Environ la moitié des patients atteints de cancer colorectal (CCR) développent des métastases, généralement au niveau du foie et des poumons. L'ablation chirurgicale des métastases hépatiques (MH) est la seule option de traitement, bien que seulement 20 à 40 % des patients soient candidats à un traitement chirurgical. La thérapie chirurgicale apporte un avantage significatif en termes de survie, avec une survie à 5 ans après résection du foie de 40 à 50 % pour les MH, contre 10 à 20 % pour la chimiothérapie seule. La transplantation du foie (TF) permettrait d'éliminer toute maladie évidente dans les cas où les métastases colorectales sont isolées au foie mais considérées comme non résécables.
Source de l'image : 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.
https://clinicaltrials.gov/ct2/show/NCT02864485
13. In Vivo Lung Perfusion Study for Metastatic Colorectal Cancer Lung Mets (Dec.07/21)
The link below contains a short video demonstrating In Vivo Lung Perfusion, which is used to isolate one lung and deliver a high dose of chemotherapy without systemic exposure. The patient was a 20-yearold woman, diagnosed with multiple metastatic lesions from sarcoma in both lungs. In Vivo Lung Perfusion is now being offered to mcrc patients at the University Health Network in Toronto. Dr. Marcelo Cypel is the lead investigator. If you have any questions, please contact CCRAN. https://pie.med.utoronto.ca/TVASurg/project/in-vivo-lung-perfusion/
LES RADIOTHÉRAPIES/RADIOLOGIE INTERVENTIONNELLE
14. Study Offered at the Odette Cancer Centre to Treat Recurrent Rectal Cancer (Oct.9/21)
L'échographie focalisée guidée par résonance magnétique (EFG-RM) est une modalité moins invasive et ambulatoire qui est étudiée pour le traitement thermique du cancer. Dans le EFG-RM, un transducteur spécialement conçu est utilisé pour focaliser un faisceau d'énergie ultrasonore de faible intensité dans un petit volume à un endroit spécifique du corps. La RM est utilisée pour identifier et délimiter la tumeur, focaliser le faisceau d'ultrasons sur la cible et fournir une cartographie thermique en temps réel pour assurer un chauffage précis de la cible désignée avec un effet minimal sur les tissus sains adjacents. Le faisceau ultrasonore focalisé produit une hyperthermie thérapeutique (40-42°C) dans le champ de la cible, provoquant la dénaturation des protéines et des lésions cellulaires. Actuellement, aucune donnée clinique prospective n'a été rapportée sur l'utilisation de l'UF-RMg dans le cadre d'un cancer rectal récurrent. Le cancer récurrent du rectum est un problème clinique délicat. Les protocoles de retraitement actuels ont une efficacité limitée. L'ajout de l'hyperthermie à la radiothérapie et à la chimiothérapie peut améliorer la réponse thérapeutique. Grâce aux récents progrès technologiques, les chercheurs émettent l'hypothèse que la EFG-RM est techniquement réalisable et peut être utilisée en toute sécurité en combinaison avec une réirradiation et une chimiothérapie simultanées pour le traitement du cancer du rectum récurrent sans augmentation des effets secondaires. L'étude est proposée au centre de cancérologie d'Odette. Voici le lien vers le protocole de l'étude :
15. Radiotherapy Maximizes Chemotherapy’s Effect in mCRC (Dec.19/21)
According to these results, the most effective treatment for metastatic colorectal cancer (mCRC) is targeted therapy and chemotherapy, which block only a specific gene with a mutation. However, some patients show a mixed response, developing tolerance in only a few lesions during treatment. To provide a solution, the team, led by Professor Jang Ji-seok of the Radiation Oncology Department, conducted a study that showed that precision radiation therapy increases the effectiveness of chemotherapy in patients with small advanced CRC.
The analysis confirmed that the minor progressive patient group who received precision radiation therapy maintained the existing drug treatment for an average of 9.5 months when the hospital suspected that tolerance had developed. 34% of the patient group maintained the existing drug for more than one year. The team stressed that considering that the average duration of chemotherapy for all mCRC patients is an average of five months, the precision radiation therapy extended the period significantly. The survival rate of the minor progressive patient group who received precision radiotherapy was also high.
https://www.koreabiomed.com/news/articleView.html?idxno=12868
DÉPISTAGE
16. 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. Researchers calculated the 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.
17. New Blood Test for CRC Found Effective – ctDNA (Nov.23/21)
A circulating tumor DNA (ctDNA) blood-based screening test (Lunar-2, Guardant) was 96% sensitive and 94% specific in detecting early-stage colorectal cancer (CRC) in nearly 700 patients, according to data presented at the 2021 annual meeting of the American College of Gastroenterology. ctDNA is the tiny amount of DNA from cancer cells that moves freely in the bloodstream and can be used as a biomarker for cancer diagnosis. Tests for ctDNA are often very sensitive to the smallest amount of tumor DNA and can catch cancer much earlier than physical screening tests such as a colonoscopy.
The test had an overall sensitivity of 96%, with the assay being 100% sensitive in several clinical scenarios, including cancers with lymphatic invasion, high-grade tumors, tumors with low MSI status and mucinous adenocarcinomas. Its lowest sensitivity was 88%, for detecting stage 1 tumors. The test had a sensitivity of 93% for detecting stage 1 or 2 low-grade cancers: 90% in asymptomatic patients and 95% in those with stage 1 or 2 symptomatic disease. In a control group of age-matched patients without cancer, the test was 94% specific in ruling out CRC.
Currently, a larger trial with more than 10,000 patients is underway (ECLIPSE study) to further test whether LUNAR-2 is able to diagnose early-stage CRC. Enrolment is expected to be completed later this year. It is important to have a less invasive and simpler test for CRC screening because of the challenges in adherence to timely screening.
18. Primary Care Clinicians Adjust Recommendations for CRC Screening to Accommodate Patient Needs and Preferences (Dec.13/21)
Research has shown that the recommendations of American primary care clinicians and gastroenterologists strongly influence whether patients are screened and what type of screening they choose. According to the research survey, colonoscopy was the most frequently preferred option for average-risk patients, favored by 96.9% of gastroenterologists and 75.7% of primary care clinicians. “Interestingly, we found that nearly 1 in 4 primary care clinicians in our study selected a stool-based test as their preferred screening option, with multitarget stool DNA selected more frequently than either fecal immunochemical test or guaiac-based fecal occult blood test,” says Lila Rutten, Ph.D., a health services researcher at Mayo Clinic and the study’s lead author. This preference came about particularly for patients who were unwilling to undergo invasive procedures; concerned about taking time from work; unconvinced about the need for screening; or refused other screening recommendations. “These findings suggest that primary care clinicians recognize the need to tailor their colorectal cancer screening recommendations to the preferences of their patients, especially with the emergence of new, less invasive options,” says Paul Limburg, M.D., a gastroenterologist at Mayo Clinic and the study’s senior author.
Source de l'image : https://www.self.com/story/uspstf-colorectal-cancer-screening-guidelines
19. CRC ‘No Longer’ Disease of Old Age, Data Supports Lowered Screening Age (Jan.07/22)
“We have known for many years that rates of colorectal cancer (CRC) are rising in individuals younger than 50, prompting several medical organizations to recommend lowering the screening age from 50 to 45. What has been missing until now is confirmatory data of the prevalence of precancerous polyps in younger individuals,” Steven H. Itzkowitz, MD, FACP, FACG, AGAF, of the Icahn School of Medicine at Mount Sinai, said in a press release.
According to results from a nationally representative retrospective study, predictors of advanced colorectal neoplasia included increasing age, male sex (67% higher compared with female sex), white race, a family history of CRC or polyps (21% and 33% higher odds, respectively) and an indication for bleeding or screening (15% and 20% higher odds). Following adjustment, each one-year increase in age correlated with an 8% increase in advanced colorectal neoplasia discovery. Further analysis of prevalence among patients aged 40 to 44 years, 45 to 49 years and 50 to 54 years revealed 26.59%, 32% and 37.72% had any neoplasia; 5.76%, 7.5% and 9.48% had advanced premalignant lesions; and 0.53%, 0.58% and 0.32% had CRC. Researchers noted a gradual increase in prevalence between 2014 and 2020 among all age groups. “The data confirm what we have been seeing in the clinic — 45 is now the new 50. Colon cancer used to be considered a disease of old age and that is no longer true,” Itzkowitz said.
20. Younger, Older Patients with mCRC Have Similar Survival Outcomes (Jan.05/22)
The analysis — the first to compare overall survival (OS) among younger vs. older participants in a clinical trial of treatment for metastatic colorectal cancer (mCRC), according to Dana-Farber researchers — included 2,326 eligible patients (median age, 59.1 years; 22.1% aged younger than 50 years at study entry, 58.3% male; 81.5% white). Researchers found no statistically significant difference between patients with young-onset vs. older-onset disease in median OS (27.07 vs. 26.12 months) or median progression-free survival (PFS) (10.87 vs. 10.55 months). Patients aged younger than 35 years had the shortest median OS (21.95 months).
“It is not clear why the youngest patients may have a worse prognosis,” said Marla Lipsyc-Sharf, MD, clinical fellow in oncology at Dana-Farber Cancer Institute/Mass General Brigham. “Though additional research will be needed to confirm this finding given the small number of these very young patients, this is concerning.” Lipsyc-Sharf told Healio this finding, as well as factors contributing to increased incidence of colorectal cancer among younger patients, remains an active area of investigation.
Source de l'image : https://www.istockphoto.com/illustrations/colon-cancer-screening
AUTRE
21. Young Adult CRC Clinic Available at Sunnybrook (Oct.12/21)
Une étude récente menée par les médecins de l'université de Toronto a observé une augmentation des taux de cancer colorectal chez les patients de moins de 50 ans. Cette étude reflète les résultats obtenus aux États-Unis, en Australie et en Europe. L'augmentation des taux de cancer colorectal chez les jeunes survient après des décennies de baisse des taux chez les personnes de plus de 50 ans, qui s'expliquent très probablement par le recours accru au dépistage du cancer colorectal (par le biais de programmes de dépistage en population) qui permet d'identifier et d'éliminer les polypes précancéreux. Les patients diagnostiqués avant 50 ans ont un ensemble unique de besoins, de défis et d'inquiétudes. Ils sont différents de ceux qui ont été diagnostiqués après 50 ans. Le Dr Shady Ashamalla (oncologue chirurgien spécialisé dans le cancer colorectal) et son équipe du Centre des sciences de la santé Sunnybrook comprennent les besoins de cette population de patients.
Le Dr Ashamalla fait partie d'une équipe multidisciplinaire d'experts de La Clinique Du Cancer Colorectal Des Jeunes Adultes qui travaillera avec les jeunes patients atteints de cancer colorectal, quel que soit le stade de la maladie, afin de créer un plan de traitement individualisé pour soutenir chaque patient dans son parcours contre le cancer. Leurs besoins et leurs préoccupations seront pris en compte dans la mesure où ils s'y rapportent :
- Préoccupations et questions relatives à la fécondité
- Les jeunes enfants à la maison
- Questions relatives aux données et à l'intimité
- Les défis au travail
- Inquiétudes concernant le cancer héréditaire
- Relations avec la famille et les amis
- Stress psychologique dû à l'un ou à l'ensemble des éléments ci-dessus
L'équipe d'experts est composée de :
- Oncologues (médicaux, chirurgicaux, radiologiques)
- Travailleurs sociaux
- Psychologues
- Généticiens
- Infirmière navigatrice
Si un patient souhaite être orienté vers Sunnybrook, il peut demander à son médecin traitant ou à son spécialiste de l'orienter vers Sunnybrook via le formulaire d'orientation électronique, accessible via le lien figurant ci-dessous. Une fois l'orientation reçue La Clinique Du Cancer Colorectal Des Jeunes Adultes sera informée si le patient a moins de 50 ans. Un rendez-vous sera alors fixé, au cours duquel le patient rencontrera différents membres de l'équipe afin de répondre à leurs préoccupations spécifiques.
http://sunnybrook.ca/content/?page=young-adult-colorectal-cancer-clinic
22. CCRAN’s Partnership with “Count Me In” (Nov.01/21)
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.”
Over 180 people from across the US & CA have said “Count Me In” to join the Colorectal Cancer Project. By sharing information via surveys and access to medical records & samples, patients can have an impact on the future of colorectal cancer. Learn more at JoinCountMeIn.org/Colorectal
23. Over Half a Million Fewer Surgeries Have Been Performed in Canada Since The Start of The Pandemic (Dec.09/21)
Canadian hospitals have performed 560,000 fewer surgeries since the start of the pandemic, compared with previous years. According to new data released by the Canadian Institute for Health Information (CIHI), the largest decline occurred during Wave 1 while the system was adjusting to accommodate the anticipated large volume of COVID-19 patients. On average, surgeries decreased by about 35,000 per month. The biggest decreases were seen in cataract surgeries (an average of 5,900 fewer surgeries performed per month) and hip and knee joint replacements (an average of 2,100 fewer per month).
Between March 2020 and June 2021, visits to emergency departments (EDs) were down on average by over 20% compared with before the pandemic. Decreases were seen across all levels of triage. However, the biggest drop in the number of visits was for those with the least-urgent conditions. In terms of demographics, the largest decrease in ED visits (50%) occurred among children age 0 to 4.
24. Burned-Out Doctors Feel ‘Emotional Sucker Punch’ as More Patients Present with Incurable Cancers (Dec.11/21)
This week, a Leger survey for the Conference Board of Canada suggested 97% of 200 doctors and nurses who provide direct patient care in hospitals reported fatigue and burnout have increased in their workplace. Most cited inadequate staffing levels resulting in stress from not being able to offer optimal care. Those offering comfort care tell CBC they’re seeing more patients who are terminally ill at their first appointment than they did before the pandemic. Cancer specialists are in a prime position to observe the effects on patients, their families and each other. Burnout can be serious and may include emotional, physical and mental exhaustion and feeling hopeless and resentful, along with headaches and backaches.
Dr. Gerald Batist, a medical oncologist and director of the Segal Centre at Montreal’s Jewish General Hospital, sees the “tsunami” of advanced cancers that are less curable than if they’d been diagnosed at an earlier stage. He said it’s happening because:
- Patients with symptoms feared coming to hospitals, which are taking precautions to reduce the risk of contact with COVID-19.
- People missed preventative screenings like mammograms and colonoscopies.
- There were cuts to operating room time during lockdowns, slower diagnostic tests and biopsies, and reduced intensive care unit staffing for surgical patients.
“It’s very hard to see people in increased numbers facing the end of their lives … sooner than they and we would have hoped.”
https://www.cbc.ca/radio/whitecoat/palliative-care-burnout-covid-wcba-1.6278131
25. Major Financial Hardship Prevalent in mCRC (Jan.05/22)
Veena Shankaran, M.D., from the Fred Hutchinson Cancer Research Center in Seattle, and colleagues examined financial hardship in 380 metastatic colorectal cancer (mCRC) patients aged 18 years or older (78 percent White, 98 percent insured, 57 percent with annual income ≤$50,000) within 120 days of mCRC diagnosis. The researchers found that at 12 months, the cumulative incidence of major financial hardship (MFH) was 71.3%. There were no significant associations observed for age, race, marital status, or income (split at $50,000 per year) with MFH. Greater MFH was seen in association with income <$100,000 and total assets <$100,000. There was an association between MFH at three months and reduced social functioning and quality of life at six months. “Nearly all patients in this study had health insurance coverage and still the vast majority reported major financial hardship, which suggests having health insurance may no longer be sufficient to protect patients and families from financial hardship and its adverse health sequelae,” write the authors of an accompanying editorial.
https://www.physiciansweekly.com/major-financial-hardship-prevalent-in-metastatic-colorectal-cancer
Source de l'image : https://www.crn.com.au/news/acma-and-tio-remind-telcos-of-financial-hardship-responsibilities-545930
26. New Discovery Enhances Understanding of CRC (Jan.03/22)
MUSC Hollings Cancer Center researchers discovered a novel mechanism showing how a certain gene mutation can allow tumors to evade detection by the immune system in colorectal cancer (CRC) patients. “The work is the first time we are aware of that someone has shown how a checkpoint inhibitor is regulated due to loss of the adenomatous polyposis coli (APC) gene function,” said Raymond N. DuBois, M.D., Ph.D., director of Hollings Cancer Center and a senior author of the study.
DuBois’ team found that in mouse models, APC gene mutations are always accompanied by very high levels of PD-L1. PD-L1 levels are elevated in a variety of human cancers, including colorectal cancer, and this sometimes leads to a poor prognosis. High levels of PD-L1 on the surface of cancer cells are related to the tumor’s ability to evade the immune system. However, the exact role PD-L1 plays in colorectal cancer is unclear. With that knowledge, they developed several mouse models where they removed the gene and examined the effect on the colon. “When we corrected the mutation in the mouse model, the checkpoint inhibitor went away, and when we reintroduced the mutation, it returned,” DuBois explained.
“This discovery represents the first evidence that we know of demonstrating that the loss of APC results in stimulation of PD-L1 in colon cancer cells via the b-catenin complex binding to the PD-L1 promoter,” DuBois said. Their findings also revealed a novel mechanism by which APC mutations allow colonic tumors to evade immune system detection via an immune checkpoint pathway and increased resistance to T-cells. “These results expand our understanding of the role of APC in colorectal cancer and pave the way for developing new target drugs as possible b-catenin inhibitors for use as alternative immune checkpoint inhibitors in colorectal cancer therapies,” DuBois said.
https://www.onclive.com/view/new-discovery-enhances-understanding-of-colorectal-cancer
NUTRITION/MODE DE VIE SAIN
27. Foods to Fight CRC (Jan.03/22)
You are what you eat, especially when it comes to colorectal cancer (CRC). While sugary beverages and red meat can increase your risk for CRC, there are some foods and spices that can help prevent it. One of them is turmeric, which contains the anti-inflammatory compound curcumin. Curcumin has been found to suppress cancer cell growth. Also, new research from Texas A&M University reports that eating spinach can reduce colon cancer risk by 50%. Other foods that can prevent colon cancer include fruits such as apples, bananas, blueberries, and raspberries; also nuts such as almonds, cashews, and macadamia nuts; whole grains; beans; legumes et fish. A study from Vanderbilt University found women who eat three servings of fish per week reduced their risk of developing colon polyps and CRC by 33%.
“In some instances, they function even better than some of the anti-cancer drugs we are using right now,” says Ajay Goel, director for the Center for Gastrointestinal Research Cancer Prevention at Baylor Scott & White Health. “They’re much safer, they’re much more inexpensive and they’re a lot more potent than some of the drugs we use for treating cancer patients.”
https://www.wndu.com/2022/01/04/medical-moment-foods-fight-colorectal-cancer/
MISES À JOUR COVID-19
28. Here’s Who May Need a Fourth COVID-19 Vaccine Dose (Oct.28/21)
In updated guidelines released this week, the Centers for Disease Control and Prevention (CDC) said moderately and severely immunocompromised people aged ≥18 years who completed an mRNA COVID-19 vaccine primary series and received an additional mRNA vaccine dose may receive a single COVID-19 booster dose (Pfizer-BioNTech, Moderna, or Janssen) at least 6 months after completing their third mRNA vaccine dose.
The CDC has found reduced vaccine effectiveness in people who are immunocompromised compared with people who are not immunocompromised. An ‘additional’ dose to refers to a subsequent vaccine dose in people who likely did not mount a protective immune response after their primary vaccination, the CDC’s Dr. Sujan Reddy said in a recent webinar with healthcare professionals.
One reason for these new guidelines is that vaccine efficacy has been shown to drop over time, placing certain groups at increased risk. “Over time, generally 6 to 9 months, the vaccine effectiveness appears to diminish,” Dr. David Hirschwerk, an attending infectious diseases specialist at Northwell Health in Manhasset, New York, told Healthline. “They do remain protective against developing severe infection, but less effective at preventing any infection at all.”
29. Foire aux questions pour COVID-19
Qu'est-ce que le COVID-19 (ou nouvelle maladie à coronavirus-19)?
R : Les coronavirus sont une grande famille de virus qui peuvent provoquer des maladies chez les humains et les animaux. Les coronavirus peuvent provoquer des maladies dont la gravité va du simple rhume à des maladies plus graves telles que le syndrome respiratoire aigu sévère (SRAS) et, plus récemment, le COVID-19. Le COVID-19 ou nouveau coronavirus est né d'une épidémie à Wuhan, en Chine, en décembre 2019. Les symptômes les plus courants associés au COVID-19 peuvent comprendre de la fièvre, de la fatigue et une toux sèche. Mais d'autres symptômes ont été associés à la maladie, notamment des douleurs, une congestion nasale, un écoulement nasal, un mal de gorge, de la diarrhée, des éruptions cutanées et des vomissements. Il est également possible d'être infecté par le COVID-19 et de ne présenter aucun symptôme ou de se sentir malade. La propagation de COVID-19 se fait principalement par la transmission de gouttelettes provenant du nez ou de la bouche lorsqu'une personne tousse, expire ou éternue. Ces gouttelettes se posent sur les surfaces autour d'une personne proche. COVID-19 peut être transmis à cette personne proche qui peut finir par toucher la surface contaminée par COVID-19 et ensuite se toucher le nez, la bouche ou les yeux. Une personne peut également contracter COVID-19 en inhalant ces gouttelettes d'une personne atteinte de COVID-19. Bien que les recherches soient toujours en cours, il est important de noter que les populations plus âgées (plus de 65 ans), celles dont le système immunitaire est affaibli et celles qui souffrent d'affections préexistantes, notamment de maladies cardiaques, d'hypertension, de maladies pulmonaires, de diabète ou de cancer, peuvent être plus exposées à une maladie grave due à COVID-19.
https://www.who.int/news-room/q-a-detail/q-acoronaviruses)
Que puis-je faire pour éviter de contracter le coronavirus ?
R : Il y a plusieurs façons de réduire le risque de contracter le COVID-19. Voici quelques mesures suggérées par l'Organisation mondiale de la santé
- Gardez au moins 2 mètres (ou 6 pieds) entre vous et les autres personnes. Cela réduira le risque d'inhaler les gouttelettes des personnes infectées par COVID-19.
- Nettoyez-vous régulièrement les mains pendant au moins 20 secondes avec de l'eau chaude et du savon, ou avec un produit de nettoyage à base d'alcool. Cela permettra de tuer tous les virus présents sur vos mains.
- Évitez de vous toucher les yeux, le nez et la bouche. Si le virus se trouve sur vos mains, il peut pénétrer dans le corps par ces zones.
- Suivez une bonne hygiène respiratoire en vous couvrant la bouche et le nez avec un mouchoir en papier ou le coude lorsque vous toussez et éternuez. Cela empêche les gouttelettes de se déposer sur les surfaces ou d'être libérées dans l'air autour de vous.
- Restez chez vous autant que possible, surtout si vous ne vous sentez pas bien. Si vous pensez être atteint du coronavirus, veuillez consulter la section "Que dois-je faire si je pense être atteint du coronavirus ?
- Veuillez porter un masque ou un couvrevisage en public lorsque la distance physique n'est pas possible.
https://www.who.int/news-room/q-adetail/q-a-coronaviruses
Y a-t-il des précautions particulières que les personnes atteintes d'un cancer peuvent prendre ?
R : Les personnes atteintes de cancer (et d'autres maladies chroniques telles que les maladies cardiaques, le diabète, l'hypertension et les maladies pulmonaires) sont plus exposées à une maladie grave en raison de la COVID-19, le cancer étant considéré comme un problème de santé préexistant. Certains traitements contre le cancer, notamment la chimiothérapie, les radiations et la chirurgie, peuvent affaiblir le système immunitaire, ce qui rend l'organisme plus difficile à combattre les infections et les virus, comme le Coronavirus. Il est important de suivre avec diligence les recommandations de l'Organisation mondiale de la santé ci-dessus pour réduire le risque de contracter le COVID-19. Si vous avez des inquiétudes quant à votre risque, il est préférable de contacter votre médecin ou votre équipe de soins.
Y a-t-il des changements en ce qui concerne mes visites médicales liées au cancer ? Chaque patient et chaque plan de traitement étant uniques, il est toujours préférable de contacter votre prestataire de soins de santé pour obtenir des informations actualisées sur votre plan de traitement. Dans certains cas, il est possible de retarder le traitement du cancer jusqu'à ce que le risque de pandémie ait diminué. Dans d'autres cas, il peut être sûr de se rendre dans une clinique distincte de celle où sont traités les patients COVID-19. Les options de traitement oral pourraient être prescrites par votre prestataire de soins de manière virtuelle, sans qu'il soit nécessaire de se rendre à la clinique. Enfin, certains rendez-vous ou discussions de suivi pourraient être organisés virtuellement (via skype ou zoom par exemple) ou par téléphone pour minimiser votre risque. Comme nous le savons, les conditions et les protocoles changent quotidiennement en raison de la nature de l'épidémie de COVID-19 et varient en fonction du lieu, par conséquent, la meilleure première étape consiste à demander conseil à votre prestataire de soins.
https://www.cancer.gov/contact/emergencypreparedness/coronavirus
Si vous souhaitez contacter votre agence locale de santé publique, veuillez voir ci-dessous.
Alberta
Informations COVID-19 pour Alberta
Les médias sociaux : Instagram @albertahealthservices, Facebook @albertahealthservices, Twitter @GoAHealth
Numéro de téléphone : 811
Colombie-Britannique
Informations COVID-19 pour Colombie-Britannique
Les médias sociaux : Facebook @ImmunizeBC, Twitter @CDCofBC
Numéro de téléphone : 811
Manitoba
Informations COVID-19 pour Manitoba
Les médias sociaux : Facebook @manitobagovernment, Twitter @mbgov
Numéro de téléphone : 1-888-315-9257
Nouveau Brunswick
Informations COVID-19 pour Nouveau-Brunswick
Les médias sociaux : Facebook @GovNB, Twitter @Gov_NB, Instagram @gnbca
Numéro de téléphone : 811
Terre-Neuve et Labrador
Informations COVID-19 pour Terre-Neuve-et-Labrador
Les médias sociaux : Facebook @GovNL, Twitter @GovNL, Instagram @govnlsocial
Numéro de téléphone : 811 ou 1-888-709-2929
Territoires du Nord-Ouest
Informations COVID-19 pour Territoires du Nord-Ouest
Les médias sociaux : Facebook @NTHSSA
Numéro de téléphone : 811
Nouvelle-Écosse
Informations COVID-19 pour Nouvelle-Écosse
Les médias sociaux : Facebook @NovaScotiaHealthAuthority , Twitter @healthns, Instagram @novascotiahealthauthority
Numéro de téléphone : 811
Nunavut
Informations COVID-19 pour Nunavut
Les médias sociaux : Facebook @GovofNunavut , Twitter @GovofNunavut, Instagram @gouvernement du Nunavut
Numéro de téléphone : 1-888-975-8601
Ontario
Informations COVID-19 pour Ontario
Les médias sociaux : Facebook @ONThealth, Twitter @ONThealth , Instagram @ongov
Numéro de téléphone : 1-866-797-0000
Île-du-Prince-Édouard
Informations COVID-19 pour Île-du-Prince-Édouard
Les médias sociaux : Facebook @GovPe, Twitter @InfoPEI,
Québec
Informations COVID-19 pour Québec
Les médias sociaux : Facebook @GouvQc, Twitter @sante_qc
Numéro de téléphone : 1-877-644-4545
Saskatchewan
Informations COVID-19 pour Saskatchewan
Les médias sociaux : Facebook @SKGov, Twitter @SKGov
Numéro de téléphone : 811
Yukon
Informations COVID-19 pour Yukon
Les médias sociaux : Facebook @yukonhss, Twitter @hssyukon
Numéro de téléphone : 811
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