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Spotlight on Clinical Research: Colon Cancer

March is National Colorectal Cancer Awareness Month
Dr. Howard Hochster
Howard S. Hochster, MD
March is National Colorectal Cancer Awareness Month, a time to focus attention on screening for colorectal cancer. Screening tests can detect this cancer early, when treatment works best, yet 23 million Americans are not up to date on screening. Unfortunately, of cancers that affect both men and women, colorectal cancer is the second leading cause of cancer deaths in the U.S. 

Yale has a tradition of offering cutting edge cancer treatment, such as the first use of chemotherapy in the U.S. in 1942. Today, Yale Cancer Center offers state-of-the-art treatment for colon cancer, including clinical trials using the latest drugs or combinations of drugs directed at those patients who can benefit the most.

PREVENTING RECURRENCE FOLLOWING SURGERY:  In a trial for patients with Stage 3 colon cancer, who have a risk of having their cancer recur, Yale doctors are comparing the standard six cycles of the FOLFOX chemotherapy drug combination to a three-month regimen, to determine if this will help reduce the neurological side effects associated with this treatment. They are also testing whether adding two years of treatment with a non-steroidal anti-inflammatory drug (NSAID) reduces the risk of recurrence.

FIRST LINE THERAPY:  For advanced colon cancer, chemotherapy is the treatment that continues to be most effective. In the STEAM trial, Dr. Howard Hochster and others around the country are testing whether a three-drug regimen works better than the standard two-drug regimen. In clinical trials in Europe the three-drug treatment has shown a much higher response rate and may help patients live longer.  The GI Oncology team is very excited about this combination.

REDUCING SIDE EFFECTS:  Sometimes drugs that are used to treat colon cancer cause severe diarrhea. Dr. Tommy Cheng has spent years using sophisticated techniques to purify a combination of four Chinese herbs to create a drug that helps reduce this toxic side effect. This combination of Yale science and Eastern medicine, known as KD018 (formerly PHY906), is being tested in a clinical trial with irinotecan, a chemotherapy drug that has a high risk of causing diarrhea. The trial will help determine whether   KD018 can help patients better tolerate this chemotherapy treatment.

GENE PROFILING AND PERSONALIZED THERAPY:  Doctors are increasingly turning to examining the genetic profile of tumors to determine the most effective treatment for their patients. At Yale, there are two clinical trials for patients with colon cancer that has the BRAF mutation. This is a mutation occurring in about 10 percent of colon cancers that causes them to grow. Drugs that block the BRAF pathway are effective at treating melanoma, but less effective for colon cancer. The two trials are testing these drugs in combination with other targeted agents as a way of more effectively blocking the BRAF pathway in colon cancer.  
Clinical trials help doctors understand which patients can benefit from certain treatments. For example, Yale doctors are using molecular profiling of tumors to look at another group of mutations, known as RAS. For patients with these mutations, cetuximab or panitumumab, monoclonal antibodies sometimes used to treat colon cancer, may not be effective.  In this case, clinical trials help doctors understand which patients may benefit from certain treatments.

When Dr. Hochster began treating colon cancer 20 years ago, there was only one drug available; today there are three new chemotherapy drugs and 5 targeted therapies. Patients are living three times as long (on the average) thanks to the availability of these agents.  These advances have been made possible through testing in clinical trials. “I’ve seen them make a huge difference in the lives of our patients,” said Dr. Hochster. “It’s through clinical trials that we’ve been able to make so much progress.”

If you would like to find out more about clinical trials for colon cancer, call the Yale Gastrointestinal Cancer Program at 203-200-4422.