Advancements in Rectal Cancer Treatments

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Advancements in Treating Rectal Cancer

Part of Fight Colorectal Cancer’s Monthly Patient Webinar Series

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1. Tonight’s speaker: Dr. Deborah Schrag, MD

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Colorectal Cancer:

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In Collaboration with the Colon Cancer Alliance




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Dr. Deborah Schrag, MD, MPH Dana Farber Cancer Institute

Associate Professor of Medicine, Harvard Medical School

Deborah Schrag MD MPH

Dana-Farber Cancer Institute

Boston, MA

American Cancer Society estimates 40,340

new cases of rectal cancer in 2013

Colon/Rectal cancer is the 3rd leading cause of

cancer-related death in US

The death rate from rectal cancer has been

dropping for 20+ years.

>1 million colorectal cancer survivors in US

Advancements:

Screening & early detection

Improvements in treatment

Detection

Workup

Staging

Treatment

Surveillance

Screening (typically starts at age 50)

Colonoscopy (camera)

CT (scan)

Procedure What is it? Why do it?

Biopsy & Pathology

Review

Remove tumor tissue &

examine it under a

microscope

To discover the

presence, cause or

extent disease.

Colonoscopy &

Proctoscopy

Examine colon & rectum

with a camera

To discover the

presence, cause or

extent disease.

CT of

chest/abdomen/pelvis An x-ray scan (image)

To see if the cancer has

spread beyond the

rectum.

CEA Blood test Carcinoembryonic antigen

(CEA) is a protein

associated with tumors.

ERUS or MRI Medical imaging that

examines soft tissue

To discover the

presence, cause or

extent disease.

Stage

describes the extent of the cancer in the body

how far the main tumor has grown into nearby areas

extent of spread to nearby lymph nodes

whether the cancer has spread (metastasized) to other

organs of the body

is an important factor in determining prognosis &

treatment options

based on the results of physical exam, biopsies, &

imaging tests

Surgery

Radiation Therapy

Chemotherapy

Surgery is usually the main treatment for rectal

cancer, although radiation and chemotherapy

will often be given before and/or after surgery.

Surgeon removes tumor and surrounding

tissues (extent of resection depends on extent

of tumor)

Advances in techniques, equipment, and

surgical specialization

More precise excision

Availability of stapling devices

J pouch and coloplasty pouch

Attention to cancer clearance - Total mesorectal

excision has reduced local recurrence following

surgery

Microsurgery

High-energy rays or particles destroy cancer

cells

Radiation may

Lower the risk that the tumor will come back

Improve operability

External-beam radiation therapy

Similar experience to getting an x-ray

Endocavitary radiation therapy

Small device inserted to deliver radiation

Brachytherapy (internal radiation therapy)

Small pellets of radioactive material placed next to

tumor

May be administered before and/or after

surgery

Drugs used to treat rectal cancer

5-Fluorouracil

Capecitabing

Irinotecan

Oxaliplatin

Regimens (combinations of drugs) used to treat rectal cancer FOLFOX = 5-FU + leucovorin + oxaliplatin

FOLFIRI = 5-FU + leucovorin + irinotecan

FOLFOXIRI = leucovorin + 5-FU + oxali + irinotecan

CapeOx = capecitabine + oxaliplatin

Addition of biologic agents Bevacizumab

Cetuximab

Panitumumab

Periodic screening & tests to see if the cancer

has come back.

History/Physical

CT Scan

Colonoscopy

Blood Tests

This research study is being done to see if

radiation can be avoided for a select group of

rectal cancer patients who have a good

response to 6 treatments with a chemotherapy

combination regimen known as FOLFOX.

The proposed study does not use new agents

or procedures, but rather sequences existing

well established treatment strategies in a

different way.

Stage II & III rectal cancer is treated in 3 phases:

1. Chemotherapy and radiation given together over 5.5 weeks –”chemoradiation”

Why? To prevent the tumor from coming back in the same location in the pelvis

2. Surgery to remove the tumor

3. Chemotherapy with a drug combination called “FOLFOX” given every 2 weeks over about 4 months

Why? To prevent the cancer from coming back in a distant organ such as the liver

With modern surgical techniques, chemotherapy advances, and MRIs it is possible that some patients can avoid radiation to the pelvis

Because chemoradiation has side effects, it would be valuable to avoid it for patients who can achieve good results without it

Rectal cancer specialists hope that FOLFOX chemotherapy before surgery will enable some rectal cancer patients to avoid chemoradiation

Radiation treatment is time consuming….daily visits

Radiation often has long term effects on bowel bladder and sexual function

Radiation in previous clinical trials does not improve overall survival rates, but does decrease the local recurrence rates

Radiation treatment may be unnecessary for some patients with early stage rectal cancer

Better imaging techniques, better surgical techniques have made it easier to carefully stage patients

We do not know the best way to treat this disease until we carefully compare these approaches.

We need your help!

Chemotherapy

for 3-4 months Surgery

5.5 weeks

of radiation

with 5FU

chemotherapy

(5FUCMT)

4-6 weeks

Recovery

4-6 weeks

Recovery

Chemo

for 3-4

Months*

Surgery

If tumor

responds to

chemotherapy

If tumor

does not

respond to

chemo

5.5 weeks

of radiation

with 5FU

chemo

(5FUCMT)

Surgery

Chemo

for 3-4

months

Re-

evaluation

3 mo. of

chemo

(6 FOLFOX

treatments)

4-6

we

eks re

co

ve

ry

4-6

we

eks re

co

ve

ry

4-6

we

eks re

co

ve

ry

4-6

we

eks re

co

ve

ry

*If the pathologist or surgeon find evidence of more extensive disease, it is

possible that postoperative 5FUCMT could also be recommended

The National Cancer Institute at:

1-800-4-CANCER (1-800-422-6237)

http://cancer.gov/clinicaltrials/

http://cancer.gov/cancerinfo/

For more information about the PROSPECT trial

(N1048):

http://www.cancer.gov/clinicaltrials/search/view?cdrid=715321&

protocolsearchid=10158136&version=patient

The lead investigator for this trial, Dr. Deborah Schrag, at

[email protected]

The protocol coordinator for this trial, John Taylor, at

[email protected]


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Health & Medicine

Advancements in Rectal Cancer Treatments