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Steady Gains Made Against Digestive Cancers

Researchers are fine-tuning chemotherapy regimens for cancers of the digestive tract, and new studies show the effort is paying off.

"We have agents that are more interesting and more effective that we can include in the armamentarium," Dr. Norman Wolmark, chairman of the National Surgical Adjuvant Breast and Bowel Project in Pittsburgh, said at a press conference Saturday at the American Society of Clinical Oncology annual meeting, in Orlando, Fla.

Cancers affecting the gastrointestinal tract, which includes the stomach, colon and pancreas, tend to be notoriously difficult to treat. However, several trials presented at the meeting offered incremental hope.

One study found that adding the drug oxaliplatin to standard chemotherapy regimens in individuals with stage II or III colorectal cancer reduced the relative risk of a recurrence by 21 percent. This is the second trial to look at oxaliplatin in combination with established chemotherapy.

That translated into an absolute benefit of about 5 percent. "That translates into many lives being saved," said Wolmark, who was lead author of the trial. "It’s hardly trivial."

The findings essentially confirm the results of an earlier European trial, he added.

A second colon cancer trial, this one conducted in Europe, found the drug irinotecan could improve the effectiveness of other chemotherapy drugs in patients with stage II and III disease.

Patients were randomized to receive standard chemotherapy drugs with or without irinotecan.

After slightly less than three years, patients on irinotecan had a 13 percent reduced risk of a recurrence, the researchers found.

The chemotherapy drug gemcitabine, currently used to treat patients with inoperable pancreatic cancer, can also benefit patients with the operable form of the disease, another study showed.

The drug nearly doubled the amount of time before the cancer reappeared, from 7.5 months in the group that had surgery alone versus 14.2 months in the group that had surgery plus gemcitabine.

Lead author Dr. Peter Neuhaus, of Charite University Medical School in Berlin, Germany, said the improvement in disease-free survival was "significant," albeit "preliminary." Researchers have only recently stopped recruiting patients, so more results will be available soon, he added.

Finally, updated results of another trial showed that giving chemotherapy to patients with cancer of the stomach and lower esophagus both before and after surgery improved survival.

Currently, patients in the United States usually have surgery before chemotherapy and radiation, while surgery remains the standard of care in Europe, explained study author Dr. David Cunningham, a professor at the Royal Marsden Hospital in Surrey, England.

Five years after their diagnosis, 36 percent of the chemotherapy group was still alive, compared with 23 percent of the surgery group. There were also delays in recurrence in the chemotherapy group.

"This is truly a first," Cunningham said. "This is showing that, as a strategy, perioperative chemotherapy shows benefit. Survival is greater than we would normally see in common solid tumors by the addition of chemotherapy treatment."