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Recent News and Articles on the Keywords: colorectal cancer + insufficient evidence + nice  Related to the article below (Last Update: 5/12/2008)

Grapefruit & breast cancer
Deccan Herald, India - Apr 14, 2008
Experts at the American Cancer Society said that there was insufficient evidence to change existing recommendations, but that women with concerns could cut ...
Smoking and Smoking Cessation in Relation to Mortality in Women
Journal of American Medical Association (subscription), IL - May 6, 2008
There is inadequate or insufficient evidence to infer the presence or absence of a causal relationship between smoking and ovarian cancer and colorectal ...
Are you D-ficient?
MiamiHerald.com, FL - Apr 22, 2008
Citing evidence that links vitamin D with up to 77 percent lower risk of breast, prostate and colorectal cancers, the Cancer Recovery Foundation recommended ...
Source: Google News

Cancer Risks and Mortality in Heterozygous ATM Mutation Carriers -
D Thompson, S Duedal, J Kirner, L McGuffog, J Last … - jnci, 2005 - jnci.oxfordjournals.org
... and three families had two cases of colorectal cancer). ... likelihood estimates of the
cancer risks associated ... if there is currently insufficient evidence to say ...

Why hasn't the National Institute been'NICE'to patients with colorectal cancer? -
MP Saunders, JW Valle - British Journal of Cancer, 2002 - nature.com
... Ir.5FU/FA combinations with evidence based on ... report claims that there is insufficient
funding from ... liver metastases from colorectal cancer after neoadjuvant ...

Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and … -
EB Rubenstein, DE Peterson, M Schubert, D Keefe, D … - Cancer, 2004 - doi.wiley.com
... MD, Center Antoine-Lacassagne (Nice, France); Michael ... There is insufficient evidence
to conclude that actions ... will prevent or treat cancer therapy?induced ...

Systematic review of laparoscopic versus open surgery for colorectal cancer -
MM Reza, JA Blasco, E Andradas, R Cantero, J Mayol - Br J Surg, 2006 - doi.wiley.com
... that have evaluated LS for colorectal cancer (many of ... up have until recently been
insufficient to allow a ... provide a better quality of evidence regarding the ...

… Colonoscopy in Individuals at Risk for Hereditary Nonpolyposis Colorectal Cancer: An Evidence-Based … -
PM Johnson, S Gallinger, RS McLeod - Diseases of the Colon & Rectum, 2006 - Springer
... MESH terms ??hereditary nonpolyposis colorectal cancer?? and ??screening ... based on
the best available evidence. ... alone is insufficient to accurately ...

Preoperative staging of rectal cancer by MRI; results of a UK survey -
A Taylor, M Sheridan, S McGee, S Halligan - Clinical Radiology, 2005 - Elsevier
... Insufficient radiology manpower n (%), Insufficient radiology expertise n ... of any
direct evidence that proves ... NICE guidelines on colorectal cancer that patients ...

[PDF] … and evidence review for the classification and care of women at risk of familial breast cancer -
A McIntosh, C Shaw, G Evans, N Turnbull, N Bahar, … - National Collaborating Centre for Primary Care/University of …, 2004 - nice.org.uk
... NICE guidelines do not currently require a cost ... In this guideline evidence based
information and recommendations ... as many as for colorectal cancer, the second ...

Overexpression of Kr?ppel-like factor 4 in the human colon cancer cell line RKO leads to reduced … -
DT Dang, X Chen, J Feng, M Torbenson, LH Dang, VW … - Oncogene, 2003 - nature.com
... have suggested that KLF4 induces apoptosis in HT29 colon cancer cells, we ... the lack
of apoptosis is due to insufficient doses of ... Cancer Res., 60, 6488?6495. ...

… Imaging Modality Impact on the Treatment of Patients With Metastatic Colorectal Cancer of the Liver … -
M Selzner, TF Hany, P Wildbrett, L McCormack, Z … - Annals of Surgery, 2004 - annalsofsurgery.com
... from referring institutions was insufficient, that is ... with [18F]fluorodeoxyglucose
in recurrent colorectal cancer. ... in patients with colorectal liver metastases ...

Making a decision to wait for more evidence: when the National Institute for Health and Clinical … -
K Chalkidou, A Hoy, P Littlejohns - JRSM, 2007 - jrsm.rsmjournals.com
... will always be cases where the available evidence is insufficient to support ... NICE
recommended that laparoscopic resection for colorectal cancer should only ...

Source: Google Scholar
 
 

Metastatic colorectal cancer - NICE: insufficient evidence to recommend Avastin and Erbitux

 
 
The Appraisal Committee has prepared a Final Appraisal Determination on the use of Avastin and Erbitux in metastatic colorectal cancer and submitted it to the Institute.

The main recommendations made are as follows:


Avastin ( Bevacizumab ) in combination with 5-FluoroUracil plus Folinic Acid, with or without Irinotecan, is not recommended for the first-line treatment of metastatic colorectal cancer.

Erbitux ( Cetuximab ) in combination with Irinotecan is not recommended for the second-line or subsequent treatment of metastatic colorectal cancer.

People currently receiving Bevacizumab or Cetuximab should have the option to continue therapy until they and their consultants consider it appropriate to stop.


The management of metastatic colorectal cancer is mainly palliative and involves a combination of treatments ( such as palliative surgery, chemotherapy and radiation ), symptom control and psychosocial support.
The aim is to improve both the duration and quality of the individual’s remaining life.
Clinical outcomes such as overall survival, response and toxicity are important, but alternative outcomes such as progression-free survival, quality of life, convenience, acceptability and patient choice are also important.

The most frequent site of metastatic disease is the liver. In up to 50% of patients with metastatic disease, the liver may be the only site of spread.
For these patients surgery provides the only chance of longer-term survival.
Approximately 10% of patients with metastatic colorectal cancer present with potentially resectable liver metastases and for approximately 14% chemotherapy may render unresectable liver metastases operable.

Individuals with metastatic disease who are sufficiently fit ( normally those with World Health Organization performance status 2 or better ) are usually treated with active chemotherapy as first- or second-line therapy.

First-line active chemotherapy options include infusional 5-FluoroUracil plus Folinic Acid or Leucovorin ( Calcium Folinate ) ( 5-FU/FA, 5-FU/LV ), Oxaliplatin plus infusional 5-FU/FA ( FOLFOX ), and Irinotecan plus infusional 5-FU/FA ( FOLFIRI ).
Oral analogues of 5-FU ( Capecitabine and Tegafur with Uracil ) may also be used instead of infusional 5-FU.
For those patients first receiving FOLFOX, Irinotecan may be a second-line treatment option, whereas for patients first receiving FOLFIRI, FOLFOX may be a second-line treatment option.
Patients receiving 5-FU/FA or oral therapy as first-line treatment may receive treatment with FOLFOX and Irinotecan as second-line and subsequent therapies.

Survival estimates for patients with metastatic colorectal cancer receiving best supportive care are approximately 6 months.
The use of infusional 5-FU/FA can increase survival to approximately 10 -12 months, whereas combinations of FOLFIRI followed by FOLFOX, or FOLFOX followed by Irinotecan, have been reported to increase survival to 20 -21 months.

Source: NICE, 2006
 
 
 
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