David J. Kerr, CBE, MD, DSc, FRCP, FMedSci


May 20, 2013

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Hello. I am David Kerr, Professor of Cancer Medicine at the University of Oxford, United Kingdom, and past President of ESMO (European Society of Medical Oncology). Here we are, looking forward to yet another meeting of the American Society of Clinical Oncology (ASCO®) and the buzz of exciting plenary sessions. I want to highlight some of the abstracts I think will be interesting in terms of gastrointestinal cancer.

Colorectal Cancer

One of my friends, David Mant, Professor of Primary Care/General Practice at Oxford, is presenting his large trial[1]of carcinoembryonic antigen (CEA) testing and CT follow-up to detect recurrence of colorectal cancer. This is another elegantly designed study that supports the use of a single CT scan taken 12-18 months after surgery vs CT scans every 6-12 months, plus or minus intensive monitoring with CEA testing every 3-6 months. The study did not show any difference in progression-free or overall survival comparing intensive vs minimal follow-up. But for those patients who had undergone the CEA monitoring, it appeared that you could detect a group of patients with disease who are more likely to be operable and therefore curable. It was a relatively small proportion, only about 6% of the total, which may be why there was no impact on overall survival. Professor Mant makes a recommendation that perhaps a cost-effective way of following patients with colorectal cancer would be to obtain regular CEA estimations and a single CT scan 12-18 months after dissection.

Next, the Dutch group will present CAIRO-3,[2] in which, after induction of chemotherapy for advanced and metastatic colorectal cancer, patients were randomly assigned to stop or continue with what we call maintenance therapy or lower-dose capecitabine and bevacizumab. They showed significant benefit across all parameters, including time to progression, progression-free survival, and overall survival. This supports the use of maintenance therapy with capecitabine and bevacizumab.

We will also hear disappointing news about cetuximab.[3] The combination of cetuximab and chemotherapy for patients with operable hepatic metastatic colorectal cancer did not appear to provide any real benefit. This was surprising given the excellent response rates with that combination, but in this large, well-designed randomized trial, they found no obvious benefits.

An interesting negative study from Charles Loprinzi and his colleagues[4] looked at the impact of infused magnesium and calcium on the prevention of the sensory neurotoxicity associated with oxaliplatin and found no benefit. This was a large, well-designed study that leaves that myth to rest, which may be of benefit in some way.

The Italian group will put forward a large, well-designed study[5] in patients with advanced colorectal cancer, looking at FOLFOXIRI plus bevacizumab vs FOLFIRI plus bevacizumab. FOLFOXIRI/bev showed some benefits in terms of progression-free survival in response rates, but as yet no discernible impact on overall survival.

There is also interesting work on the molecular side.[6] Researchers are looking at the GlaxoSmithKline inhibitors for BRAF and MEC, selecting the subpopulation of patients with colorectal cancer who have the BRAF mutants. These are early data, but it does look as if there may be some interesting activity in the relatively refractory patient group.


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