Reporting from:
– Gastrointestinal Cancers Symposium, January 27-29, 2005, Hollywood, Florida

Scientific Editors:
George Canellos, Dana-Farber Cancer Institute, Boston
Gordon McVie, European Institute of Oncology, Milan
Pat Price, Christie Hospital, Manchester
Gianni Bonadonna, Istituto Nazionale Tumori, Milan
Producer: Derek Thorne
Correspondents: Peter Goodwin, Peter Beer, Derek Thorne
In this edition:

Bruce Giantonio and Robert Mayer discuss the Eastern Cooperative Oncology Group study in which bevacizumab was added to an oxaliplatinbased regimen for the management of advanced colorectal cancer previously treated with chemotherapy.

Heinz-Josef Lenz reports on an investigation showing single-agent cetuximab to be effective in the treatment of advanced colorectal cancer that is refractory to all of the usual cytotoxic drugs.

Malcolm Moore‘s trial involving patients with advanced pancreatic cancer, in which gemcitabine standard therapy has been supplemented with erlotinib (a drug targeting the epidermal growth factor pathway), has shown a small but definite improvement in survival and disease control. Robert Mayer discusses the results.

Daniel Haller explains how his ONCOSURGE decision-making system for the treatment of colorectal cancer metastases can be applied to potentially extend life and even cure patients by helping clinicians decide which strategies to use in each particular clinical situation.

Abstract 169a
Bruce Giantonio, University of Pennsylvania, Philadelphia

Chemo-naive patients with advanced colorectal cancer have already been shown to have improved overall survival by receiving further treatment with bevacizumab plus cytotoxic chemotherapy. But the benefit of adding the new targeted therapy to pre-treated patients was not known. At the gastrointestinal cancers symposium results from the Eastern Cooperative Oncology Group study in which bevacizumab was added to an oxaliplatin-based regimen in patients who had already received chemotherapy also showed an improvement in survival.

COMMENT: Robert Mayer, Dana-Farber Cancer Institute, Boston

Abstract 167
Aimery de Gramont, Hopital Saint Antoine, Paris

The latest findings on adjuvant chemotherapy for colorectal cancer from the French MOSAIC trial might give strength to the case for treating patients with Stage II tumors as well as those with Stage III disease. The trial, which now has a median follow up of 4 years, randomised over 2000 patients to either 5-FU/leucovorin or the FOLFOX4 regimen.

COMMENT: Robert Mayer, Dana-Farber Cancer Institute, Boston

Abstract 225
Heinz-Josef Lenz, University of Southern California, Los Angeles

Among patients with advanced colorectal cancer who are already refractory to all of the usual cytoxic drugs, single agent cetuximab, also known as erbitux, has been found to be effective. That’s according to a new study discussed at the gastrointestinal cancers symposium by Heinz-Josef Lenz.

Abstract 35
Ernest Rosato, Thomas Jefferson University Hospital, Philadelphia

In patients with cancer of the distal esophagus and the the gastroesophageal junction, a trial of about 70 patients has suggested that neoadjuvant chemotherapy with 5-FU, carboplatin and paclitaxel given together with radiation can markedly improved survival as compared with using surgery alone.

Abstract 77
Malcolm Moore, Princess Margaret Hospital, Toronto

Patients with advanced pancreatic cancer may receive gemcitabine as standard therapy given that the disease is inoperable and incurable. But now a phase III study combining gemcitabine with erlotinib – a drug targeting the epidermal growth factor pathway – has shown a small but definite improvement in survival and disease control.

COMMENT: Robert Mayer, Dana-Farber Cancer Institute, Boston

Abstract 76
Randall Brand, Evanston Northwestern Healthcare, Glenview

An elegant analysis of data from over 27 000 patients presented at the symposium seems to show that smoking can play a role in the early stages of pancreatic cancer.

Education section Page 54
Todd Baron, Mayo Clinic, Rochester

Patients with cholangiocarcinoma, or bile-duct cancer, need to have the duct obstruction cleared by intervention. As compared with stenting, the new method of photodynamic therapy – using a photo-sensitizer and a laser – has shown a clear advantage.

Abstract 140
Jason Foster, Roswell Park Cancer Institute, Buffalo

Gallbladder cancer now, and according to a retrospective study presented at the symposium, T2 and T3 stage tumours can benefit from radical resection rather than just cholecystectomy.

Abstracts 183 & 184
Nancy Kemeny, Memorial Sloan-Kettering Cancer Center, New York

For colorectal cancer patients with liver metastases, can a hepatic arterial infusion pump improve survival as compared with systemic chemotherapy? Nancy Kemeny’s group had data from two randomised trials which addressed this question: an intergroup CALGB study in 135 patients who did not receive surgery, and a slightly larger trial, in which all patients were resected.

COMMENT: Robert Mayer, Dana-Farber Cancer Institute, Boston

Abstract 162
Daniel Haller, University of Pennsylvania Abramson Cancer Center, Philadelphia

Because the management of liver metastases in colorectal cancer patients can potentially extend life and even cure patients, a group led from Philadelphia has developed a decision-making tool – called ONCOSURGE – that helps clinicians decide which strategies to use in a particular clinical situation.

Education section Page 74
Steven Curley, M D Anderson Cancer Center, Houston

The management of colorectal cancer patients with disseminated disease was a big theme at the gastrointestinal cancers conference. Steven Curley gave a review of all the available strategies.