Colorectal Cancer: New Treatments, Improved Prognosis
New drugs show promise, but more research needs to be done.
A Dramatic Rise in Costs continued...
"With prices this high, I'm sure the insurance companies will start
erecting barriers to patients trying to get these drugs," says Back.
"These companies just can't afford it."
Saltz worries that it's already happening. He says some insurance companies
are relying on "debunked" science -- namely, the EGF receptor test,
which was thought to predict whether a person would be helped by Erbitux.
"The EGF receptor test is a bad test," he says. "Studies have
shown that it has no predictive or prognostic value and should not be marketed.
But insurance companies are using it as a way to deny people treatment with
Hoff agrees that the current test is a problem. "It's just not sensitive
enough," he says. "We just don't have the data to justify using it to
exclude people from treatment."
Augustyn, who is also chief of gastroenterology at California Pacific
Medical Center in San Francisco, hopes that competition from other
pharmaceutical companies might drive the prices down. But it will still be many
years before any similar drugs can be tested, approved, and sold.
Surgery Remains the Standard of Care for Early Colorectal Cancer
While new drugs may get the most attention, surgery remains the standard
treatment for people in the earlier stages of colorectal cancer. In recent
years, minimally invasive -- or "keyhole" -- surgery has become a
With this approach, the procedure is done by the surgeon through a small
incision using special instruments and a laparoscope, a long flexible tube with
a camera and light attached. The surgeon performs the operation while looking
into a monitor. This minimally invasive approach allows for smaller incisions,
less pain after surgery, and quicker recovery.
A 2005 study published in The Lancet found that laparoscopic
surgery worked as well as traditional open surgery for some colon cancer
patients, but more studies looking at long term outcomes are needed.
"There's definitely a trend toward using laparoscopic surgery for colon
resection," says Augustyn. "We're finding that 80% or more of colon
cancers can be done that way."
However, The Lancet study also found that for rectal cancer,
laparoscopic surgery has not been shown to be as effective as open surgery.
Hoff points out another problem with the keyhole approach. "While we
have evidence that laparoscopic colon surgery is safe and probably as good as
open surgery, that's only true if the surgeon is experienced with the
technique," he says. "Not all surgeons are."
Hoff also thinks that people can have inflated ideas about the benefits of
keyhole surgery. "Laparoscopic surgery is still surgery," he tells
WebMD. "You're still getting a piece of the colon removed and you'll still
need recovery time. While the hospitalization may be a little shorter, it's not
a big difference."