Colorectal Cancer: New Treatments, Improved Prognosis
New drugs show promise, but more research needs to be done.
A Dramatic Rise in Costs continued...
"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 Erbitux."
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 popular choice.
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."