New Hope for Colon Cancer Patients
Sept. 27, 2000 -- For the first time in decades, there is new hope for patients with even the most advanced colon cancer. In a groundbreaking study, patients who received a combination of three widely used anticancer drugs experienced more tumor shrinkage and lived longer without more side effects than did those who received the standard two-drug therapy.
"This represents a step forward in how we treat this disease, and I think that's really pretty exciting," study leader Leonard B. Saltz, MD, associate attending physician at Memorial Sloan-Kettering Cancer Center in New York, tells WebMD. "The use of irinotecan [ireeno-TEE-kin], fluorouracil or 5-FU, and leucovorin [luke-oh-VOR-in] as first-line treatment for colorectal cancer is simply the best available treatment right now." It replaces the current approach, he says, in which irinotecan is given only after the standard treatment with 5-FU and leucovorin has failed.
To test how well the three drugs would work together, the researchers randomly assigned nearly 700 men and women, aged 25 to 87, with highly-advanced colon cancer to receive the combination therapy, the standard therapy, or irinotecan alone.
Compared with patients who received the standard therapy, those who got the new combination lived longer without their tumors growing and had significantly more tumor shrinkage.
Patients who received irinotecan alone had similar results to those who got the standard two-drug therapy. The results were published in the Sept. 28 issue of The New England Journal of Medicine.
"We showed that using all the drugs together up front has a better chance of shrinking the tumor, a longer time until [the disease progresses], and affords a modest improvement in overall survival, [all] without an increase in overall side effects and without any detriment to quality of life, compared to what used to be standard," Saltz says.
"Patients are understandably impressed when they hear about progress," says Robert J. Mayer, MD, who wrote an editorial accompanying the paper. "Often lost in those headlines is the extent of side effects associated with the newer form of treatment. But the addition of this new drug irinotecan to the 5-FU and leucovorin does not seem to increase diarrhea significantly," he tells WebMD. Mayer is director of the center of gastrointestinal oncology at The Dana Farber Cancer institute, and professor of medicine at Harvard Medical School in Boston.
What the findings represent, says Mayer, "is evidence that after 40 years, effective alternative forms of drug treatment to 5-FU have been developed [and that] adding such drugs to 5-FU can ... prolong survival." The hope, he tells WebMD, is that ongoing medical research will demonstrate that this new approach "increases the likelihood of cure in this very common malignant condition."
Participants in this study had "basically incurable disease [that had spread to other parts of the body]," says Saltz, and the data indicate that the combined therapy is the best available option for that population. The team has already begun a similar investigation to determine whether the three drugs will improve survival in people with less severe colon cancer.