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Colorectal cancer
Patient Monitoring
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Patient Monitoring
Therapy
The treatment of choice for most types of colorectal cancer is surgery, although radiotherapy and chemotherapy have important roles to play. With Xeloda
® and Avastin
® Roche has introduced unprecedented products for the treatment of colorectal cancer. They complete the Roche Group's unique portfolio for early detection, prevention, diagnosis and therapy of colorectal cancer.
Surgery
Surgery is the definitive treatment for localized colorectal cancer. If it succeeds, the patient may be rendered free from cancer. When curative surgery is not possible, patients may benefit from stenting to relieve obstruction, or from palliative surgery. The kind of surgery depends on the localisation and extension of the tumour.
In metastatic colorectal cancer surgery may be necessary in order to assure intestine passage.
Adjuvant chemotherapy
The standard systemic treatment in patients with Dukes C / UICC stage III colorectal cancer has been a course of 5-fluorouracil (5-FU) and folinic acid (leucovorin), given intravenously over six months.
In Dukes B / UICC stage II administration of systemic chemotherapy is a matter for discussion between patients and their oncologists. Chemotherapy is not recommended for patients with Dukes’ stage A cancers.
Chemotherapy in metastatic disease
First line chemotherapy with intravenous 5-FU and leucovorin (Mayo Clinic regimen) until progress of disease has long been standard treatment of metastatic colorectal cancer. Randomized phase III studies demonstrated superior response to Xeloda
® monotherapy versus 5-FU/leucovorin with at least equivalent time to progression and survival.
Xeloda® (capecitabine) is a prodrug that undergoes a three-step enzymatic conversion to 5-FU. It can be administered orally and is indicated as first-line treatment of patients with metastatic colorectal carcinoma. Currently, studies are underway to evaluate the use of Xeloda
® instead of 5-FU/leucovorin in combinations.
Furtulon® (doxifluridine) from Roche is also a 5-FU prodrug which that can be administered orally and is beneficial in patients with advanced colorectal cancer.
In case of progressive disease, combinations of 5-FU/leucovorin with irinotecan or oxaliplatin are administered. In EGF positive, irinotecan-refractory disease, irinotecan may be combined with cetuximab.
Avastin® - inhibition of angiogenesis
Despite the improvement in chemotherapy treatments, the available options still remained unsatisfactory, especially in patients with advanced colorectal cancer. The unique new cancer drug Avastin
® (bevacizumab) from Roche is a milestone for cancer therapy, offering improved efficacy, tolerability and convenience.
Avastin
® (bevacizumab) is the first treatment that inhibits angiogenesis by targeting the vascular endothelial growth factor (VEGF), a key mediator of angiogenesis. The monoclonal antibody has been shown to increase survival about 30 % from 15.6 to 20.3 months when added to the combination of 5-FU/leucovorin in previously untreated patients with advanced colorectal cancer. Additional studies have shown that Avastin
® increases survival when used in combination with an oxaliplatin-containing chemotherapy regimen in patients who have previously failed one chemotherapy regimen. Furthermore, Avastin
® improves overall response rates in combination with oxaliplatin-containing chemotherapy regimens in previously untreated patients.
Patient Monitoring
Monitoring of patients depends on the initial tumor stage. Follow-up is efficient and cost-effective, if patients at higher risk are followed up more intensively than those at lower risk. Patients at greatest risk are those with more advanced tumours at the time of resection - particularly Dukes’ stage C.
Follow-up of patient with colorectal cancer includes:
- Medical history, physical examination
- Determination of carcinoembryonic antigen (CEA, see below)
- Colonoscopy
- Sonography of the abdomen (easy to perfom and most cost-effective measure to detect liver metastasis)
- Sigmoidoscopy (only in the case of rectal carcinoma without neoadjuvant or adjuvant radiochemotherapy)
Patients who did not undergo complete colonoscopy before surgery should be offered colonoscopy within 3 to 6 months of discharge. This can be regarded as completion of initial diagnostic work-up, to identify individuals who have polyps or a tumour elsewhere in the colon. Similarly, patients who did not have a computed tomography scan of the liver before surgery should have such a scan within six months. Colonoscopy may be offered at three- to five-yearly intervals to check for new polyps or tumours; patients with five or more adenomas should be offered more frequent checks.
Carcinoembryonic antigen (CEA)
The American Society of Clinical Oncology and the European Group on Tumour Markers recommend to determine CEA every 2 to 3 months within the first two years after surgery.
If the CEA value is elevated, more intense diagnostic procedures are necessary. However, it is not indicative for commencing a systemic chemotherapy due to suspicion of metastatic tumour. Also, about 30 % of colorectal carcinomas do not secrete CEA, and 44 % of the patients with normal preoperative values exhibit postoperative increases of CEA.
XELODA, FURTULON and AVASTIN are trademarks of a member of the Roche group.
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