Amazing Life

One treatment option for people with colon cancer is surgery, followed by chemotherapy. This combination can be effective at managing, and in many cases completely curing, colon cancer. How soon after surgery is the optimal time to start chemotherapy?
A study presented at the recent Gastrointestinal Cancers Symposium in San Francisco aimed to answer this question. The study authors hope the information will help people make more informed treatment decisions that will give them the highest likelihood of a colon cancer cure.
Colon Cancer Meta-Analysis for Better Understanding
The researchers weren't able to conduct a randomized controlled trial, but they did the next best thing. They collected information (data) from nine studies that included 14,357 colon cancer patients.
They analyzed all of this information together in a type of study called a meta-analysis. The larger number of patients being studied in a meta-analysis allows for statistical testing that wouldn't be possible in smaller studies.
Within Four Weeks Optimal
After considering all of this information, the researchers found:

• Patients treated within four weeks of surgery had a better chance of survival compared with people who started chemotherapy more than four weeks post-surgery.
• There was a 15% increased risk of disease recurrence at five years after diagnosis, for every additional four weeks of treatment delay, beyond the initial four weeks after surgery.
• There was 12% increased risk of death at five years after diagnosis, for every additional four weeks of treatment delay, beyond the initial four weeks after surgery.
• Even though risk of recurrence went up with every additional four weeks after surgery that a patient didn't start chemotherapy, there was still some benefit to receiving chemotherapy even after three months post-surgery.

The bottom line is that starting chemotherapy within one month of your colon cancer surgery is optimal. Waiting longer may increase the chances of cancer recurrence.
If you have been diagnosed with colon cancer, ask your doctor what steps you can take to help yourself heal and get your strength back after surgery. This will help ensure you're ready to tackle chemotherapy as soon as possible.
If you have to wait longer than four weeks after surgery to start chemotherapy, you still can get benefit from your treatment. However, you'll want to work with your medical team to come up with a good plan for monitoring your health after treatment ends.
The best way to treat any type of cancer recurrence is to catch it as soon as possible after it occurs.

Advanced, or metastatic colon cancer, is cancer that has spread beyond the colon to other areas of the body. Colon cancer experts are constantly testing new treatment options to determine the best way to manage the disease. A recent study compared two induction chemotherapy treatments to determine which provided the best results for patients.
What is Induction Chemotherapy?
Often, chemotherapy is given after surgery to remove the tumor from the colon. Induction chemotherapy, however, is given before surgery. The goal is to shrink tumors with the hope of making surgery more successful.
In most cases, smaller tumors are easier to remove than larger ones. Induction chemotherapy also may be able to eliminate or slow down cancer cells that have spread to other parts of the body.
FOLFIRI vs. FOLFOXIRI
A recently published trial compared risks and benefits of two induction chemotherapy methods in 244 people with advanced (metastatic) colon cancer:

1. FOLFIRI - a combination of the chemotherapy medications 5-fluorouracil, leucovorin, and irinotecan
2. FOLFOXIRI - a combination of the chemotherapy medications 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin

The researchers looked at progression-free survival, which is the amount of time a person lives during which their colon cancer does not advance, grow larger, or spread any further in the body. They also considered average survival time and 5-year survival in the two groups.
After following the group for a median (similar to average) of five years, the researchers found that:

• The FOLFOXIRI group had median progression-free survival of 9.8 months vs. 6.8 months for the FOLFIRI group.
• The FOLFOXIRI group had median overall survival of 23.4 months vs. 16.7 months for the FOLFIRI group.
• The FOLFOXIRI group had a 5-year survival rate of 15% vs. 8% for the FOLFIRI group.

Survival differences of months may not seem like much, but to someone who's dealing with advanced colon cancer, this can mean the difference between seeing a loved one get married, graduate from high school or college, or reach some other important milestone, and missing this opportunity
The 5-year survival rate was nearly doubled in the FOLFOXIRI group compared with the FOLFIRI group.
Making Your Best Treatment Choices
You probably noticed that the main difference between these two treatments was the addition of one chemotherapy drug, called oxaliplatin. With every new drug that is added to cancer treatment, the chances of side effects go up.
Sometimes these side effects are more of a nuisance. Other side effects can be debilitating and painful, so it's important to fully understand the risks and benefits of any treatment you are considering. The chances to double your odds of survival may be worth serious side effects to some people, but not to others.
Only you know what is right for you. Consult with your family and friends. Discuss the options with your medical team. Get second opinions if you need them. Once you know all the facts, you can move forward with your treatment plan for advanced colon cancer.

Bevacizumab (Avastin) is one of the newer, targeted therapies that have been added to the list of colon cancer treatment options in recent years. Bevacizumab works by inhibiting the growth of blood vessels around a tumor.
Blood vessel growth is referred to as angiogenesis, so bevacizumab is an angiogenesis inhibitor. The objective is to "starve" the tumor by preventing it from getting a good blood supply.
Bevacizumab is often used to treat advanced colon cancers, those that have spread beyond the colon to other parts of the body. In addition to colon cancer, bevacizumab is used to treat advanced cancers of the breast, lung, kidney, pancreas, and prostate.
The Big Picture on Bevacizumab
Now researchers have conducted the largest study to date on bevacizumab, to determine potential risks and benefits of this treatment. The researchers performed a type of study known as a meta-analysis. A meta-analysis allows information (data) from many studies to be considered (analyzed) together.
The larger number of patients being studied in a meta-analysis allows for statistical testing that wouldn't be possible in smaller studies. In this way, meta-analysis helps researchers get a better picture of the overall risks and benefits of a given treatment.
Bevacizumab by the Numbers

The most important thing to come out of this new study is that the risk of fatal side effects, which is any side effect that results in a patient's death, is higher than originally suspected. Compared with people receiving standard chemotherapy alone, those who received standard chemotherapy plus bevacizumab had a 46% increased risk of dying (having a fatal adverse event).
Another way to look at this is that 1.7% of people receiving standard chemotherapy alone had a fatal adverse event (death) vs. 2.5% of people receiving chemotherapy plus bevacizumab. This may not sound like a big deal, but it is. Unless a treatment has a very significant benefit, even a tiny increase in the risk of death must be considered as a potential reason not to use that treatment.
Problematic Combinations
The biggest problems with bevacizumab seemed to occur when it was used in combination with certain other medications. The risk death in patients receiving bevacizumab plus taxanes or platinum drugs was about three and a half times higher than the risk in people taking bevacizumab and other medications.
The Bevacizumab Bottom Line
Bevacizumab can be a useful treatment for advanced colon cancer, but it needs to be considered with care and respect. If your doctor would like to use this medication as part of your treatment, find out all the facts. Ask specifically about the risk of very serious side effects, such as excessive bleeding or blood clots.
Be sure to ask how these risks will be managed and what you can do to keep the risk as low as possible. And always ask for the full list of potential risks and benefits of any treatment you're receiving.
An informed patient is much more likely to make the right treatment decisions for his or her particular situation. It's OK to question your doctor and it's OK to get a second opinion.

"Modern medicine has focused so intently on fighting disease that it has overlooked a natural ally in the battle--the patient's personal mental management of the stresses associated with cancer." Thus begins a very important commentary in a recent issue of the Journal of the American Medical Association.
In this commentary, Dr. David Spiegel, MD, highlights the importance of attending to the mental, emotional, and psychological needs of people living with advanced cancer. He points to studies suggesting that supportive information sessions on resuscitation preferences, pain control, and quality of life, as well as cancer support groups, can significantly extend life in those with advanced cancer. Not only that, people have a much better quality of life too.
Taking Care of Your Needs
One of the most important messages to take away from this commentary is that when cancer cannot be cured, providing supportive care and mental/emotional resources for people may extend life more effectively than treating the disease aggressively.
However, this does not mean that people should give up hope or give up on treatment. That is not the key message. The commentary simply points to the potential downsides of providing treatment at the expense of providing supportive care. You can seek to get the best of both worlds.
If you have advanced cancer and are pursuing aggressive treatment, don't forget to take care of your mind too. Aggressive treatment often causes people to focus on the medical issues, leaving little focus on coping with the stresses of cancer and its treatment.
Talk to your medical care team about supportive and informational services that are available to you. If the thought of walking into a room full of people with cancer who are talking about their emotional concerns is overwhelming, consider online support resources.
_{Sources
Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ. Early palliative care for patients with metastatic non-small-cell lung cancer. New England Journal of Medicine 2010;363:733-42.
Spiegel D, Bloom JR, Kraemer HC, Gottheil E. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 1989;2:888-91.}