When administered before chemoradiation, the common anti-cancer drug cisplatin neither improved disease-free survival nor reduced the number of colostomies needed when compared to the standard treatment for patients with anal canal cancer, according to a study published in the April 23 issue of the Journal of the American Medical Association.
In the largest cooperative phase III randomized controlled trial of its kind, a multicenter research team led by Jaffer Ajani, M.D., professor in the Department of Gastrointestinal Medical Oncology at The University of Texas M. D. Anderson Cancer Center, compared the standard treatment regimen of fluorouracil plus mitomycin and radiotherapy to fluorouracil plus cisplatin and radiotherapy in 644 patients with anal canal cancer. The five-year disease-free survival rate was 60 percent in the mitomycin-based group and 54 percent in the cisplatin-based group. The five-year overall survival rate was 75 percent in patients receiving mitomycin versus 70 percent receiving cisplatin, with more cancer-related deaths in the cisplatin-based group (54 patients) compared to mitomycin-based group (28 patients).
Patients who received cisplatin-based treatment resulted in significantly higher rates of colostomy (19 percent versus 10 percent). It is widely held among practicing oncologists that the colostomy procedure, which creates an alternative exit from the colon to divert waste, should only be used as a last resort in the treatment of anal canal cancer due to its considerable affect on the patient's quality of life.
"Based on preliminary data from smaller trials that suggested considerable sensitivity to the fluorouracil plus cisplatin combination, cisplatin has gained popularity among oncologists as a drug to treat anal canal cancer," said Ajani. "However, it is clear from this data that cisplatin is not the drug to use and its use should be discontinued in standard therapy."
The study expanded on findings from two pilot studies that encouraged oncologists to believe that cisplatin could potentially be used to reduce the cancer in the primary tumor and lymph nodes prior to administration of concurrent chemoradiation. The research group hypothesized that using cisplatin to downsize the tumors first could be an effective strategy for treating the disease because previous studies have established that chemoradiation is more effective for smaller anal canal carcinomas than larger ones.
"There have been incremental advancements in the treatment for anal canal cancer in the last decade and there was hope that the unique cisplatin-based strategy would offer an improved, less-toxic therapy to patients suffering from the disease," Ajani said. "While our research did not uncover a new standard of treatment, comparative studies such as this one are imperative to determining best practices and informing community oncologists."
According to the American Cancer Society, an estimated 5,070 new cases of anal canal cancer will be diagnosed in 2008. The five-year disease-free survival of approximately 65 percent has not improved since the early 1990s. Primary anal canal tumor size has a direct bearing on cure rates, and the five-year survival rates decrease significantly for tumors larger than 5 cm diameter. Approximately 25 percent of newly diagnosed anal carcinomas are larger than 5 cm in diameter.
From this study, it is anticipated that researchers will look to explore other options such as newer targeted therapies and intensity-modulated radiation plus concurrent chemotherapy to improve disease-free and colostomy-free survival relative to the continued standard of concurrent chemoradiation with fluorouracil and mitomycin.
This study was part of the U.S. Gastrointestinal Intergroup trial RTOG 98-11. In addition to Ajani, researchers contributing to the study include Kathryn A. Winter, M.S., Radiation Therapy Oncology Group; Leonard L. Gunderson, M.D., Mayo Clinic, Scottsdale, Arizona; John Pedersen, M.D., Cross Center Institute, Edmonton, Alberta, Canada ; Al B. Benson III, M.D., Northwestern University, Chicago, Illinois; Charles R. Thomas Jr., M.D., University of Oregon, Portland; Robert J. Mayer, M.D., Dana-Farber Cancer Institute, Boston, Massachusetts; Michael G. Haddock, M.D., Mayo Clinic, Rochester, Minnesota; Tyvin A. Rich, M.D., University of Virginia, Charlottesville; Christopher Willett, M.D., Duke University, Durham, North Carolina.
About M. D. Anderson
The University of Texas M. D. Anderson Cancer Center in Houston ranks as one of the world's most respected centers focused on cancer patient care, research, education and prevention. M. D. Anderson is one of only 39 Comprehensive Cancer Centers designated by the National Cancer Institute. For five of the past eight years, M. D. Anderson has ranked No. 1 in cancer care in "America's Best Hospitals," a survey published annually in U.S. News and World Report.
Robyn Stein | EurekAlert!
Rutgers-led innovation could spur faster, cheaper, nano-based manufacturing
14.02.2018 | Rutgers University
New study from the University of Halle: How climate change alters plant growth
12.01.2018 | Martin-Luther-Universität Halle-Wittenberg
A newly developed laser technology has enabled physicists in the Laboratory for Attosecond Physics (jointly run by LMU Munich and the Max Planck Institute of Quantum Optics) to generate attosecond bursts of high-energy photons of unprecedented intensity. This has made it possible to observe the interaction of multiple photons in a single such pulse with electrons in the inner orbital shell of an atom.
In order to observe the ultrafast electron motion in the inner shells of atoms with short light pulses, the pulses must not only be ultrashort, but very...
A group of researchers led by Andrea Cavalleri at the Max Planck Institute for Structure and Dynamics of Matter (MPSD) in Hamburg has demonstrated a new method enabling precise measurements of the interatomic forces that hold crystalline solids together. The paper Probing the Interatomic Potential of Solids by Strong-Field Nonlinear Phononics, published online in Nature, explains how a terahertz-frequency laser pulse can drive very large deformations of the crystal.
By measuring the highly unusual atomic trajectories under extreme electromagnetic transients, the MPSD group could reconstruct how rigid the atomic bonds are...
Quantum computers may one day solve algorithmic problems which even the biggest supercomputers today can’t manage. But how do you test a quantum computer to...
For the first time, a team of researchers at the Max-Planck Institute (MPI) for Polymer Research in Mainz, Germany, has succeeded in making an integrated circuit (IC) from just a monolayer of a semiconducting polymer via a bottom-up, self-assembly approach.
In the self-assembly process, the semiconducting polymer arranges itself into an ordered monolayer in a transistor. The transistors are binary switches used...
Breakthrough provides a new concept of the design of molecular motors, sensors and electricity generators at nanoscale
Researchers from the Institute of Organic Chemistry and Biochemistry of the CAS (IOCB Prague), Institute of Physics of the CAS (IP CAS) and Palacký University...
15.02.2018 | Event News
13.02.2018 | Event News
12.02.2018 | Event News
23.02.2018 | Physics and Astronomy
23.02.2018 | Health and Medicine
23.02.2018 | Physics and Astronomy