Like all of our audio programs, this issue of Colorectal Cancer Update is stuffed like a kishka with scientific content. Herb Hurwitz updates us on the evolving and very encouraging short- and long-term safety data on the anti-VEGF agent bevacizumab; Peter Enzinger comprehensively reviews recent data on adjuvant chemotherapy, particularly trials of oxaliplatin regimens like FOLFOX and FLOX (I prefer lox) and studies of capecitabine, either alone or with oxaliplatin; and Al Benson discusses the background and design of ECOG trial 5202, a critical study evaluating FOLFOX alone or with bevacizumab in Stage II tumors that a central lab at MD Anderson designates as higher risk based on microsatellite instability and 18q deletions.

There is also a Cracker Jack^®-like special prize included with this program, a report on an exciting patient education project we recently conducted on 150 people with colorectal cancer who reacted to an audio program outlining the risks and benefits of adjuvant chemotherapy.

As discussed on the last issue of this series, our findings provide a number of interesting insights about patient perspectives on this disease. To that end, the enclosed monograph includes a comprehensive look at the survey results and a CD with the 50-minute audio interview with John L Marshall, MD that formed the basis of the survey. Many of Dr Marshall’s comments are also excerpted in the print report.

As this note is being composed, our CME group is preparing to travel to San Francisco for the third annual ASCO GI symposium, where we will present a poster outlining many of our major findings from this project. We look forward to onsite and “virtual” feedback regarding this initial foray into patient education and our plan to pilot a “boxed set” of six CDs in 2006 on a variety of patient education issues related to adjuvant systemic therapy for colon cancer.

Of all the fascinating nuggets to come out of this initiative, perhaps my favorite relates to ECOG trial 5202, which randomly assigns patients with higher-risk Stage II tumors to FOLFOX alone or with bevacizumab. Based on Dr Marshall’s description of this study, 75 percent of the participants would be willing to enter the study if eligible (1.1, 1.2, 1.3).

Seventy-five percent is an impressive fraction and is far more than the estimated two to three percent of cancer patients nationally who enter clinical trials. Yet, perhaps we should not be too surprised by this finding. Trial 5202 offers participants not only a chance to move the field forward and protect the health of future generations but also the unique opportunity to have their tumor tissue analyzed by one of the best labs in the country. Based on those findings, participants can potentially receive a relatively nontoxic therapeutic agent (bevacizumab) that would not be available off protocol.

Seventy-five percent. Let’s tap into this signal and get trials like 5202 and its siblings, NSABP-C-08 and AVANT, done — and done soon. We need more good stuff to talk about on our CME programs in the future, and nothing would be more interesting and encouraging than a trastuzumab-like step forward in adjuvant therapy for colon cancer.

— Neil Love, MD
NLove@ResearchToPractice.net
January 30, 2006