OBR Daily Commentary

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A Survival 'Paradox' in Colon Cancer

(Medscape Medical News) Aug 5, 2016 - There is a "survival paradox" in colon cancer? patients with a lower-stage malignancy have poorer survival than patients with higher-stage disease? and a new study confirms the phenomenon.

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Richard Goldberg, MD (Posted: August 05, 2016)

quotesAdjuvant trials have shown the worse prognosis for T4 stage II tumors as compared to T2 and T3 stage IIIA (1-3 + nodes) for some time. Rather than representing a paradox this appears to highlight that staging is useful to give us a common currency for classifying tumors but is not necessarily the best predictor of outcomes. Staging is our attempt to impose an anatomical order on the chaos of cancer and yet it currently does not take biology as defined by molecular genetic and other drivers into account. The AJCC staging system is currently undergoing revision but will remain anatomically based for the next edition until there are more data to help refine the staging system through genomic analyses. The NCI is mounting a huge effort to extend genomic analyses in patients accrued to clinical trials in colon cancer and many other primary cancers to try to help refine our understanding of the interplay between biology and anatomy. quotes

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Oxaliplatin-Based Adjuvant Chemo for Stage III MMR CRC

(Medscape Medical News) July 22, 2016 - The largest study to date to focus on patients with colorectal cancer (CRC) with deficient DNA mismatch repair (dMMR) has found that adjuvant therapy with fluoropyrimidine combined with oxaliplatin (Eloxatin, Sanofi-Aventis), but not fluoropyrimidine alone, significantly improved disease-free survival when compared with surgery alone in patients with stage III disease.

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Richard Goldberg, MD (Posted: July 26, 2016)

quotesWhile there are some data for Stage II patients suggesting harm from 5-FU alone in MSI-H patients there has been little available to guide us in Stage III patients with MSI-H tumors. While this is retrospective data it does provide some evidence for using oxaliplatin in this setting that is corroborated by xenograft experiments. Even in patients with borderline PS trying a reduced dose of oxaliplatin initially seems like a reasonable strategy in patients who are getting adjuvant treatment for Stage III tumors and whose tumors are MSI-H. quotes

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FOLFOXIRI Plus Bevacizumab Ups Outcome in Metastatic CRC

(Monthly Prescribing Reference/HealthDay News) Oct 23, 2014 - For patients with untreated metastatic colorectal cancer, chemotherapy with fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) plus bevacizumab improves outcome versus fluorouracil, leucovorin, and irinotecan (FOLFIRI) plus bevacizumab, according to a study published in the Oct. 23 issue of the New England Journal of Medicine.

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Richard Goldberg, MD (Posted: October 24, 2014)

quotesIt is notable that this study accrued patients bewteen 7/08-5/11. The 31 month median overall survival is heartening. The question remains, in the era of the multiple active agents that are now available for treating metastatic colorectal cancer, whether treatment with five drugs at once is best. Data from the 80405 study presented at the 2014 ASCO meeting which used FOLFOX or FOLFIRI with cetuximab or bevacizumab also reported median overall survivals exceeding 30 months with all of the regimens used in that trial. Many oncologists gravitate to the strategy of using combinations of 2-3 agents in series rather than delivering more agents simultaneously. This is in order to preserve options for later lines of therapy as well as to optimize quality of life. It is not clear if FOLFOXIRI + bevacizumab buys longer life at the compromise of greater toxicity. When comparing the results achieved by the patients enrolled in 80405 to those in the GONO trial, the data suggest that both strategies- drug & dose intensive inital therapy and less drug intensive doublet or triplet treatment may lead to equivalent survival outcomes. In the US, at least, it seems unlikely that the FOLFOXIRI + bevacizumab regimen will become the standard of care. quotes

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Meet the Editorial Board

Community Oncology
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Dean Gesme, MD

FACP FACPE FASCO President, Minnesota Oncology...

Breast Cancer
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Debu Tripathy, MD

Professor and Chair, Department of Breast Medical Oncol...

Lung Cancer
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H. Jack West, MD

Medical Director, Thoracic Oncology Program, Swedish Ca...

Gastrointestinal Cancers
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Howard S. Hochster, MD

Associate Cancer Center Director, Yale Cancer Center P...

Radiation Oncology
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Howard Sandler, MD, MS, FASTRO

Professor and Chair, Department of Radiation Oncology...

Community Oncology
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Jeff Patton, M.D.

CEO Tennessee Oncology...

Precision Medicine Section Editor
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Jennifer Levin Carter, MD, MPH

Chief Medical Officer and Founder, N-of-One...

Health Policy
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Joseph Bailes, MD

National Health Policy Expert...

Financial Sector
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Michael G. King Jr.

Managing Director and Senior Biotechnology Analyst...

Gastrointestinal Cancers
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Richard Goldberg, MD

Professor and Physician-in-Chief of the Ohios State Uni...

Editor-In-Chief
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Robert A. Figlin, MD., FACP

Professor and Director, Division of Hematology Oncology...

Community Oncology
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Thomas Marsland, MD

Vice President Integrated Community Oncology Network ...

Community Oncology
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William Harwin MD

Florida Cancer Specialists President and Managing Part...

Health Policy
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William McGivney, PhD

National Health Policy Expert...

Payer
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Winston Wong, PharmD

President, W-Squared Group...