Advancements in Rectal Cancer Treatments


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In this presentation, Dr. Deborah Schrag, Medical Oncologist from Dana Farber Cancer Institute covers therapy options, surgery options, and radiation options, that are specific to rectal cancer patients. She also touches on the importance of clinical trials for this population, and highlights a few trials in research that she finds most interesting.

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Advancements in Rectal Cancer Treatments

  1. 1. Welcome!Advancements in TreatingRectal CancerPart of Fight Colorectal Cancer’s Monthly Patient Webinar SeriesOur webinar will begin shortlywww.FightColorectalCancer.org877-427-2111
  2. 2. Fight Colorectal Cancer1. Tonight’s speaker: Dr. Deborah Schrag, MD2. Archived webinars: Follow up survey to come via email. Get a free Blue Star ofHope pin when you tell us how we did tonight.4. Ask a question in the panel on the right side of your screen andlook for hyperlinks during throughout the presentation.5. Or call the Fight Colorectal Cancer Answer Line at 877-427-2111www.FightColorectalCancer.org877-427-2111
  3. 3. Fight Colorectal CancerDisclaimerThe information and services provided by Fight ColorectalCancer are for general informational purposes only.The information and services are not intended to be substitutesfor professional medical advice, diagnosis, or treatment.If you are ill, or suspect that you are ill, see a doctorimmediately. In an emergency, call 911 or go to the nearestemergency room.Fight Colorectal Cancer never recommends or endorses anyspecific physicians, products or treatments for any condition.www.FightColorectalCancer.org877-427-2111
  4. 4. Fight Colorectal CancerUp coming webinarWednesday, June 19th8pm-9pm ESTColorectal Cancer:Whats New and Whats on the Horizon?In Collaboration with the Colon Cancer
  5. 5. Fight Colorectal Cancerwww.FightColorectalCancer.org877-427-2111Dr. Deborah Schrag, MD, MPHDana Farber Cancer InstituteAssociate Professor of Medicine, Harvard Medical School
  6. 6. Deborah Schrag MD MPHDana-Farber Cancer InstituteBoston, MA
  7. 7.  American Cancer Society estimates 40,340new cases of rectal cancer in 2013 Colon/Rectal cancer is the 3rd leading cause ofcancer-related death in US
  8. 8.  The death rate from rectal cancer has beendropping for 20+ years. >1 million colorectal cancer survivors in US Advancements: Screening & early detection Improvements in treatment
  9. 9. DetectionWorkupStagingTreatmentSurveillance
  10. 10.  Screening (typically starts at age 50) Colonoscopy (camera) CT (scan)
  11. 11. Procedure What is it? Why do it?Biopsy & PathologyReviewRemove tumor tissue &examine it under amicroscopeTo discover thepresence, cause orextent disease.Colonoscopy &ProctoscopyExamine colon & rectumwith a cameraTo discover thepresence, cause orextent disease.CT ofchest/abdomen/pelvisAn x-ray scan (image)To see if the cancer hasspread beyond therectum.CEA Blood testCarcinoembryonic antigen(CEA) is a proteinassociated with tumors.ERUS or MRIMedical imaging thatexamines soft tissueTo discover thepresence, cause orextent disease.
  12. 12.  Stage describes the extent of the cancer in the body how far the main tumor has grown into nearby areas extent of spread to nearby lymph nodes whether the cancer has spread (metastasized) to otherorgans of the body is an important factor in determining prognosis &treatment options based on the results of physical exam, biopsies, &imaging tests
  13. 13.  Surgery Radiation Therapy Chemotherapy
  14. 14.  Surgery is usually the main treatment for rectalcancer, although radiation and chemotherapywill often be given before and/or after surgery. Surgeon removes tumor and surroundingtissues (extent of resection depends on extentof tumor)
  15. 15.  Advances in techniques, equipment, andsurgical specialization More precise excision Availability of stapling devices J pouch and coloplasty pouch Attention to cancer clearance - Total mesorectalexcision has reduced local recurrence followingsurgery Microsurgery
  16. 16.  High-energy rays or particles destroy cancercells Radiation may Lower the risk that the tumor will come back Improve operability
  17. 17.  External-beam radiation therapy Similar experience to getting an x-ray Endocavitary radiation therapy Small device inserted to deliver radiation Brachytherapy (internal radiation therapy) Small pellets of radioactive material placed next totumor
  18. 18.  May be administered before and/or aftersurgery Drugs used to treat rectal cancer 5-Fluorouracil Capecitabing Irinotecan Oxaliplatin
  19. 19.  Regimens (combinations of drugs) used totreat rectal cancer FOLFOX = 5-FU + leucovorin + oxaliplatin FOLFIRI = 5-FU + leucovorin + irinotecan FOLFOXIRI = leucovorin + 5-FU + oxali + irinotecan CapeOx = capecitabine + oxaliplatin Addition of biologic agents Bevacizumab Cetuximab Panitumumab
  20. 20.  Periodic screening & tests to see if the cancerhas come back. History/Physical CT Scan Colonoscopy Blood Tests
  21. 21.  This research study is being done to see ifradiation can be avoided for a select group ofrectal cancer patients who have a goodresponse to 6 treatments with a chemotherapycombination regimen known as FOLFOX. The proposed study does not use new agentsor procedures, but rather sequences existingwell established treatment strategies in adifferent way.
  22. 22.  Stage II & III rectal cancer is treated in 3 phases:1. Chemotherapy and radiation given together over 5.5weeks –”chemoradiation” Why? To prevent the tumor from coming back in the samelocation in the pelvis2. Surgery to remove the tumor3. Chemotherapy with a drug combination called“FOLFOX” given every 2 weeks over about 4 months Why? To prevent the cancer from coming back in a distantorgan such as the liver
  23. 23.  With modern surgical techniques, chemotherapyadvances, and MRIs it is possible that some patientscan avoid radiation to the pelvis Because chemoradiation has side effects, it would bevaluable to avoid it for patients who can achieve goodresults without it Rectal cancer specialists hope that FOLFOXchemotherapy before surgery will enable some rectalcancer patients to avoid chemoradiation
  24. 24.  Radiation treatment is time consuming….daily visits Radiation often has long term effects on bowel bladderand sexual function Radiation in previous clinical trials does not improveoverall survival rates, but does decrease the localrecurrence rates Radiation treatment may be unnecessary for somepatients with early stage rectal cancer Better imaging techniques, better surgical techniqueshave made it easier to carefully stage patients We do not know the best way to treat this disease untilwe carefully compare these approaches. We need your help!
  25. 25. Chemotherapyfor 3-4 monthsSurgery5.5 weeksof radiationwith 5FUchemotherapy(5FUCMT)4-6 weeksRecovery4-6 weeksRecovery
  26. 26. Chemofor 3-4Months*SurgeryIf tumorresponds tochemotherapyIf tumordoes notrespond tochemo5.5 weeksof radiationwith 5FUchemo(5FUCMT)SurgeryChemofor 3-4monthsRe-evaluation3 mo. ofchemo(6 FOLFOXtreatments)4-6weeksrecovery4-6weeksrecovery4-6weeksrecovery4-6weeksrecovery*If the pathologist or surgeon find evidence of more extensive disease, it ispossible that postoperative 5FUCMT could also be recommended
  27. 27.  The National Cancer Institute at: 1-800-4-CANCER (1-800-422-6237) For more information about the PROSPECT trial(N1048): The lead investigator for this trial, Dr. Deborah Schrag, The protocol coordinator for this trial, John Taylor,
  28. 28. Fight Colorectal CancerCONTACT USFight Colorectal Cancer1414 Prince Street, Suite 204Alexandria, VA 22314(703) 548-1225Toll-Free Answer Line: 1-877-427-2111www.FightColorectalCancer.orgEmail us: