Improving Lives of People With Gastrointestinal Cancer

Highlights from the 2017 Gastrointestinal Cancers Symposium
January 17, 2017
Greg Guthrie, ASCO staff

The 2017 Gastrointestinal Cancers Symposium begins this week in San Francisco, running from January 19th to the 21st. This 3-day meeting covers the latest science in cancers of the esophagus, stomach, pancreas, small bowel, colon, rectum, and anus. share on twitter  Drawing experts from the United States and internationally, it is an opportunity for people to exchange ideas about how to improve the treatment of cancers that affect parts of the gastrointestinal system. Here are 3 studies that will be presented at the symposium that may help improve the treatment of people with gastrointestinal cancer.

Physical activity may help people with metastatic colorectal cancer live longer

An analysis of people with metastatic colorectal cancer suggests that people who are more physically active may live longer. People who were getting at least 30 minutes of moderate exercise a day when they started chemotherapy had a 19% reduction in their chance of dying.

The analysis looked at 1,231 patients enrolled in a phase III clinical trial of chemotherapy for metastatic colorectal cancer. Before they started chemotherapy, patients filled out a questionnaire, including information about their physical activity. The analysis showed that people who got the equivalent of 30 or more minutes of moderate physical activity per day (or 2.5 hours or more per week) had lower rates of cancer worsening and of death.

In a second analysis of the data, more time spent in non-vigorous physical activity, such as walking or mowing the lawn, was linked to living longer. People who spent 5 or more hours per week in non-vigorous physical activity saw a 25% reduction in mortality. However, the study found no connection between vigorous physical activity, like running and playing sports, and reduced risk of cancer worsening or of death.

“These findings suggest that it doesn’t take a lot of physical activity to improve outcomes. While exercise is by no means a substitute for chemotherapy, patients can experience a wide range of benefits from as little as 30 minutes of exercise a day.”

—lead study author Brendan John Guercio, MD, Brigham & Women’s Hospital, Boston, MA

Pairing PET scans with chemotherapy in the treatment of esophageal cancer

A new study suggests there may be a role for positron emission tomography (PET) scans in helping guide chemotherapy treatment decisions for people with stage II or stage III esophageal cancer or gastroesophageal junction (GEJ) cancer.

These patients usually receive 5.5 weeks of chemotherapy with radiation therapy, called chemoradiation, followed by surgery. Previous research has shown that chemoradiation before surgery helps people live longer than if they have just surgery. There are many different chemotherapy regimens, or plans, that can be used to treat esophageal and GEJ cancers as part of chemoradiation, but doctors can’t predict which chemotherapy will work in specific patients.

In this study, 257 people with stage II or III cancer were randomly assigned to receive 1 of 2 standard chemotherapy regimens. After a few cycles of therapy, patients received a PET scan to see if the chemotherapy had worked. If the tumor had shrunk, then the same chemotherapy regimen was completed as part of chemoradiation before surgery. If the PET scan showed that the chemotherapy was not effective, then the patient was given the other regimen instead. Overall, 39 out of 129 people who received the first chemotherapy regimen switched to the second regimen, and 49 out of 128 people who received the second chemotherapy regimen switched to the first regimen after the PET scan. Among those who did switch as a result of the PET scan, just under 16% had no trace of cancer in the tissue sample taken during surgery. These people would have seen no effect from chemotherapy if they had stayed on their original regimen.

 “In this study, we are adding induction chemotherapy before chemoradiation and showing that using PET scans after the induction chemotherapy to assess response can help doctors make quick course corrections to maximize patient benefit from chemotherapy. Although our approach does lengthen a patient’s time before surgery, we found that assessing treatment efficacy by PET scans can improve the efficacy of the treatment as shown by the ability to achieve a pathologic complete response, meaning there were no traces of cancer in the tissue specimen taken at the time of surgery.”

—Karyn A. Goodman, MD, University of Colorado School of Medicine, Aurora, CO

Watch-and-wait approach in rectal cancer may be an option for patients

Around the world, rectal cancer is often treated with surgery. People with most stages of rectal cancer often receive chemotherapy and/or radiation therapy before the surgery. In about 25% of people who receive this treatment before surgery, the tumor completely disappears after the chemotherapy and/or radiation therapy is finished. However, it is not standard practice to review the tumor after chemotherapy and/or radiation to see if surgery is still necessary. Researchers are investigating whether surgery is needed because of the risk of side effects from this surgery, including urinary, bowel, and sexual problems. 

This large observational study used data collected through the International Watch and Wait Database Consortium, which includes 35 institutions in 11 countries. The analysis included 802 people who had no signs of cancer based on a physical exam, endoscopy, or magnetic resonance imaging (MRI) or computed tomography (CT) scans after chemotherapy and radiation therapy for rectal cancer. The people all received watch-and-wait care, meaning that they were closely monitored for any signs of recurrence instead of having surgery. In the first 2 years after treatment stopped, people went to the hospital every 3 months for an endoscopy, MRI scans, and physical exams. This is not a standard of care for people with rectal cancer.

After a median watch-and-wait of 2.6 years, 25% of the people had surgery because the cancer came back nearby, called a local recurrence, and 7% had the cancer come back in distant parts of the body, called metastasis. The median is the midpoint. Overall, the 3-year survival rate was 91% for all patients and 87% for those who had a local recurrence. These survival rates are similar to those for people who have had surgery to treat the cancer.

“Some people with rectal cancer undergo surgery after chemoradiation therapy, even though it may not be necessary. From the data we have now, it seems that watch-and-wait may be safe in selected patients with rectal cancer, but it is too soon to say whether this approach should be routinely offered.”

—lead study author Maxime van der Valk, MD, International Watch and Wait Database Consortium and Leiden University Medical Center, Leiden, Netherlands