Treating Colon Cancer With Ch... Video Transcript

Participants

, Michael Lieberman MD, John S. Macdonald MD, David R. Marks MD

Summary

Although there are only a few agents available, chemotherapy is the most common form of treatment for colon cancer. What treatments are most effective, and when should they be used? What is the newest treatment available? What future agents are on the horizon? Join our panel of experts as they discuss the latest in chemotherapy for colorectal cancer.

Webcast Transcript

DAVID R. MARKS, MD: Hi, and welcome to our webcast. I'm Dr. David Marks. Chemotherapy is commonly used to treat cancer, but only a few chemo drugs are effective in treating colon cancer. This may be changing, though, because a number of new agents have shown promising results.

Here today to talk about these new drugs, are two experts. First is Dr. John Macdonald. He's an oncologist at St. Vincent's Comprehensive Cancer Center in New York City. Welcome.

JOHN MacDONALD, MD: Glad to be here, David.

DAVID R. MARKS, MD: Next to him is Dr. Michael Lieberman. He's a colorectal surgeon at the Weill Cornell Medical College. Thanks for being here.

MICHAEL LIEBERMAN, MD: Thank you, David.

DAVID R. MARKS, MD: When is chemotherapy used in colon cancer?

JOHN MacDONALD, MD: There are basically two parts of the disease that it's used in. One is what's called adjuvant therapy, when what you're trying to do is prevent a recurrence after a surgeon has done a resection of the colon. And that's really preventive chemotherapy. As they say, you're taking somebody who has a high risk for recurrence, and by giving them chemotherapy, typically for six months, you decrease it.

The other area, now, that's evolving quite quickly is the use of chemotherapy in patients who already have metastatic disease. In these patients, what you're trying to do is to reduce the metastatic disease, palliate them, make them live longer, decrease the symptoms due to the cancer.

More recently, we've become very interested as we have newer agents that are more effective in reducing the disease to the point where it might be surgically resected. Where a surgeon may be able to take cancer out of the liver and render the patient free of disease.

DAVID R. MARKS, MD: So is there any guideline as to what stage of disease the person has to be in to have chemo?

JOHN MacDONALD, MD: If you look at what's generally accepted in adjuvant therapy, everybody agrees that in Stage III disease, and that means the colon's been resected, and when the pathologist looks at it, the lymph nodes show some evidence of metastatic disease, there's no question that those patients benefit from the use of chemotherapy after resection. It decreases the likelihood that they're going to recur, and improves their overall survival.

The other group are patients with what's called Stage IV disease, which is metastatic disease. Again, you're treating them to reduce the disease, reduce the symptoms. And, potentially, with some patients, with a fraction of those patients, to eventually be able to surgically resect all the disease they have.

DAVID R. MARKS, MD: From a surgeon's perspective, what role does chemotherapy play in your management?

MICHAEL LIEBERMAN, MD: In terms of the peri-surgical management of patients with colorectal cancer, very useful techniques to make the tumors more amenable to resection, particularly in the rectum, have utilized both the combination of chemotherapy and radiation therapy prior to surgery. And then we would follow up with resection.

There's been some association with sphincter salvaging surgery by utilizing this technique for rectal cancers. And also downsizing the tumor, making it more amenable to a complete resection when it's in the rectum.

DAVID R. MARKS, MD: So it gives a person a greater chance of being cured with surgery?

MICHAEL LIEBERMAN, MD: Of resectability, and of functional improvement, by being able to preserve their sphincter, and give us a negative margin. So we've used that as a useful technique for rectal cancer.