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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_304"
                     title="&apos;Virtual&apos; Colon Scans Effective in Seniors (CME/CE)"
                     score="0.004"
                     href="http://www.medpagetoday.com/HematologyOncology/ColonCancer/tb/18164?impressionId=1265806675197"
                     
      Patients 65 and older are as suitable as younger individuals for CT colonography, said researchers conducting a large retrospective study.&lt;br&gt;
&lt;br&gt;Advanced neoplasias were detected with CT colonography  --  often called &quot;virtual colonoscopy&quot;  --  in older patients at more than double the rate in the general screening population, reported David H. Kim, MD, of the University of Wisconsin in Madison, Wis., and colleagues in the February issue of &lt;em&gt;Radiology&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;They found that 7.6% of older patients had advanced neoplasias, compared with 3.2% of all patients screened in the university&apos;s clinic (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;On the basis of this and other findings in 577 individuals 65 and older versus the entire group of 3,120 patients undergoing the procedure, Kim and colleagues concluded that &quot;CT colonography performance is maintained in an older cohort.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Overall, the observations from this clinical experience confirm that CT colonography may be a valuable screening modality in the older population,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;On the other hand, the study did not address several objections raised by the Centers for Medicare and Medicaid Services (CMS) in its decision last year to deny Medicare coverage for the procedure. (See &lt;a href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/Medicare/14186&quot; mce_href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/Medicare/14186&quot; target=&quot;_blank&quot;&gt;Medicare Finalizes Denial of Virtual Colonoscopy Coverage&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;CMS had pointed to relatively low sensitivity of CT colonography compared with optical colonoscopy in prospective trials, especially for small lesions.&lt;/p&gt;
&lt;p&gt;The agency also determined that CT colonography increased the costs of positive findings, since abnormalities in the CT scans must be confirmed with optical colonoscopy. In addition, CMS said there was no evidence to support claims that the less invasive imaging procedure would be more acceptable to patients and therefore would raise screening rates.&lt;/p&gt;
&lt;p&gt;The data analyzed by Kim and colleagues did not allow for calculations of false-negative rates or predictive values of positive or negative findings. Nor did the researchers report cost information.&lt;/p&gt;
&lt;p&gt;Mean age of their older cohort was 69.2 (SD 3.8). The oldest was 79.&lt;/p&gt;
&lt;p&gt;The researchers reported that 15.3% of the older patients were referred for optical colonoscopy on the basis of the CT results, compared with 7.9% of the overall screening group.&lt;/p&gt;
&lt;p&gt;Less than 4% of positive findings were determined to be false with the optical procedure (3.6% for polyps 6 to 10 mm in diameter, 2.1% for larger lesions).&lt;/p&gt;
&lt;p&gt;Of the 59 advanced neoplasias identified in the older patients, all but three were at least 10 mm in size.&lt;/p&gt;
&lt;p&gt;The scans also suggested abnormalities outside the colon in 89 (15.4%) patients. Of these, 45 received a full workup, which revealed substantial and previously unsuspected diagnoses in 21 cases  -- 18 were vascular aneurysms. The other three included one lung tumor, a femoral hernia, and a malrotation.&lt;/p&gt;
&lt;p&gt;Kim and colleagues reported that no &quot;substantial complications&quot; such as perforations or major hemorrhage occurred in the older patients, either with the CT scan or follow-up colonoscopy.&lt;/p&gt;
&lt;p&gt;They also indicated that the ratio of large to small neoplasias was similar in the older patients compared with their CT screening group as a whole. Histologic and morphologic findings were similar as well.&lt;/p&gt;
&lt;p&gt;The researchers cited the observational nature of the study, in which negative findings were not corroborated with optical colonoscopy, and its restriction to a single center as its main limitations.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;No external funding for the study was reported.&lt;/p&gt;&lt;p&gt;Kim and one co-author reported relationships with Viatronix and Medicsight and are co-founders of a company called VirtuoCTC, which produces educational materials on CT colonography.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_276"
                     title="ASCO GI: Antibody Slows Metastatic Colon Cancer"
                     score="0.003"
                     href="http://www.medpagetoday.com/MeetingCoverage/ASCOGI/tb/18134?impressionId=1265806675197"
                     
      ORLANDO  --  Patients with nonmutated colorectal tumors had significant improvement in progression-free survival (PFS) when the monoclonal antibody panitumumab (Vectibix) was added to conventional chemotherapy, data from two randomized clinical trials showed.&lt;br&gt;
&lt;br&gt;When used in first-line therapy for metastatic cancer, the antibody-chemotherapy combination was associated with a 20% improvement in the hazard ratio for progression compared with chemotherapy alone. In the second-line metastatic setting, the combination improved the hazard ratio by 27%.&lt;br&gt;
&lt;br&gt;Separate analyses of the trials showed that the addition of panitumumab to chemotherapy did not improve PFS in patients whose tumors had K-ras mutations.&lt;br&gt;
&lt;br&gt;Overall survival was similar between treatment arms in both trials, according to presentations here at the Gastrointestinal Cancers Symposium.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;&quot;The results of these two studies are consistent in that they demonstrate a benefit from the addition of panitumumab among patients with wild-type K-ras tumors,&quot; Salvatore Siena, MD, of Ospedale Niguarda Ca&apos;Granda in Milan, Italy, said in an interview. &quot;The results also are consistent with what we know about the role of K-ras in colorectal cancer.&quot;&lt;/p&gt;
&lt;p&gt;&quot;The addition of panitumumab to the chemotherapy regimens used in the studies was well tolerated, as no unexpected toxicity was observed,&quot; he added.&lt;/p&gt;
&lt;p&gt;Panitumumab is a fully human monoclonal antibody against epidermal growth factor receptor (EGFR). The agent is approved for treatment of chemotherapy-refractory metastatic colorectal cancer.&lt;/p&gt;
&lt;p&gt;The two clinical trials initially were designed to evaluate panitumumab in all patients, irrespective of K-ras status. Following reports about the adverse effect of K-ras mutations on therapeutic outcomes in colorectal cancer, the trials&apos; protocols were amended to test the hypothesis that adding panitumumab to chemotherapy would improve PFS in patients with wild-type K-ras status.&lt;/p&gt;
&lt;p&gt;The trial of first-line metastatic therapy compared panitumumab plus 5-FU/leucovorin/oxaliplatin (Eloxatin) chemotherapy versus chemotherapy (FOLFOX) alone. The open-label, randomized trial involved 1,183 patients enrolled at centers in Canada, South America, Europe, South Africa, and Australia.&lt;/p&gt;
&lt;p&gt;The primary endpoint was PFS, and secondary endpoints included overall survival, overall response rate, time to response, duration of response, and safety. The protocol excluded patients with prior chemotherapy for metastatic colorectal cancer or prior EGFR inhibitor therapy.&lt;/p&gt;
&lt;p&gt;Tissue samples were collected for biomarker assessment, but EGFR and K-ras status assessment were not required at entry. Siena said K-ras status was ascertained in 93% of the patients and showed that 60% of both treatment arms had wild-type K-ras tumors.&lt;/p&gt;
&lt;p&gt;In the primary analysis involving patients with wild-type K-ras tumors, the addition of panitumumab to FOLFOX was associated with a PFS of 9.6 months compared with 8.0 months for patients treated with chemotherapy alone (HR 0.80, 95% CI 0.66 to 0.97, &lt;em&gt;P&lt;/em&gt;=0.02). Addition of the antibody was associated with a trend toward improved overall survival (23.9 months versus 19.7 months, &lt;em&gt;P&lt;/em&gt;=0.07) and overall response rate (55% versus 48%, &lt;em&gt;P&lt;/em&gt;=0.07).&lt;/p&gt;
&lt;p&gt;Patients with mutant-type K-ras tumors fared better with chemotherapy alone, which led to a median PFS of 8.8 months versus 7.3 months for chemotherapy plus panitumumab (&lt;em&gt;P&lt;/em&gt;=0.02).&lt;/p&gt;
&lt;p&gt;Similar results emerged from the study of second-line therapy for metastatic cancer, reported by Marc Peeters, MD, of University Hospital Ghent in Belgium.&lt;/p&gt;
&lt;p&gt;The trial involved 1,186 patients who had previously received chemotherapy for metastatic colorectal cancer enrolled at centers in the U.S., Europe, Asia, and Australia. As in the study of first-line therapy, about 60% of the patients had wild-type K-ras tumors.&lt;/p&gt;
&lt;p&gt;The trial compared FOLFIRI chemotherapy (5-FU/leucovorin/irinotecan [Camptosar]) alone versus FOLFIRI plus panitumumab.&lt;/p&gt;
&lt;p&gt;Among patients with wild-type K-ras tumors, the addition of panitumumab was associated with a median PFS of 5.9 months versus 3.9 months for chemotherapy alone (HR 0.73, 95% CI 0.59 to 0.90, &lt;em&gt;P&lt;/em&gt;=0.004).&lt;/p&gt;
&lt;p&gt;Median overall survival was 14.5 months with the monoclonal antibody and 12.5 months without, a difference that did not reach statistical significance. The overall response rate was significantly higher in the panitumumab arm (35% versus 10%, &lt;em&gt;P&lt;/em&gt;=0.001).&lt;/p&gt;
&lt;p&gt;As in the first-line study, patients with mutant K-ras tumors did not benefit from the addition of panitumumab, which was associated with a median PFS of 5.0 months versus 4.9 months with chemotherapy alone. Overall survival was 11.8 months with panitumumab and 11.1 months without it, a nonsignificant difference.&lt;/p&gt;
&lt;p&gt;The panitumumab regimen was generally well tolerated in both studies. The principal difference in adverse events was an excess of skin toxicity with panitumumab, a recognized side effect of the monoclonal antibody.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Both studies were supported by Amgen.&lt;/p&gt;&lt;p&gt;One or more investigators in the studies disclosed relatinships with Amgen, Merck Serono, Roche, Baxter International, Merck &amp;amp; Co., Roche, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, ImClone Slystems, sanofi-aventis, and Pfizer.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_247"
                     title="Low Vitamin D Linked to Colorectal Cancer (CME/CE)"
                     score="-0"
                     href="http://www.medpagetoday.com/HematologyOncology/ColonCancer/tb/18104?impressionId=1265806675197"
                     
      &lt;p&gt;Low levels of circulating vitamin D are associated with a greater risk of colorectal cancer, European researchers said.&lt;/p&gt;
&lt;p&gt;In a nested case-control study, the risk was 40% lower for participants in the top fifth of vitamin D levels than for those in the bottom fifth, according to Mazda Jenab, PhD, of the International Agency for Research on Cancer in Lyon, France, and colleagues.&lt;/p&gt;
&lt;p&gt;But more research is needed to see if increasing circulating vitamin D can effectively reduce the risk of the disease, they concluded online in &lt;em&gt;BMJ&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The main role of vitamin D is to maintain calcium homeostasis and bone metabolism, the researchers noted in the journal. But there is some evidence that it may also play a role in cancer control by modulating cell growth and death and by reducing the development of blood vessels to support tumor tissue.&lt;/p&gt;
&lt;p&gt;Unfortunately, they said, epidemiological evidence  --  mostly based on dietary intake of the vitamin rather than circulating levels  --  is inconclusive.&lt;/p&gt;
&lt;p&gt;To fill the gap, they turned to the European Prospective Investigation into Cancer and Nutrition (EPIC) study, which is prospectively following 520,000 volunteers from 10 European countries.&lt;/p&gt;
&lt;p&gt;Jenab and colleagues compared 1,248 people who developed colorectal cancer after enrollment with 1,248 controls who were disease-free.&lt;/p&gt;
&lt;p&gt;The main outcome measure was pre-diagnostic circulating vitamin D concentration, as measured by enzyme immunoassay. Dietary and lifestyle data were obtained from questionnaires.&lt;/p&gt;
&lt;p&gt;For the analysis, a mid-level concentration was defined as 50 nanomoles per liter or more but less than 75. Volunteers were stratified by quintiles, with those in the bottom fifth having less than 25 nanomoles per liter and the top fifth 100 or more.&lt;/p&gt;
&lt;p&gt;The researchers found: &lt;ul&gt; &lt;li&gt;There was a linear trend for colorectal cancer, with those in the lower quintiles significantly more likely (at &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) to get the disease than those in higher fifths.&lt;/li&gt; &lt;li&gt;The same trend was seen for colon cancer (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) but not rectal cancer (&lt;em&gt;P&lt;/em&gt;=0.320).&lt;/li&gt; &lt;li&gt;Compared with volunteers with a mid-level concentration, those in the lowest fifth had a 32% increased risk of colorectal cancer. (The incidence rate ratio was 1.32, with a 95% confidence interval from 0.87 to 2.01. Similarly, those in the second-lowest fifth had an incidence rate ratio of 1.28.)&lt;/li&gt; &lt;li&gt;Higher concentrations were associated with lower risk. Those in the top fifth had an incidence rate ratio of 0.77, while those in the second-highest quintile had a ratio of 0.88.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The vitamin D concentration was associated with lower colorectal risk in a dose-response manner, the researchers reported. The multivariate incidence rate ratio for the lowest fifth, compared with the highest, was 0.6 (95% CI 0.46 to 0.80, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001.)&lt;/p&gt;
&lt;p&gt;But the researchers found the link was stronger for the colon  --  with a rate ratio of 0.47 (95% CI 0.33 to 0.68) than for the rectum, at 0.98 (95% CI 0.56 to 1.43).&lt;/p&gt;
&lt;p&gt;The study&apos;s strengths include its large size and prospective design, the researchers said. Also, pre-diagnostic levels of circulating vitamin D were available for all participants.&lt;/p&gt;
&lt;p&gt;On the other hand, follow-up was relatively short, which may mean that some participants with disease already had the illness at the time the samples were taken. Nor can residual confounding be ruled out, the researchers said.&lt;/p&gt;
&lt;p&gt;In addition, the study did not control for colorectal screening; however, the investigators said this is not routinely performed in Europe.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the World Cancer Research Fund. The EPIC study had support from European governments and anti-cancer agencies. The researchers did not declare any competing interests.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_226"
                     title="ASCO GI: Blood Test Detects Colorectal Cancer"
                     score="-0.002"
                     href="http://www.medpagetoday.com/MeetingCoverage/ASCOGI/tb/18079?impressionId=1265806675197"
                     
      &lt;p&gt;ORLANDO  --  A novel blood test that measures CD24 protein levels may detect early colorectal cancer and precancerous adenomas, researchers found.&lt;/p&gt;
&lt;p&gt;The investigational assay had 78.4%% sensitivity and 86.8% specificity for distinguishing patients with colorectal adenoma or cancer from healthy controls in a study led by Sarah Kraus, PhD, of Tel Aviv Souraski Medical Center in Israel.&lt;/p&gt;
&lt;p&gt;Further validation for the biomarker would be needed before considering clinical use in surveillance, they cautioned here at the ASCO Gastrointestinal Cancers Symposium.&lt;/p&gt;
&lt;p&gt;But the results were exciting and could represent &quot;a very significant advance,&quot; commented Robert P. Sticca, MD, of the University of North Dakota in Grand Forks.&lt;/p&gt;
&lt;p&gt;&quot;It looks like it may be a very reliable marker for not only the early detection of colon cancer and even precancerous conditions, but also could be used for follow-up for patients who previously had cancer for recurrence,&quot; he said as moderator of a press briefing at which the results were discussed.&lt;/p&gt;
&lt;p&gt;Colorectal cancer screening is effective, with early detection and treatment shown to improve survival.&lt;/p&gt;
&lt;p&gt;However, colorectal cancer is often diagnosed at a late stage with poor prognosis, in part because of &lt;a href=&quot;http://www.medpagetoday.com/Gastroenterology/ColonCancer/10115&quot; mce_href=&quot;http://www.medpagetoday.com/Gastroenterology/ColonCancer/10115&quot; target=&quot;_blank&quot;&gt;poor uptake of colonoscopy&lt;/a&gt;, Kraus said at the press briefing.&lt;/p&gt;
&lt;p&gt;Unfortunately, there are no sufficiently accurate blood-based screening tests, he noted, although there have been &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/ECCO-ESMO/16057&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/ECCO-ESMO/16057&quot; target=&quot;_blank&quot;&gt;attempts&lt;/a&gt; to develop them.&lt;/p&gt;
&lt;p&gt;Her group had previously found that the CD24 protein  --  expressed on the cell surface, where it plays a role in cell adhesion and metastasis  --  was associated with development of colorectal cancer in a gene expression study.&lt;/p&gt;
&lt;p&gt;So, with two independent cohorts, they tested whether CD24 could be a good biomarker for colorectal cancer.&lt;/p&gt;
&lt;p&gt;The first cohort included 63 patients with colorectal cancer, 19 with adenoma, and 68 controls with a clean bill of health on colonoscopy. Of these 150 individuals, 143 were externally evaluated by a blinded investigator.&lt;/p&gt;
&lt;p&gt;CD24 expression was nearly six-fold higher among adenoma and colorectal cancer cases than among controls, a significant difference. Levels were similar between the cancer and adenoma groups.&lt;/p&gt;
&lt;p&gt;The second cohort included 73 subjects: 38 normal controls, 24 with colorectal adenoma, and 11 with colorectal cancer.&lt;/p&gt;
&lt;p&gt;The test could distinguish colorectal cancer cases from controls with &quot;relatively high&quot; sensitivity and specificity (92.3% and 83.8%, respectively), Kraus said.&lt;/p&gt;
&lt;p&gt;Its performance in detecting adenoma versus normal colonoscopy results was lower, 75.0% sensitivity and 89.2% specificity.&lt;/p&gt;
&lt;p&gt;Kraus said her group is now testing this CD24 approach in a larger sample and developing an enzyme-linked immunosorbent assay (ELISA) that could be more widely used.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_2_571"
                     title="Rural Cancer Patients Get to the Doctor Earlier than City Dwellers"
                     score="-0.005"
                     href="