European Journal of Cancer: Highlights of Issue 40:02

A green light for the addition of chemotherapy?

Compliance of rectal cancer patients with treatment

Compliance of rectal cancer patients with radiation therapy and the feasibility of surgery are not reduced following the addition of chemotherapy to the preoperative treatment regimen, Bosset and colleagues report in this issue. In a multicentre, randomised trial run by the European Organisation for the Research and Treatment of Cancer, patients (T3-4, M0) receiving 45Gy in 25 fractions over 5 weeks (Group A; n=398) were compared with those given additional chemotherapy (Group B; n=400; 2 courses of 5-fluorouracil/leucovorin during the 1st and 5th weeks of radiation). Toxicity - in general- was similar in the 2 groups, although there was significantly more diarrhoea in the chemotherapy group (34.3% compared with 17.3%). The compliance of patients with the radiation treatment was 98.5% and 95.5%, in Groups A and B, respectively. Surgery was cancelled for 10 and 7 patients and there were 5 and 9 early deaths, respectively. "The compliance with the radiation protocol or the feasibility of surgery did not decrease", they concluded.

Watchful-waiting not openly discussed in advanced disease

Watchful-waiting is not always openly discussed as a treatment option in patients with advanced cancer, according to Dutch authors reporting in this issue. "Without information, making an informed choice is impossible", they said. Koedoot and colleagues prospectively examined the content and information given to 95 patients with advanced disease with regard to possible treatment options and their disease course. They found that although most patients (84%) were told there was no cure, watchful-waiting was only mentioned to approximately half of the patients, either in one sentence (23%) or more extensively (27%). Older, married patients and those in an academic hospital generally received more information. It is likely that patients do not consider watchful-waiting as an equivalent treatment option, they said. "It is questionable whether patients who are not well informed about alternative treatment options are equipped to make treatment decisions".

Establishment of colon xenotransplants to mimic the clinical situation

In this issue, Fichtner and colleagues have established colon xenotransplants that closely mirror the clinical setting. They used early passage cells from clinical material (n=35) and surgically implanted these into nude mice. They had a take rate of 43% (15/35). The xenotransplants showed response rates of 33%, 93% and 57% to commonly used chemotherapeutic drugs, 5-fluorouracil, irinotecan and oxaliplatin, respectively. Interestingly, in 5 patients treated for synchronous metastases, the response of the xenografts closely mirrored the response to chemotherapy in these patients. Furthermore, xenografts with mutations in codon 12 of K-ras had a low response rate to oxaliplatin. "These well characterised models are useful tools for the preclinical development of novel therapeutic approaches and for investigating translational research aspects", they concluded.

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