Current controversial issues in the treatment of colorectal cancer focus on defining which patients benefit from receiving chemotherapy after surgery and what those treatment regimens should consist of. In addition, optimal treatment regimens are still being defined for patients known to benefit from chemotherapy. Nationally and internationally, Perlmutter Cancer Center's GI investigators lead the development of new colorectal cancer treatment regimens, including treatment programs combining with new targeted drug agents.
Perlmutter Cancer Center clinical trials are open to participants at all stages of colorectal cancer. Current clinical trials define who should receive adjuvant treatment in early-stage disease, investigate adjuvant therapy in node-positive disease, and test new treatment methods for advanced metastatic disease.
Oxaliplatin and Bevacizumab (Avastin)
In the last decade, NYU investigators have added combination chemotherapy drugs and incorporated targeted agents to 5FU, an agent previously used alone, to lead development of colon cancer therapy.
- NYU was among the first to bring oxaliplatin to the U.S. with the 1998 protocol developing oxaliplatin with bolus 5FU (bFOL). Oxaliplatin was later studied in two national studies directed by Dr. Howard Hochster, comparing it to the more common infusion 5FU method (FOLFOX).
- NYU participated in the first national trials using the anti-angiogenesis antibody bevacizumab (Avastin) for colorectal cancer. This landmark trial demonstrated a survival benefit for this antibody in first-line therapy of colorectal cancer.
- Dr. Hochster’s TREE trial was the first national and randomized trial to demonstrate the effectiveness of bevacizumab with oxaliplatin and 5FU regimens.
- NYU GI investigators are developing use of oxaliplatin in first-line colorectal cancer. Dr. Hochster co-chairs the national CONCEPT trial, which asks whether giving breaks in oxaliplatin therapy while continuing the other drugs may delay onset of nerve toxicity, a cumulative effect of this drug.
- NYU is pioneering the combination of oxaliplatin with an oral form of 5FU (capecitabine, Xeloda) and Erbitux in a novel 2-week treatment schedule.
- NYU participated in the very first trial of cetuximab (Erbitux) with irinotecan in refractory colorectal cancer. This trial contributed to the observation that this antibody, which blocks signaling of the epidermal growth factor pathway, can be added to a previously ineffective chemotherapy drug to generate a response in some patients with colon cancer. This trial eventually led to a European trial that confirmed these observations and resulted in FDA approval.
- Following the landmark cetuximab-irinotecan trial, NYU investigators combined Erbitux with Avastin in an NCI-sponsored phase II trial. This trial, the first to combine anti-angiogenesis with anti-EGF agents, showed the benefit of this approach for refractory colorectal cancer. Phase III international trials are now testing this approach on a larger scale.
- NYU is participating in the NCI studies toward using targeted agents to treat patients whose colon cancer has been surgically removed, and who are candidates for adjuvant therapy (preventive chemotherapy). Agents include Erbitux in stage III colon cancer (N0147) and Avastin in high-risk stage II disease (E5202).
Newer agents including the novel SRC kinase inhibitor SKI 606 and the mTOR inhibitor RAD001 are currently being tested. Researchers are investigating the influence of changes in gene expression (epigenetic changes) by testing for methylation of MGMT, the gene that breaks down the oral chemotherapy agent temozolomide. Patients with high methylation status will qualify for treatment.
Neoadjuvant Chemoradiation and Multi-modality Therapy for Rectal Cancer
NYU’s GI researchers are investigating neoadjuvant chemoradiation, participating in national intergroup clinical trials of multi-modality therapy including pre-operative chemo-radiation and definitive resection.
Currently NYU is participating in E5204 using postoperative FOLFOX with or without Avastin. Metastatic rectal cancer patients are treated in advanced colon and rectal protocols.
Virtual Colonoscopy for Colorectal Cancer Screening
Researchers at NYU are currently evaluating virtual colonoscopy in the screening and detection of colon cancer. This test combines a computed tomography (CT) scanner providing x-ray images of the colon with sophisticated image processing computers that create a 3-D display to recreate the inner surface of the colon. Skilled radiologists interpret the resulting images.
For more information or to schedule an appointment for a virtual colonoscopy: (212) 263-8868
Patients will need a prescription/referral from their physician.