Bowel cancer: New treatments, improved prognosis
New medicines show promise, but more research is needed
Fine-tuning chemotherapy for bowel cancer
With the development of more medications for bowel cancer, doctors are now trying them in new combinations and sequences.
Experts have developed a number of regimens that combine the benefits of different medications. For some time, IFL or the "Saltz Regimen" (irinotecan, 5-fluorouracil and leucovorin) was a primary treatment. However, new regimens are eclipsing it, says Hoff.
"It [IFL] is considered a little more toxic and less effective than FOLFOX (folinic acid, fluorouracil, leucovorin and oxaliplatin) and FOLFIRI (folic acid, leucovorin, fluorouracil and irinotecan)."
In people with metastatic cancer, these regimens may be combined with bevacizumab or cetuximab. Many other combinations, including the use of bevacizumab and cetuximab at the same time, are being tested in clinical trials.
Researchers are also studying whether these two medicines could be used in earlier stages of the disease, when the chances of actually curing the cancer are much higher. However, the results of those trials are some way off.
A dramatic rise in costs
A major problem with the new targeted therapies is their cost, which poses a major burden on health services. It should be noted that bevacizumab has not been approved by the National Institute for Health and Clinical Excellence (NICE) for prescribing under the NHS (NICE gives advice on which new medicines or treatments should be available on the NHS). Thus, bevacizumab may not be widely available. NICE has approved the use of cetuximab in combination with chemotherapy as a possible treatment for some people with bowel cancer that has spread to the liver. NICE does not recommend cetuximab for everyone in this situation. Your cancer specialist can discuss with you whether this medicine is recommended for you.
Surgery remains the standard of care for early bowel cancer
While new medications may get the most attention, surgery remains the standard treatment for people in the earlier stages of bowel cancer. In recent years, minimally invasive laparoscopic - or "keyhole" - surgery has become a popular choice.
With this approach the procedure is performed by the surgeon through a small incision using special instruments and a laparoscope, a long flexible tube with a camera and light attached. The surgeon performs the operation while looking at a television monitor. This minimally invasive approach allows for smaller incisions, less pain after surgery and quicker recovery.
A 2005 study published in The Lancet found that laparoscopic surgery worked as well as traditional open surgery for some colon cancer patients, but more studies looking at long-term outcomes are needed.
However, The Lancet study also found that for rectal cancer, laparoscopic surgery has not been shown to be as effective as open surgery.
Hoff thinks that people can have over-optimistic ideas about the benefits of keyhole surgery. "Laparoscopic surgery is still surgery," he says. "You're still getting a piece of the colon removed and you'll still need recovery time. While the hospitalisation may be a little shorter, it's not a big difference."