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The article discusses studies which investigated the overall survival (OS) in metastatic colorectal cancer (mCRC) after treatment with regorafenib (REG) and aflibercept +FOLFIRI. It states that OS in mCRC patients has been extended from 15 months and more with leucovorin and 5FU to 15-20 months with FOLFIRI and FOLFOX. It notes that the studies were well designed and both performed auxiliary analyses in Phase III trials.

Colon cancer is common in Canada and leads to significant morbidity, mortality, and social and economic impact. In 2010, the estimated incidence of colorectal cancer in Canada was 22,500 cases, with 9100 deaths. In early-stage colon cancer, surgery remains the primary curative procedure. However, due to increased risk of recurrence, adjuvant treatment is now a well-established standard of care. Adjuvant treatment has become more complex with the addition of new chemotherapy regimens that have proven active against this disease. As well, molecular prognostic and predictive tools have emerged to better tailor therapy to higher-risk populations. This overview summarizes changes in adjuvant treatment of colon cancer over the past decade, including: modification of the TNM classification system; the role of adjuvant systemic treatment in Stages II and III colon cancer; issues surrounding treatment in the elderly; and optimal timing of chemotherapy following surgery. Adjuvant systemic treatment of colon cancer continues to be an area of active research, with a focus on identifying patients who will benefit most from chemotherapy and minimizing the long-term side effects. [ABSTRACT FROM AUTHOR]

Introduction: Geriatric oncology is the clinical field of cancer treatment in older adults (above 65 years) and in the oldest-old (above 80 years). As age is the most significant risk factor for cancer, and with the aging of the population, there is a vast increase in the number of older cancer patients., Background: The cases highlight the unique challenges in geriatric oncology: disease goals may differ; treatment toxicities are higher; the extensive use of prescription medication increases the chances of harmful drug-drug interactions; finally, older adults have unique psychosocial needs. Cancer treatment in older adults poses a risk of under-treatment as well as a risk for over-treatment., Discussion: 'Onco-geriatrics' is a field in geriatrics in which a comprehensive geriatric assessment (CGA) is performed. The CGA focuses on specific therapeutic challenges of the older patient, on frailty and on toxicity-risk assessment. In geriatric oncology, a field in oncology aimed at providing care to older cancer adults, the most important first step is to define treatment intent - cure or palliation. Achievement of cure usually mandates a multi-disciplinary aggressive approach. Compromising any component of the treatment may hamper its success rate, yet administering the full therapeutic plan may be too toxic. Thus, each older patient being considered for definitive treatment must be discussed in a multi-disciplinary tumor board, and preferably assessed by a dedicated geriatrician prior to decision-making. In cases in which treatment intent is palliative - i.e. prolongation of survival and/or improvement in quality of life, we propose the following scheme - accurate definition of the palliative goal; adaptation of the therapeutic regime to the patient's geriatric condition; frequent clinical monitoring and flexibility in administration; continued treatment as long as palliative benefit is achieved, and early cessation in its absence. Such a scheme maintains the principal of 'primum non nocere' while facilitating the palliative benefit for older adults.

Adrenocortical Carcinoma (ACC) is rare with an annual incidence of 0.5-2 cases per million worldwide. Some ACC tumors over express N-cadherin, which correlates with metastatic potential. ADH-1 (Exherin™) is a competitive inhibitor of N-cadherin, resulting in rapid onset of tumor vascular angiolysis and apoptosis in preclinical models. Targeting N-cadherin may cause direct anti-tumor and anti-vascular effects. We report a case of ACC with benefit from ADH-1 therapy. A 24 year old woman with an N-cadherin expressing metastatic ACC was treated on a phase I trial and treated with ADH-1 subsequently received additional doses through a special access program. The patient presented with cushingoid features from cortisol over-secretion and was diagnosed with metastatic ACC in January 2003. Tumor progression followed treatment with a combination of doxorubicin, cisplatin and mitotane. In October 2003, as a part of a phase I clinical trial she was treated with as a single dose of ADH-1 at 150 mg/m(2). This resulted in transient normalization of cortisol, tumor necrosis on CT imaging, and reduction in tumor perfusion on DCE-MRI. Following progression on several additional lines of chemotherapy, she was again treated with ADH-1 under a Special Access Program (SAP). After 33 weekly doses (22 with 150 mg/m(2) and 11 with 300 mg/m(2)) radiographic tumor progression was demonstrated and treatment discontinued. She survived 40 months with metastatic disease, dying 12 months after her last dose of ADH-1. This observation merits consideration for prospectively evaluating the efficacy of ADH-1 in patients with cortisol secreting ACC that over express N-cadherin.

The epidermal growth factor receptor is a member of the receptor tyrosine kinase family whose members play a critical role in oncogenesis. In particular, EGFR has been shown to participate in colon cancer development. Due to its role in the progression of colon cancer, EGFR has become an attractive target for therapy and two different classes of biologic agents have been evaluated: the EGFR monoclonal antibodies and the tyrosine kinase inhibitors. These two groups of agents differ in the specific molecular site which they target on the EGFR and in their efficacy in the treatment of colon cancer. This review will discuss the EGFR's evolving role as a prognostic and predictive biomarker in colon cancer. Once thought to be an inherent predictive factor for anti-EGFR monoclonal antibodies (MAbs) the EGFR has been replaced by KRAS and to some extent BRAF. The efficacy of both anti-EGFR MAbs, cetuximab and panitumumab, has been clearly demonstrated to depend upon the KRAS mutational status. The anti-EGFR monoclonal antibodies and their predictive biomarkers have taken colon cancer treatment another step closer towards the goal of tailored cancer therapy.

Objective: Taxotere-based chemotherapy is the only approach which has recently demonstrated prolongation of survival in patients with androgen-independent prostate cancer. This article presents our experience with this therapy., Methods: Since August 1999 we treated 49 patients with Taxotere/Estramustine or Taxotere/Prednisone combinations., Results: Biochemical response occurred in 27 (55.1%) patients, unaffected by prior exposure to chemotherapy. Among the 32 patients with measurable disease, 7 (21/8%) patients demonstrated partial response and an additional 16 (50%) patients obtained stable disease. Half of the patients withdrew morphine palliative therapy. The median survival of all patients was 12.6 months, significantly longer in patients with biochemical response (14.3 vs 5.4 months) and no prior chemotherapy (14.3 vs 9.1 months). The disease recurred equally among osseous and soft tissue sites (18 sites each group). The most significant toxicity was neutropenia grade 3-4 in 26 (53%) patients. Infection, among them one fatal, developed in 18 (37.3%) patients., Conclusions: Taxotere-based chemotherapy is active and tolerated in androgen-independent prostate cancer. Heavily pretreated patients are sensitive to therapy. Progression occurred in bone and soft-tissue sites.