Here and There – ASCO seminar-Bits and Pieces- 2013

Hi, everyone,

Here are some of the bit and pieces of what I colud remember; not all of them are relate to CCA; but for “solid cancers” which may be of future benefit to our disease; the info are useful not only to you but may be for people you know.

– For COLON cancer, there are NO benefit to add oxaliplatin to 5FU/LV regimen for stage II colon cancer for adjuvant chemotherapy(the QUASAR trial);The same applied to stage II and II patient who are >70 years of age(patient pop. in the other study=42,032). Only slight benefit of 3%-5% for stage III for overall survival.
-5 year OS( for colon cancer): Stage I=>90%,Stage II=80%;Stage III= 60% and Stage IV=around 8%.
-From 1980-2010, 5fu, irinotecan, capecitabine, oxaliplatin, and since early 2000, targeted agents like cetuximub, bevacizumab and panitumumab have been used for colon cancer.
-Regovrafenib has been recently approved for refractory colon cancer;side effect included high blood pressure,diarrhea,fatigue and hand and foot symptom. regorafenib is for the treatment of patients with metastatic colorectal cancer (mCRC) who have been previously treated with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy, an anti-VEGF therapy, and, if KRAS wild type, an anti-EGFR therapy.
-There is no reliable prognostic biomarkers for stage II/III colon cancer;prognostic factors include BRAF 600E status,Lymph node ratio,and tumor microsatellite instability.
_Standard histopathologic staging for COLON cancer still provide the best determination of disease recurrence risk and benefit for ADJUVANT therapy.
too be continue….

God bless.

Hi, everyone,

This ASCO convention is the most challenging and the most productive ASCO that I have ever attended. since I will go to another session very shortly.
let me just say this.
If you,the members, are looking for miracles development for our CCA, you will be disappointed; but if you want to understand the future about treating cancer, you will be excited to find out there are a lot of different approaches for curing cancer;the new drugs may or may not work; they may work for a very short period of time before they develop resistance and you need to use another new one; they will be expensive(ie: a new 2 drug combo that may work for a short period of time(2months for example) will cost average opf 45,000 dollars,not to mention a three drugs combo and the short time for overall survival of a few months.
This year I concentrate on immunology and tumor biology; onr thing I can tell you is that , what I have found out may not be the answers you want to hear, but it does not mean that the info are not useful in terms of looking forward for the best treatment in the future. I am happy to learn about the new knowledge and confusion of it and will share with all of you who will be interested in this subject.

In short, this convention is the most confused but very fruitful for my interest in finding out the best future treatment plans and the obsticls and have a keen sense on what the obsticles lied ahead for all of us who suffer from this chronic disease.

Please excuse my typing error since time is very precious at this moment.

God bless.

Hi, everyone,

In one of the immunology session ,experts had reviewed about 25 posters that they picked out for their worthiness. All of them are about other diseases,but the one the experts that are in the immunology field picked out ; title “Adoptive T-cell therapy(ACT) with TILS for metastatic melanoma:clinical responses and durable persistence of anti-cancer responses in peripheral blood(abstract 3026)” by M Donia et,al. the expert concluded that this is the most promising abstract for treatment of melanoma in immunology. I remember one of our member was on this treatment for CCA at NIH and shown good long term releive of symptoms until recently.( I think the disease free period for her is around one year with only one treatment.)
In short I think ACT with TIL for treatment for CCA may be relatively a good alternative treatment if other treatment plan are exhausted.( I think the clinical trial is still open.)

The use of calcium and magnesium IV infusions in the treatment of cancer like colon cancer didnot make any significant change or shown benefits in the overall protective and preventive treatment for neuropathy toxicity caused by oxaliplatin.

There are no significant benefit for using Avastin in colon cancer due to the high cost and the overall survival difference of 8 weeks may not be worth it.

Therare only a 3% difference in the preventive follow up monitoring among using CEA test only;CEA test+CT scan or Ct scan alone after colon resection.

There is no significant difference between using Xyloda twice daily as maintenance therapy and observatioon alone in the preventiion of recurrence of colon cancer.( from the dutch cancer foundation study); irinotecan will the 2nd line treatment if disease progress.

NLR( the ratio of neutrophil/lymphocyte)>/ may be useful as a prognostic marker for biliary cancer recurrence especially for extrahepatic cholangiocarcinoma; they are still working on whether the same principle will be applied to ICCA.( BTW, this is a continuing research study at Mass General).

The number one biliary treatment center in Hong Kong is the Queen Mary Hospital affilitated with the University of Hong Kong.

There is a poster from MSK from New York about “Hepatic Arterial Infusion for Unresectable Cholangiocarcinoma” ; I will put up the update on this poster later.But the interesting facts is that ,through the exchange of ideas between me and the presenter,who is a surgerical fellow doctor working with Dr. Fong, to whom some of our board membersw were treated by Dr.Fong. Base on what I can understand, Dr. fong is investigating to use robotic (ie: the Devinci robotic system) to perform liver resections,start with small tumors first , so this may be a new way to come in addition to use the arterial pump with FUDR.

In one poster study, It shows there were no difference in UK and Japan with regard to the efficacy in using GEM/CIS , both in OS and PFS.

God bless.

Hi, everyone,
Day 2 On the session title “Thrombosis and Cancer:Emerging data for the Practicing Oncologist.” some points worth of noticing. there are as follows:

1. The new anticoagluants recently on the market did not have enough indepedent data for prophylaxis and treatment of VTE;or enough report on the after market adverse drug reactions, so it is not recommended by the panel of spearers Anna Falanga from Ospedali Riuniti di Bergamo; Alok Khorana from Univ. of Rochester and Gary Lyman from Duke University. (VTE included DVT,PVT AND PE ).
2. If you are prone to develop DVT,PE or PVT(portal vein thrombosis),but do not have the symptomatic signs or symptoms yet,you may have to discuss this matter with your oncologist;since prophylaxis usage of anticoaugluant may not be needed. Periodical chechk up(ie: with scans ),blood work are recomended. Routine prophylaxis is not recomemded for average risk patients;but for high risk cancer patients with solid tumor and on chemotherapy ,it should be done on a case by case basis.
3.If you have developed DVT or PE or PVT already ,you may have to be on anticoagluant for as long as you are on chemothrapy to prevent recurrence of VTE. Use coumadin is fine,but dr.Gary Lyman prefers Lovenox once daily(check creatinine for adjusting the dose.) or other Low Molecular weight heparin(LMWH). Generic LMWH is now available so the cost will be much lower and will be in par with using coumadin with PT/INR clinic monitor included.
4. Patient education on using anticoaugluant and risk asscessment should be done either as inpatient or as out patient to monitor the patient’s VTE.
5. There are no difference in symptomatic VTE and incidental VTE in mortality in pancreatic cancer ,for example.
6.The risk of VTE is more with the antibodies but not with the oral TKA targeted agents.
7. 50,000 is the limit for thrombocytopenia in terms of treatement limit.

got to go now, please excuse typing error.

God bless,

Hi, Gavin,

Thanks for your concern. I cannot match Marion’s energy and perserverence . But I will try harder if God is willing to give me te second chance as long as HE wishes.
Sometimes , the more you know, the more you wonder whether there will be a cure in the near future.
Depressed? Yes.
To give up? NO.

God bless.

Hi, everyone,
This morning, I attend another lecture on “Recently Approved Agents”,
there are
1. Regorafenib by George Blumrnchein from MD Anderson;it is used for refractory colon cancer; regorafenib is for the treatment of patients with metastatic colorectal cancer (mCRC) who have been previously treated with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy, an anti-VEGF therapy, and, if KRAS wild type, an anti-EGFR therapy.

2.TDM-1 ,by Howard Burris from Sarah Cannon Research Institute;it is used for GIST and breast cancer for the treatment of patients with HER2-positive (HER2+), metastatic breast cancer (MBC) who previously received trastuzumab and a taxane, separately or in combination. Patients should have either: Received prior therapy for metastatic disease, or
Developed disease recurrence during or within six months of completing adjuvant therapy.
3. Pertuzumab by Michael Gordon from Pinnacle Oncology Hematology;it is used for in combination with Herceptin (trastuzumab) and docetaxel chemotherapy for people with HER2-positive metastatic or locally recurrent, unresectable breast cancer, who have not received previous treatment or whose disease has relapsed after adjuvant therapy.
4.Enzalutamideby Charlse Ryan from UC at San Francisco;it is used for prostate cancer. enzalutamide is for the treatment of patients with metastatic castration-resistant prostate cancer who have previously received docetaxel.
5. Ruxolitinib by Srdan Verstovsek ,MD Anderson; it is used for the treatment of intermediate and high risk myelofibrosis, including primary myelofibrosis, post-polycythemia vera myelofibrosis and post-essential thrombocythemia myelofibrosisbrosis.

6.Ponatinib by Jorge Cortes from MD Anderson; it is used for CML; to treat adults with chronic myeloid leukemia (CML) and Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL), two rare blood and bone marrow diseases.

7. Carfilzomib by Kyriakos Papadopoulos from START Center for Cancer Care; it is for myeloma.It is for the treatment of patients with multiple myeloma who have received at least two prior therapies, including bortezomib and an immunomodulatory agent, and have demonstrated disease progression on or within 60 days of the completion of the last therapy.

None of the new drugs are for either the liver or CCA.

This year ,ASCO make the molecular landscape of cancer by using “PANOMICS’ as one of the three “drivers of change”.

Panomics is defined as the understanding of the complex combination of genes, proteins, molecular pathways and the unique patient characteristics that together drive the disease of cancer,as well as
an understanding of how to target these factors in combination to develop prevention strategies and curative therapies.

God bless.