Carolyn Vachani, MSN, RN, AOCN
Last Modified: March 2, 2003
Volume 3, Issue 2
OncoLink would like to recognize the contribution of the National Colorectal Cancer Research Alliance (NCCRA) whose initiative with Pharmacia Oncology and Pfizer has made this publication possible.
Molly McMaster was diagnosed with stage II colon cancer in 1999 on her 23rd birthday. Her initial shock quickly turned to determination; Molly completed her chemotherapy in the fall of 1999 with a vow to live for the moment and live life to the fullest. She has used her experience as a chance to educate many others about colon cancer, and knowing and trusting your own body. You see, Molly's physicians dismissed her symptoms early on, but she continued to pursue a diagnosis. Although this misdiagnosis has caused her some anger, it has inspired her to teach others about the signs and symptoms of colon cancer.
Molly's efforts include Rolling to Recovery, a 71-day inline skate from Glen Falls, New York to Greely, Colorado. The trip raised over $60,000, which has been donated to The American Cancer Society, The Cancer Center at the Glen Falls Hospital in New York, and the Sunflower Fund (a fund for cancer patients at the Glen Falls Hospital). Aside from the money donated, the trip gained quite a bit of media attention, and surely raised awareness of this deadly disease! Molly's latest endeavor is the colossal colon, a forty-foot long, four-foot tall model of a human colon - complete with polyps, cancer, Crohn's disease, hemorrhoids, and diverticuli, among other colonic diseases. Actual colonoscopy footage was used to ensure that the colon is as realistic as possible. Visitors can crawl through the colon, or peer into strategically placed windows to view the abnormalities. Molly's goal was to create a colon so outrageous, you can't help but talk about it- and she has done just that.
This year the colossal colon is taking a road trip around the United States - see it in a location near you! Visit Molly's website to learn more about the crazy things she has been doing to raise colon cancer awareness.
Our body's immune systems are set up to ward off disease. Unfortunately, these immune cells are often ineffective at recognizing and killing cancer cells. Researchers believe that if we can stimulate the immune system, we may be able to make it more effective in preventing the growth and spread of cancer cells. Using this idea, Aventis Pasteur, a company based in Toronto, Canada, has developed cancer "vaccines" for colorectal, breast, and skin cancer, which are currently being studied in clinical trials.
The colorectal cancer vaccine, called ALVAC-CEA/B7.1, works by targeting the CEA antigen (carcinoembryonic antigen), which is expressed on about 95% of colorectal cancer cells and is not expressed by normal cells. The body's immune system does not normally recognize CEA as something to attack and destroy. The vaccine is designed to stimulate the immune system to recognize CEA as foreign, and subsequently destroy the cancer cells. The vaccine causes a short-lived infection, which activates the immune system, causing it to attack the CEA-expressing cancer cells. The B7.1 component of the vaccine is designed to strengthen the immune response caused by ALVAC-CEA.
The current clinical trials are looking at giving the vaccine in conjunction with traditional chemotherapy. We know that, despite receiving chemotherapy after surgery, some patients will still have a recurrence of their cancer. The purpose of the vaccine is to track down and destroy any wayward cancer cells that are not destroyed by the chemotherapy. Earlier trials have found that the vaccine is safe when given alone, with side effects including mild, local reactions at the injection site, but they did not overlap with the side effects of chemotherapy. The goals of the current trials include evaluating the safety of giving the vaccine in conjunction with traditional chemotherapy and if differing administration times can improve the effect. Early studies found improved survival in patients who mounted an immune response to the vaccine.
Two studies are currently enrolling at multiple locations in the United States and Canada. A Phase II trial for patients with metastatic colon cancer, which has not yet been treated with chemotherapy, is being conducted at 13 locations in the U.S. and Canada. Participants in this trial will be randomized to one of three regimens (or arms). They will receive standard chemotherapy with fluorouracil (5-FU), Leucovorin, and irinotecan, with the vaccine given either before each treatment or following the completion of treatments, depending on which arm they are assigned to. One arm will also receive tetanus toxoid with each dose of the vaccine to determine if it can further enhance the immune response.
The second study is being conducted at several sites in Canada only. This is a phase I trial for patients with stage III colon cancer that has not yet been treated with chemotherapy. Patients will receive standard chemotherapy (fluorouracil (5-FU) and Leucovorin) in conjunction with the ALVAC-CEA/B7.1 vaccine given either before each treatment or starting after the completion of chemotherapy treatments.
Five to ten percent of familial colorectal cancers are linked to the genetic syndromes Hereditary Non-Polyposis Colon Cancer and Familial Adenomatous Polyposis. Another thirty percent are considered familial and are assumed to have a yet unknown genetic cause. Dr. Sanford Markowitz and his team at The Ireland Cancer Center at Case Western Reserve University have preliminarily identified an area on human genes that appears to account for a great number of families that have developed multiple cases of colon cancer. In order to further clarify this finding, Dr. Markowitz's team is looking for help from families in which someone has had colon cancer or colon polyps at age 65 or younger. The team would particularly like to hear from families in which two or more brothers or sisters have had colon cancer or polyps before age 65. You can learn more about Dr. Markowitz's Colon Cancer Sibling Study by calling The Ireland Cancer Center at 216-368-0497 or by registering with the NCCRA resource center database. Once you are registered in the database, the team will contact you if you qualify.
You can help the NCCRA researchers with other trials by participating in the NCCRA resource center database. Currently, it can take months to fill clinical research trials, however, by reaching large numbers of people, the NCCRA hopes to reduce those waits down to several weeks or a month. Such an effort would serve to allow trials to reach their conclusions more quickly, and literally move science forward.
The resource center serves as a database where interested persons can register, then accredited researchers, after receiving approval from the NCCRA's Medical Advisory Board, would be allowed to search the database to find patients who match their study criteria.