Colorectal Cancer Mabs

Another monoclonal antibody, i.e. "MAb", has been approved by the US Food & Drug guys for the treatment of chemo-resistant metastatic colorectal cancer. This time, its Amgen's panitumumab (Vectibix), a purely human MAb that's priced to give ImClone's cetuximab (Erbitux) a run for the money.  Priced to cost 20% less, its "just" a Filipino-sized US$ 7000 per month for those who may have already failed a gamut of chemo options.

How best to tell folks with the right to know? My patients are well above average in our economic totem pole, yet only 2/3 of them can afford the costs of plain old FOLFOX6 chemo. I wonder what its like to be told that one's disease is back yet again, to know that there's a new fast-tracked targeted therapy for slowing it down, & then to agonize over whether one should sell more stocks or the children's future to avail of it.

To the Powers-that-be… Never mind the MAbs for now. Maybe just a national information & screening program that actually works.

Previous Comments

good day sir!

I’m Nina Bumanglag, a student at UPLB taking up biology. I’ll be having an undergraduate seminar regarding colorectal cancer next year on january 2007.

I was hoping if I could ask for your help about what sort of treatments your patients undertake, the most common and the likely reasons for chooisng it. Your insights would really help with the seminar I am about to undertake.

Thank you Sir and God Bless!

Nina Bumanglag

Posted by nina bumanglag at December 18, 2006, 9:12 am

Hello, Nina. Its a very broad topic. Management would depend upon whether its the colon or rectum that’s affected, the stage, the presenting symptoms, co-morbidities, etc. In fact, even in specialty fora, it helps when discussions are case-based.
Best look at the simplified algorithms for patients. For evidence-based info, look here–> http://www.nccn.org/default.asp
Posted by oncodoc at December 18, 2006, 1:12 pm

hello sir!
I’m a student doing research on colon cancer and its preventive medicines. I was just wondering if you happen to know the rate of colon cancer incidences in the philippines and who are the people commonly “attacked” by this type of cancer.
thank you and god bless!
Posted by ethel at January 16, 2007, 7:46 pm

Online sources for stats include Globocan (2002) at the IARC website. The DOH puts out stats as well. Beware of under-reporting– its a serious consideration hereabouts.
As to risk factors for colon cancer specific to the Philippine population, I’m not aware of any local population-based study in this area. Maybe you can do one. Western medical literature has extensive coverage of risk, however, and you can freely access the information online in both “health professional” and “patient” versions. (See “Links”)
Posted by oncodoc at January 16, 2007, 11:14 pm

Prostate Cancer Variables

Prostate cancer is a highly prevalent malignancy but, come to think of it, most medical oncologists I know have but a handful of cases. In my own clinic, prostate cancers are outnumbered by even the sarcomas & gliomas. Since the role of the medical oncologist is most active in stage IV of this disease, does this mean that majority of patients are diagnosed early & subsequently cured? Are even very advanced cases managed by another specialty? Are full options offered at all?

Since I don't work with a specialized urologic tumor group, the cases I see have already failed previous cancer treatment &/or are in a very advanced stage for which chemotherapy is contemplated. There are points in a case history that medical oncologists look into upon first evaluation to "know" an individual tumor. Many times in the course of such a review, the advantages of the tumor group concept is highlighted. Telling details may be found in the answers to the following:

First Presentation:

Risk category (eg. Partin tables, MSKCC nomograms) includes tumor extent, PSA, Gleason scores…
Choice & appropriateness of initial therapies
Type & extent of surgery, if applicable.
Brachytherapy details, if applicable. Ports too, if external beam irradiation.
Initial & subsequent hormonal manipulations

Treatment Failure/Relapse/Recurrence:

Duration of initial response, if any
Management of apparent "PSA failure"
Staging procedures
General health & other medical problems
Patient's wishes

What is this gibberish?! Well, if you're a patient, make it your business to find out. Ask, even if you must get another opinion from a specialty team. Prepare for the talk by checking out the NCCN guidelines.

Previous Comments

Hi, My Dad is being treated for Prostrate Cancer. He has been given Luprolex 3X (Apr 2008 to Dec 2008 - given every 3 months) He wants to know when it will stop? His PSA started 3000+, then 5.6, then 1.5 level. His health his improved. Pls advice. thank you.

Posted by Leonard Dy at January 2, 2009, 12:57 pm

In the old days, they just removed the testicles. That was permanent– and much cheaper. If he’s responding to hormonal manipulation alone (am assuming stage IV), I’m afraid that the end to leuprolide is not in sight. Or so one hopes. Docetaxel is the chemotherapy drug indicated when stage IV disease no longer responds to hormonal agents. Its so much tougher to take.
Posted by oncodoc at August 15, 2009, 2:46 pm

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Head and Neck Cancer: The Organ Preservation Option

Concomitant irradiation & chemotherapy can help preserve the normal anatomic outline in locally advanced head and neck cancer without sacrificing treatment efficacy. 

It seems that the latest outcomes of combined chemoradiation are comparable to those of radical surgery with further postoperative treatment.

True, chemoradiation requires focused expertise and is technology-dependent.  As such, this option is found only in the larger Centers. True, the addition of terrific induction chemo may further improve organ preservation rates or, if preliminary trial results hold up, even survival. 

Yes, well & good... but will function be preserved as well as anatomy?  And… can Filipinos afford these cancer treatments?   These are matters up for discussion, but not just amongst medical professionals.

Its obvious that doctors should get their acts together to organize Head and Neck cancer services at their institutions. The name of that game is multidisciplinary coordination, wherein radiotherapists, medical oncologists, subspecialty surgeons, and supportive services work to provide full options to the community.  It would be a shame if a life-saving opportunity is lost by improperly timed interventions.  The final decision is the patient's after all, and acceptance or rejection of risks, side effects, and costs is an exercise of their personal choice. 

Evidence-based information from all participating specialties is invaluable in this regard.  All patients deserve a multispecialty plan of action.