Gastrointestinal cancer club delhi india, Dr.Ajay K.Sachdev delhi based Dept. of Gastrointestinal Surgeon serior gastro intestinal surgeonconsultant Surgery G.I. Surgeon G I Surgery Radiotherapy,Chemotherapy, G.I Cancers Advanced Hepatobiliary, Pancreatic, Esophageal,Intestinal,Colorectal surgeries and G.I. Oncoogy cancers of abdominal organs Gastroenterology IASG CANCERS OF ABDOMINAL ORGANSEXPERIENCED G.I. SURGEON

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Median survival has improved to 18 months from earlier
8-10 months.
Folfox-4 or Folfiri were the standard of care.
Monoclonal antibodies- Anti VEGF and Anti EGFR.
Addition of Bevacizumab to Irinotecan based chemotherapy increases survival by 5-6 months and is considered present standard of care in first line treatment.
Anti EGFR - Cetuximab
Median survival has now improved to 24-30 months.

Despite the fact that a majority of patients have the entire tumor removed by surgery, as many as 50 to 60% will develop a recurrence. Chemotherapy is given to reduce this chance of recurrence. Generally, patients with stage II disease who present with a bowel perforation or obstruction, or who have poorly differentiated tumors (determined by a pathologist looking at the tumor under a microscope)and all patients with stage III ( spread of cancer to adjoining lymph glands ) are considered at higher risk for recurrence and are treated with 6 months of fluorouracil (5-FU) ,leucovorin (LV) and Oxaliplatin ( So called FOLFOX-4 regimen) ( chemotherapy agents). Other patients with stage II disease are followed closely, but generally receive no chemotherapy.

Forty to fifty percent of patients have Metastatic disease (cancer that has spread to other organs) at the time of diagnosis, or have a recurrence of the disease after therapy. Unfortunately, the prognosis for these patients is poor. The standard therapy for patients with advanced disease is a combination of fluorouracil, leucovorin, and Irinotecan or Oxaliplatin. Regimens adding either Irinotecan or Oxaliplatin to fluorouracil and leucovorin were found to be more effective than using the fluorouracil and leucovorin alone. With this therapy, an average of 39% of patients has a response, but the average survival is still only 20 months.

Bevacizumab (Avastin) is a new type of treatment called anti-angiogenic therapy. Tumors need nutrients to survive and are able to get these nutrients by growing new blood vessels. This medication works by attacking the new blood vessels the tumor has formed -- in other words, by cutting off its food source. Bevacizumab is used in combination with chemotherapy.

Cetuximab (Erbitux) is a new type of monoclonal antibody that targets cancer cells specifically, sparing the normal cells and therefore causing fewer side effects. The drug causes the patient's immune system to recognize the cancer cells as foreign and attack them. Cetuximab is given either alone or in conjunction with chemotherapy agents. It is expected that Bevacizumab and Cetuximab will be combined with chemotherapy drugs as initial management in cancer which has spread beyond stage III.

Capecitabine (Xeloda), an oral form of fluorouracil, is also being used in the treatment of colon cancers when the patient cannot tolerate or has progressed on the above therapies.

Patients and their physicians must weigh the benefits of therapy versus the side effects of the treatment. Patients who are younger and/or in better physical shape are more likely to tolerate therapy, but elderly patients should not be excluded from chemotherapy based on age alone.