December 2013

Gastrointestinal Oncology Program at UNC Lineberger

 

The Gastrointestinal (GI) Oncology Program offers advanced multidisciplinary treatment and care for patients with gastrointestinal cancers, such as colon, liver, pancreatic, rectal and stomach cancers. Established in 1979, the Gastrointestinal Oncology Program is one of the oldest and largest referral centers in the state, combining the expertise of physicians from medical oncology, surgical oncology, radiation oncology, thoracic surgery, transplant surgery, GI surgery, GI medicine, diagnostic radiology, surgical pathology, reconstructive surgery, and oncology nursing. In addition, collaboration within UNC and throughout the nation ensures patients receive the most advanced specialty care for management of these complex diseases.

To make a referral, call 919-966-9700 or 919-843-8843. For additional information, visit the, visit the program's website.

Increase in local excision raises questions about patient safety

A review of trends in rectal cancer surgeries conducted by researchers at UNC Lineberger Comprehensive Cancer Center found that use of local excision, in lieu of more radical surgery, has increased, raising concerns about whether clinical guidelines are being followed appropriately.

The study, published by the Journal of Clinical Oncology, examined more than 111,450 rectal cancer patients recorded in the National Cancer Database from 1998 to 2010 to find that the use of local excision, which by the guidelines should be a rarely used option, has grown steadily. Study author Karyn Stitzenberg, MD, MPH, assistant professor of surgical oncology and UNC Lineberger member, said the research was spurred by a concern that physicians and patients were not following guidelines when considering surgical options.

Research has shown that patients undergoing local excision face a much higher rate of cancer recurrence than patients who undergo proctectomy, 28 percent versus 4 percent at five years. Because of the higher risk of the cancer returning, the National Comprehensive Cancer Network and the American Society of Colorectal Surgeons recommend local excision only for a very small subset of patients, those with stage 1 tumors that are 3 cm or less in size and have not penetrated the lymphovascular system.

Future research is needed to determine the reasons for the frequency of the procedure being used. Dr. Stitzenberg plans to follow up on this research to determine the clinical rationale behind the increase of the procedure.

Improving colon cancer screening for diverse populations

A study led by Dan Reuland, MD, MPH, associate professor in the Department of Medicine and UNC Lineberger member, will focus on assessing the impact of a clinic-based intervention that includes having patients view a multimedia decision aid in English or Spanish before seeing their physician, as well as support from a bilingual patient "navigator" on completion of recommended colon cancer screening tests.

The study will be a pragmatic test of the effectiveness of this intervention in clinics serving diverse, vulnerable populations. The goal is to demonstrate the effectiveness of a linguistically and culturally appropriate, practical and potentially scalable intervention for colon cancer screening that can be implemented in the Patient Centered Medical Home context, where diverse patient populations are served. Findings will also inform future interventions that target cancer screening disparities as well as policies that address access to cancer screening.

"There is increasing recognition that improving preventive and chronic care will require an enhanced primary care model that employs proactive, team-based approaches," said Dr. Reuland. "These approaches will need to move beyond the model of having physicians acting as individuals delivering care in brief visits with limited care coordination or support, particularly when it comes to caring for our most vulnerable patient groups."

Featured clinical trials from the Gastrointestinal Oncology Program

CALGB80702: A Phase III Trial of 6 versus 12 Treatments of Adjuvant Folfox Plus Celecoxib or Placebo for Patients with Resected Stage III Colon Cancer (PI: Sanoff)

LCCC0809: A dose-finding, safety and preliminary efficacy study of Stereotactic Radiosurgery for Hepato-cellular carcinoma and Colo-rectal liver metastases (PI: Tepper)

LCCC1029: Multi-Center, Randomized Placebo-Controlled Phase II Study of Regorafenib in Combination with FOLFIRI (Irinotecan, 5-Fluorouracil, and Leucovorin) versus Placebo and FOLFIRI as Second Line Therapy in Patients with Metastatic Colorectal Cancer (PI: Sanoff)

LCCC1036: A Phase I Study of BKM120 with mFOLFOX6 in Patients with Advanced Solid Tumors with Expansion Cohorts in KRAS Wild Type Metastatic Colorectal and Metastatic Pancreatic Cancers (PI: McRee)

LCCC1105: Phase II Single Arm Clinical Trial of FOLFIRINOX for Unresectable Locally Advanced and Borderline Resectable Pancreatic Cancer (PI: McRee)

LCCC1225: PET/MRI as a Predictor for Response to Preoperative Radiation Therapy and Chemotherapy in Resectable Rectal Cancer: The Role of PET/MRI in Individualizing Curative Therapy. (PI: Tepper)

LCCC1227: A prospective evaluation of the effect of curcumin on dose-limiting toxicity and pharmacokinetics of irinotecan in colorectal cancer patients (PI: Asher)

N1048-CIRB: A Phase II/III Trial of Neoadjuvant FOLFOX with Selective Use of Combined Modality Chemoradiation versus Preoperative Combined Modality Chemoradiation for Locally Advanced Rectal Cancer Patients Undergoing Low Anterior Resection with Total Mesorectal Excision (PI: Stitzenberg)

OSU-11182: A Phase II Study of the Combination of Aflibercept (VEGF-Trap) plus Modified FOLFOX 6 in Patients with Previously Untreated Metastatic Colorectal Cancer (PI: McRee)

 

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For questions about all clinical trials at UNC, contact the UNC Lineberger Protocol Office at 919-966-4432 or (toll-free) 1-877-668-0683. For questions about clinical trials offered at other sites, contact the UNC Cancer Network at 919-966-7359 or (toll-free) 1-877-668-0683.

 

To make an appointment at the N.C. Cancer Hospital for one of your patients, visit our web page for referring physicians. You may also contact the Carolina Consultation Center at 1-800-862-6264.