Clinician-to-Clinician Update Clinician-to-Clinician Update

Promising New Treatments for Gastrointestinal Cancers

February 2016

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— Derived from a compound found in the plant thunder god vine (Tripterygium wilfordii), shown at left, Minnelide is under study as a therapy for pancreatic cancer.

Gastrointestinal (GI) cancers are among the most common, with approximately 300,000 new cases diagnosed in the United States per year.1 With the exception of cancers of the colon and rectum, the 5-year survival rates for GI cancer have historically been quite low: from 15% to 30% for most GI cancers to as low as 8% for pancreatic cancer, despite treatments including surgery, chemotherapy, and radiation.2

Researchers at Masonic Cancer Center, University of Minnesota investigate and devise pioneering treatments for these challenging cancers. Among these are hyperthermic intraperitoneal chemotherapy (HIPEC) for treating metastatic cancers in the abdominal cavity and the treatment of advanced pancreatic cancer available through the Minnelide clinical trial.

Minnelide Trial for Pancreatic Cancer

Pancreatic cancer remains a particular challenge, as the current standard-of-care chemotherapy lengthens overall survival by fewer than 4–6 months.3 A new treatment known as Minnelide has shown in vitro activity against pancreatic cancer cells. Identified by Masonic Cancer Center preclinical researchers and derived from a naturally occurring compound found in the plant thunder god vine, Minnelide is a water-soluble inhibitor of a heat shock protein, HSP 70.

HSP 70 is present at abnormally high levels in pancreatic cancer cells and has been proven to promote tumor growth. Based on very successful studies in mice, a phase I safety trial of Minnelide in pancreatic cancer patients was initiated in 2013 and has shown promising evidence of activity.4 Phase II trials will begin soon.

Hyperthermic Intraperitoneal Chemotherapy

Unlike traditional chemotherapy, HIPEC delivers treatment directly to cancer cells in the abdominal cavity and may avoid some of the side effects posed by oral or intravenous chemotherapy. In this procedure, highly concentrated, heated chemotherapy is administered intraperitoneally in the operating room after the surgeon has removed as much of the visible GI neoplasm as possible. Approved for patients with epithelial neoplasms of the appendix, HIPEC is associated with a better median survival rate for these patients at 25 versus 77 months.5 Clinical trials are ongoing for the use of HIPEC.6 Providers at University of Minnesota Medical Center are among the few in the United States with extensive experience in administering HIPEC and currently perform HIPEC for patients with appendiceal, colon, and mesothelial cancers of the abdomen.

References

1. Siegel RL, et al. Cancer Statistics, 2015. Ca Cancer J Clin. 2015;65:5-29.

2. National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. Survival Statistics, 2005-2011. Available at http://seer.cancer.gov/canques/survival.html.

3. Chan K, et al. A Bayesian meta-analysis of multiple treatment comparisons of systemic regimens for advanced pancreatic cancer. PLoS One. 2014;9:e108749.

4. Banerjee S, Saluja A. Minnelide, a novel drug for pancreatic and liver cancer. Pancreatology. 2015;15:S39-43.

5. Shaib WL, et al. Hyperthermic Intraperitoneal chemotherapy following cytoreductive surgery improves outcome in patients with primary appendiceal mucinous adenocarcinoma: a pooled analysis from three tertiary care centers. Oncologist. 2015;20:907-914.

6. Loggie BW, Thomas P. Gastrointestinal cancers with peritoneal carcinomatosis: surgery and hyperthermic intraperitoneal chemotherapy. Oncology (Williston Park). 2015;29:515-521.

When To Refer

The gastrointestinal (GI) cancer team at the Masonic Cancer Clinic treats hundreds of common, rare, and complex cases each year with a wide range of treatments. Treatment options include chemotherapy, radiation, and surgery, including minimally invasive and robotic techniques. More experimental therapies include intraperitoneal and intrahepatic chemotherapy, stereotactic radiosurgery, and intensity-modulated radiation therapy.

Collaborative Care

Our multidisciplinary approach ensures that patients benefit from a coordinated treatment plan developed by clinicians with highly specialized expertise in all aspects of GI cancer care. Each patient has a personal care team, which may include gastroenterologists, diagnostic and interventional radiologists, pathologists, GI oncology surgeons, medical oncologists, radiation oncologists, genetic counselors, palliative care specialists, nurse practitioners, and oncology nurses. We consider the referring provider to be a critical part of the multidisciplinary care team, and we are committed to prompt communication around all aspects of your patient’s care.

Physician Outreach Program

The Cancer Care Outreach Program is designed to provide education and facilitate knowledge sharing between our team and the medical community.

To schedule a physician meeting or to visit our facility, contact Melinda Arvold, Oncology Outreach Manager.

Phone: 612-867-3411; email: marvold1@fairview.org.

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