Cancer Close Up - Colon and Rectal Cancer

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The State of the Fight: Colon Cancer

by Nita Ahuja, M.D., and Nilo Azad, M.D.

The State of the Fight: Colon Cancer

Colon cancer is the second largest cause of cancer death in men and women combined, affecting people of all ages. Surgery is often an option for those patients whose cancer is caught early, but sadly, we have just a few lines of treatment for patients with advanced disease. The hope is that our research will one day develop better therapies for patients whose cancer is too advanced for surgery.

Together, we co-direct a colon cancer clinical trial that uses two drugs that target epigenetic changes in a tumor. Epigenetics is the study of how genes are turned off and on. In cancer, genes that normally protect us from developing

the disease are turned off, and other genes that fuel cancer development are turned on. Accordingly, we can try to target these genes that are changed epigenetically and thus turn “good” genes on and “bad” genes off.

By treating cancer cells with certain drugs, you can potentially turn “good” genes back on. Our laboratory work has shown that the two drugs we’re testing do just that, and may also inhibit tumor growth in animal models. That’s why we, along with other clinical

researchers in the SU2C group, wrote and opened this trial - to test these drugs targeting this mechanism. The trial is intended for patients for whom all known treatments for colon cancer have failed.

At the same time, we are examining patients’ tumors to determine if there are epigenetic factors unique to their cancers that could predict response to treatments. That will help us select the right patients for these drugs.

We also hope that our studies will elucidate the importance of epigenetic changes in the development and progression of cancer and add to the science and be used to craft treatments for various other cancers.

Patients who participate in clinical trials are so important in the fight against this disease. None of the laboratory science has any meaning unless we can bring this work into the patient care arena, and we need patients to do that. There are so many possible good new drugs that we need to test, with the help of willing patients.

Colon cancer is preventable in many patients with adequate screening. If you catch it when it’s a precancerous polyp, you have a good chance of preventing the disease entirely. That is why screening is so critically important.

We urge people to follow the screening guidelines, with examinations beginning at age 50 (or earlier, if you have certain risk factors, such as a family history of colon cancer, or if you are having symptoms). Unexplained weight loss, a change in your bowel habits, a distended belly, unexplained gas, blood in your stools and other things that don’t make you feel right could be potential warning signs that you should get examined. If a vast majority of people followed these guidelines, we believe that we could take a cancer that kills tens of thousands of Americans every year and shrink that number exponentially.

The scientific community is constantly working hard to find new cures for cancer. Our SU2C team is committed to moving our work in epigenetics into clinical trials to hopefully one day provide meaningful benefits and new treatments for patients diagnosed with colon cancer.

Nita Ahuja, M.D., is a surgical oncologist at Johns Hopkins Medicine and the Johns Hopkins Kimmel Cancer Center who takes care of patients with gastrointestinal cancers. A member of the Stand Up To Cancer Epigenetic Dream Team, she directs the clinical trial on treatment of colon cancer with epigenetic therapy along with Dr. Azad. She also runs a laboratory involved in developing better biomarkers for early detection of cancers.

Nilo Azad, M.D., is a clinical oncologist at Johns Hopkins Kimmel Cancer Center who takes care of patients with GI malignancies and specializes in colon cancer. As a clinical researcher, she runs trials of new treatments for patients with colon cancer.

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