Introduction

Article Outline

• Copyright

This supplement to Seminars in Oncology contains selected proceedings of the European Gastrointestinal Conference, “Research Driven Clinical Approaches to Gastrointestinal Oncology,” held in Paris, France on February 1–2, 2006. The conference was co-sponsored by the International Society of Gastrointestinal Oncology (ISGIO) and the International Congress on Anti-Cancer Treatment (ICACT). The ISGIO is committed to improving research, education, and care of patients with gastrointestinal (GI) malignancies. Thus, these proceedings represent the ISGIO’s ongoing, fundamental goal to communicate important GI oncology research and clinical practice issues.

Topics covered by the international faculty providing manuscripts for this supplement range from molecular mechanisms of disease, imaging techniques to monitor therapeutic response, and standard and emerging treatment approaches for various GI malignancies.

Dr Julie G. Izzo et al review molecular mechanisms in development of esophageal cancer, and provide data implicating several molecular effectors as potential markers to assess cancer risk in patients with Barrett’s esophagus, and as potential therapeutic targets for chemopreventive interventions and to enhance response to anticancer therapies.

The expanding application of hepatectomy for patients with colorectal cancer and liver metastases is covered by Dr René Adam. Use of neoadjuvant chemotherapies with newer agents such as oxaliplatin or irinotecan has increased response rates and thus the proportion of patients eligible for resection of liver metastases, while it is hoped that the addition of biologic agents targeting active molecular pathways in this disease may further increase resectability rates. Moreover, improved surgical and ablative techniques are improving the ability to perform potentially curative hepatectomy procedures in patients previously considered unresectable.

Dr Philippe Rougier and coauthors provide an update on hepatocellular carcinoma and management strategies, including potentially curative approaches, adjuvant therapies, and palliative treatments. While orthotopic liver transplantation is currently the preferred curative approach because it treats both the tumor and cirrhosis, fewer than 5% of patients are candidates for the procedure, and other curative methods such as resection or local destruction have high rates of disease recurrence or cirrhosis-related mortality. Adjuvant treatments have as yet only been evaluated in small studies. Molecular therapies are being tested alone and combined with agents such as gemcitabine/oxaliplatin and irinotecan in hopes of improving outcomes of this largely chemoresistant tumor.

Dr Stacey Gabriel describes tools being used to uncover contributions of the germline and somatic genomes to cancer development and phenotype. The completion of the human genome sequence, data from the International HapMap project, as well as technologic advances, will advance our understanding of the common mutations that can cause distinct human cancers, as well as help to identify new targets for drug discovery, to facilitate patient selection, and to assess therapeutic response.

Current treatment approaches for advanced pancreatic cancer are presented by Dr Michel Ducreux et al who review the “gemcitabine era” and describe potentially promising approaches that include both gemcitabine-containing and non-gemcitabine regimens, as well as combinations with biologics targeting molecular pathways in this very aggressive disease.

Patients with esophageal cancer who have complete pathologic response to neoadjuvant chemoradiotherapy have improved clinical outcome. Noninvasive methods to predict response or resistance to treatment before surgery are needed to help individualize patient management. Dr K. S. Clifford Chao discusses the first study to assess positron emission tomography (PET) imaging using 3′-deoxy-3′18F-fluorothymidine (FLT) to detect early alterations in tumor cell proliferation after chemoradiation therapy in in vitro and in vivo models of esophageal cancer. Results suggest the utility of this approach in assessing response to neoadjuvant chemoradiation therapy for esophageal cancer, and that it is more specific than FDG-PET ([18F]fluorodeoxyglucose-PET) in this setting.

Dr Aimery de Gramont reviews the current status of adjuvant therapy for stage II and III colorectal cancer. The relative benefits of various combination chemotherapy regimens and targeted therapies in colorectal cancer, based on recent clinical trials, are reviewed.

It is hoped that you find the information in this supplement timely, stimulating, and useful in patient management and the design of clinical trials.