Foundation for Applied Research in Gastrointestinal Oncology

The Foundation for Applied Research in Gastrointestinal Oncology (FARGO) is a non-profit 501 (c)(3) organization that promotes research, education and patient care in gastrointestinal oncology. FARGO's primary objective is to facilitate the transfer of basic science research into innovations in patient care. The responsibilities of FARGO include financial support, administrative support, and space for continued progress in the prevention and treatment of gastrointestinal cancer.

Donations to FARGO are tax deductible and can be made to:

FARGO
c/o Washington Hospital Center
Room CG-185
110 Irving St., NW
Washington, D.C. 20010

FARGO was created in 1993 by Dr. Paul Sugarbaker and the FARGO Board of Directors. Current FARGO staff include:

A major goal of FARGO is the transfer of basic science research into improvements in patient care. The primary means to accomplish this transfer of information is the publication and presentation of research. FARGO supported in-part 53 publications in 1997. There were 9 exhibits and poster presentations and 12 speaking engagements by persons sponsored by FARGO.



A Message From the President of FARGO

On a daily basis, we hear about "basic science breakthroughs" that the press implies will soon benefit patients with cancer. Yet, the months and years go by with little or no progress in digestive tract cancer management. Few clinicians recognize that these malignancies have a unique anatomic location that gives them a special natural history and provides a rationale for local-regional therapy. Our strategy in gastrointestinal cancer research (stomach, pancreas, and large bowel cancer) is to eliminate the last cancer cell by combinations of surgery and regional chemotherapy. Revisions in the techniques by which primary cancer is resected promises to minimize the incidence of abdominal and pelvic recurrences. Regional chemotherapy now being tested in phase III trials should further reduce the portion of patients having "surgical treatment failures". Also, a small portion of patients with established peritoneal surface disease can be rescued long-term through the use of aggressive surgery and intraperitoneal chemotherapy. Clinical and laboratory research supervised and funded by FARGO have improved the survival of patients with gastrointestinal cancers treated at The Washington Cancer Institute/Washington Hospital Center. Many small changes in the way these cancers are approached have resulted in great differences in the lives of these patients. Pseudomyxoma peritonei, peritoneal mesothelioma, small volume peritoneal surface spread of colon cancer, and limited sarcomatosis have now been recognized around the world as reasonable options for these treatments. FARGO’s goal is not only to continue this productivity, but also to expand these treatment options to other institutions in other countries.



Our Mission

The Foundation for Applied Research in Gastrointestinal Oncology (FARGO) is a non-profit 501 (c)(3) organization that is intended to promote research, education, and patient care in gastrointestinal cancer. FARGO’s outreach is world wide. The Foundation’s major goal is to implement the transfer of basic science research to innovations in patient care. The responsibilities of FARGO are to provide financial support, administrative support, and space for continued progress in the prevention and treatment of gastrointestinal cancer.



Current Research Projects

FARGO supports financially and intellectually a wide variety of research projects in gastrointestinal oncology. The following is a report of current research projects.


Heated Intraoperative Intraperitoneal Chemotherapy (HIIC) Using the Coliseum Technique

The investigational phase of hyperthermic intraoperative intraperitoneal chemotherapy with mitomycin C was completed after 60 patients were enrolled in our IRB approved study. This is now the standard of care for patients with demonstrated peritoneal surface spread of appendiceal cancer, pseudomyxoma peritonei, colonic cancer with limited peritoneal carcinomatosis, and some patients with recurrent peritoneal carcinomatosis from ovarian malignancy. Pharmacokinetics were measured on the first 18 patients who had the "closed abdomen technique" and the first 10 patients who had the "coliseum technique". To date, a total of 295 patients have been treated with mitomycin C. There is a spectacular pharmacologic advantage with the intraperitoneal delivery of chemotherapy as compared to its intravenous use. Heat increases the cytotoxicity of the chemotherapy, increases drug penetration and, in some instances, may cause thermal cell kill. Currently, esophageal doppler monitoring is being used to optimize uniformly distributed heat and chemotherapy. Temperatures that were found toxic with the closed method, are safe when using the coliseum technique and esophageal doppler monitoring. The immense survival advantage seen with this "cytoreductive approach" comes from a comparison with previous published data from the Mayo Clinic. Phase II studies in heated intraoperative intraperitoneal chemotherapy are continuing on a daily basis.

A study of hyperthermic intraperitoneal cisplatin enrolled 49 patients. The first 20 patients signed an informed consent in an IRB approved protocol. The histologies in this study included recurrent abdominopelvic sarcoma with sarcomatosis, peritoneal mesothelioma, and peritoneal carcinomatosis from recurrent ovarian cancer. Pharmacokinetics were measured in the first 19 patients. A dose escalation study with doxorubicin has brought us to a standardized treatment using the combined drugs. Currently, heated intraoperative intraperitoneal doxorubicin (15 mg/m²) and cisplatin (50 mg/m²) are being used in the operating room with esophageal doppler monitoring. The safe level of heat administration is currently being optimized.

The coliseum technique will be used in order to pursue other research projects. Prolonged use of the coliseum (open abdomen technique for 5-7 days) will allow us to use enzymes and chemotherapy in order to more completely debride mucinous tumor from small bowel surfaces and other sites of residual disease. The possibility of a randomized trial (mitomycin C plus heat versus heat alone) in pseudomyxoma peritonei patients with a CC-1 cytoreduction is being considered. Another possible randomized study is to compare heated mitomycin C to heated cisplatin and doxorubicin.


An adjuvant protocol for the treatment of pancreas cancer with surgery and heated intraoperative intraperitoneal Gemcitabine is under development. Gemcitabine has produced responses when given intravenously to pancreas cancer patients. We will attempt to utilize this exciting new drug to eliminate microscopic residual disease after complete resection of the pancreas malignancy.



External Hyperthermia with the RF-8 Thermotron.

This feasibility study has entered 26 patients. Our plans for this research project are as follows:

1. Publish experience with 200 cycles of external hyperthermia, supplemented by mitomycin C.

2. Continue to find ways to optimize heat delivery (multiple ports, EMLA Cream, narcotic premeditation, intravenous fluid administration, profound environmental cooling). We have begun the entrance of patients with unresectable liposarcomas into the study. New drugs will eventually be incorporated into the protocol (doxol and CPT-11).

3. Initiate treatment of Grade I abdominal and pelvic sarcomas.



In-vitro Tumor Marker Analysis

This study will determine the effectiveness of monitoring CA 15-3, CA 19-9, CA 72-4, CA-125 and CEA as an indication of tumor recurrence or efficacy of therapy. The trends and levels of these tumor markers will be compared to conventional techniques of monitoring patients in an attempt to find a reliable and lower cost method of surviellance after surgery.