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Emergency Preparedness
The Health Department's Office of Emergency Preparedness strives to keep Fairfax County residents up to date about preparedness for possible public health emergencies, including those caused by terrorism, weather disasters, and naturally-occurring diseases such as "bird-flu."
The following links on this page provide regularly updated information that is part of our ongoing effort to promote awareness of these issues among residents:
Cities Readiness Initiative
Training & Exercise Program
The Health Department wishes to thank everyone who participated in the October 27th Cities Readiness Initiative (CRI) full-scale exercise at George Mason University. The exercise was a great success and an important component of Fairfax County's ongoing commitment to emergency preparedness.
Results and feedback from the exercise are being compiled into an After Action Report which will be used to revise the County's CRI plan. Initial estimates indicate approximately 1100 volunteer residents were processed through the Quick Distribution Center (QDC) with about a 95% accuracy in dispensing proper medication!
If you have questions or to request a participation verification letter, please e-mail the MRC.
Pandemic Flu
- Pandemic Flu
- Fairfax County Pandemic Flu planning page
Medical Reserve Corps (MRC)
The MRC is an organization of medical and non-medical volunteers that would assist the county's Health Department in responding to a bio-terrorist event or naturally occurring epidemic.
Emergency Preparedness
The Office of Emergency Management in Fairfax County has devised a useful document entitled, "Emergency Planning Guidance for Medical and Patient Care Facilities" (PDF). This document was designed to assist facilities in creating a comprehensive emergency preparedness plan.
Both residents as well as their families should be mindful and inquire about a facility's emergency preparedness plan. Inquiries should be made regarding the following: the actual plan, questions about staffing, supplies, resident information, coordination with other resources, and the role of the family.
For further information on Emergency Preparedness in Fairfax County, please visit the Office of Emergency Management .


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Arnette Firedrill SunglassesMSRP: $70.00
Water? Check. Candy? Check. Crazy eye? Check. Hours with nothing but heavy weirdness in store? Check. If you have learned one thing by now, it's that you best come prepared, and nothing says "I'm ready" like a blank stare of false confidence provided by a good pair of shades. The Firedrill is a modern twist on an old favorite, a throwback to the days when people color-coded their trips with blues or reds and choices were as simple as up or down. It was an innocent time and oversized 6-base polycarbonate lenses were a thing of the future much like STDs and their long-term side effects. Thankfully, with the Firedrill's myriad of vibrant color combos and the miracle of modern science, we have a varied assortment of choices these days.
Buy Now
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Oakley Flight Deck Women's Goggle – 2017Price: $210.00

subset: commoncrawl


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Duggar family to campaign for Cuccinelli
RICHMOND, Va. (AP) - A busload of reality television stars - all from the same family - will cruise through Virginia to support Republican Ken Cuccinelli's gubernatorial campaign.
The Duggar family from the TLC series "19 Kids and Counting" is planning a three-day bus tour starting Monday. The Duggars will make stops in Lynchburg, Richmond, Virginia Beach, Fredericksburg and Woodbridge in support of Cuccinelli, the father of seven.
The tour is sponsored by Family Research Council Action. The executive director of the conservative advocacy group is 25-year-old Josh Duggar, the oldest of the 19 Duggar children.


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Guarlford is a village and civil parish in the Malvern Hills District in the county of Worcestershire, England. The village is situated between the settlements of Barnards Green and Rhydd approximately three kilometres (two miles) east of Great Malvern, the town centre of Malvern. The village is compact, and has a parish church (St Mary's); the Church of England parish includes Madresfield village.
Guarlford is in the administrative area of Malvern Hills District Council and is part of the informal region known as The Malverns. Settlements in Guarlford have existed for around 4,000 years and have been known as Garford (Lay Subsidy Rolls 1275), Gerleford (Lay Subsidy Rolls 1333), Garleford (Valor Ecclesiasticus 1535), Galvert (Map of Worcestershire 1820), and Galfords (Ordnance Survey 1830).
Until 1894 Guarlford was a hamlet in the civil and ecclesiastical parish of Great Malvern. Its first parish council was established in December 1894 according to a new Local Government act, and its boundaries covered much of eastern Great Malvern including Pickersleigh, Poolbrook, Barnards-Green, Hall-Green, and Sherrards-Green. In 1934 following a review, the boundaries were changed, and those areas came under the control of the Great Malvern Urban District.
From 1894 until 1974 Guarlford was a parish in the Upton-upon-Severn Rural District. Since 1974 it has been part of the Malvern Hills District, first in the county of Hereford and Worcester, and then, since 1998, in Worcestershire again.
There is a sketchmap of the parishes of Upton-upon-Severn Rural District on the rural district page.


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150cc Air Cooled Engine
The cooling system on this model is designed to an incredibly high standard. It keeps the engine temperatures level while offering the perfect amount of power for a more reliable engine and quality scooter.
Reliable Rear Drum Brake
Come with Rear Drum Brake which can provides quick and safety stopping power.
Upgraded Rear Dual Shock Suspension
Rear Dual Shock Suspension can make your ride as comfortable as it can be.
Easy-to-read Instrument Panel
This instrument panel shows the rider the speedometer, RPM, turn signals, and fuel gauge.
Large Headlight
These headlights are a very unique design that perfectly fit the style and shape of this vehicle. They are also very bright and will light your way while driving at night
Bright Taillight
Bright multireflector taillight for great visibility when you ride at the night.
Performance Aluminum Exhaust Pipe
To add to the already incomparable style of this gas moped, it comes with Dual Performance Aluminum exhaust pipe. It's the little details that matter in the world.
Convenient Glove Compartment
Located in the front underneath instrument panel area, you will find a spacious compartment to store any items you need to take with you while you ride.
Large Rear Luggage Trunk
Store anything you need to take with you in the spacious trunk.
Durable Aluminum Foot Mat
Come with Aluminum foot mat which is more durable than plastic foot mat .
Dual Rear-View Mirrors with Integrated Blinkers
This stylish rearview mirror with Integrated Blinkers is designed to allow the driver to see the area behind the vehicle through the back window.
Including Taiwan free-maintenance Battery, Free Tools Kit and Free Owner's Manual Handbook.


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Sign into our member site to view your information online.Forget your username or password? Not registered? Register here
exenatide (generic name)
Byetta (brand name)
It is used to improve blood sugar control in adults with type 2 diabetes
(ex EN a tide)
Table of Contents
Top Learning Centers(Recursos en Español)
What is this medicine?EXENATIDE (ex EN a tide) is used to improve blood sugar control in adults with type 2 diabetes. This medicine may be used with other oral diabetes medicines.
What should I tell my health care provider before I take this medicine?They need to know if you have any of these conditions:
How should I use this medicine?This medicine is for injection under the skin of your upper leg, stomach area, or upper arm. You will be taught how to prepare and give this medicine. Use exactly as directed. Take your medicine at regular intervals. Do not take it more often than directed.
It is important that you put your used needles and syringes in a special sharps container. Do not put them in a trash can. If you do not have a sharps container, call your pharmacist or healthcare provider to get one.
A special MedGuide will be given to you by the pharmacist with each prescription and refill. Be sure to read this information carefully each time.Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.
What if I miss a dose?If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.
What may interact with this medicine?Do not take this medicine with any of the following medications:
This medicine may also interact with the following medications:
Many medications may cause changes in blood sugar, these include:
Some medications can hide the warning symptoms of low blood sugar (hypoglycemia). You may need to monitor your blood sugar more closely if you are taking one of these medications. These include:


text: Lightweight, soft and breathable solid pashmina wrap, perfect for Spring and Summer. Take this beautiful must-have shawl to the beach and throw it on during a chilly night. Also wear it as a scarf and look fabulous day-to-night. This soft viscose purple summer pashmina scarf will add instant color and style to your look, trasnforming your outfits from drab to fab in an instant. It makes for a great gift for any woman looking for a soft feminine summer scarf. 70" x 22" with fringe. Viscose. Hand wash cold or dry clean.


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Light facial toner spray hydrates and refreshes. Help condition the skin and prepare for proper moisture absorption when you spritz over skin after cleansing, and before applying your prescribed Dermalogica Moisturizer.Learn More
Light facial toner spray hydrates and refreshes.Learn More
After performing the Dermalogica Double Cleanse, spray directly over the entire face and throat with eyes closed. Follow with prescribed Dermalogica Moisturizer.
Use in flight to keep skin hydrated.
Water/Aqua/Eau, Butylene Glycol, Aloe Barbadensis Leaf Juice, Lavandula Angustifolia (Lavender) Extract, Melissa Officinalis Leaf Extract, Sodium Lactate, Sodium PCA, Sorbitol, Proline, Propylene Glycol, Malva Sylvestris (Mallow) Flower/Leaf/Stem Extract, Hedera Helix (Ivy) Leaf/Stem Extract, Cucumis, Sativus (Cucumber) Fruit Extract, Sambucus Nigra Flower Extract, Arnica Montana Flower Extract, Parietaria Officinalis Extract, Ricinoleth-40, Polysorbate 20, Methyl Gluceth-20, PEG-12 Dimethicone, Dipotassium Glycyrrhizate, Linalool, Polyquaternium-4, Disodium EDTA, Sodium Citrate, 1,2-Hexanediol, Caprylyl Glycol, Phenoxyethanol, Ethylhexylglycerin, Lavandula Angustifolia (Lavender) Oil.
Dermalogica is dedicated to maintaining the accuracy of the ingredient lists on this website. However, because ingredients are subject to change, we cannot guarantee that these lists are complete, up-to-date and/or error-free. For an accurate listing of ingredients in each product, please refer to your product packaging.
Start with Dermalogica's skin health essentials, designed to deliver your best skin daily.
Redefine your skin's health with real products, real innovation, and real results! Dermalogica products for skin health are still amongst the most loved and most awarded products amongst skin care professionals and beauty editors worldwide.
All Dermalogica products are made in the USA and are free of artificial fragrances, artificial colors, drying S.D. alcohol, and ingredients like Mineral Oil – all of which are known to exacerbate common skin concerns. With cutting-edge formulas and powerful ingredients, you can be assured you're giving your skin what it needs to be healthy, and stay healthy, for a lifetime. Maximize your product results! Use Dermalogica products as prescribed by your Face Mapping® skin analysis, available only from a Dermalogica Professional Skin Therapist.
REVIEW SNAPSHOT®by PowerReviews
Best Uses
Reviewed by 263 customers
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Comments about multi-active toner:
I love that this toner is so lightweight. Never makes my skin feel greasy!
Comments about multi-active toner:
I love spraying this toner on my face before I use my Dermalogica intensive moisture balance facial cream. It helps reduce the amount of product you need to use on your face. It also feels wonderful with just a few squirts.
Comments about multi-active toner:
This is one of my Dermalogica products favorite. After finishing my travel size of multi-active toner I bought this full size...it feels so refreshing and after I clean my face, use this toner and my moisturizer...I am ready to go...with a great feeling my face is clean and fresh looking.
Comments about multi-active toner:
Expensive toner to not have it work correctly. The spray pump gets stuck and I have to stop and lift it back up in order to get another spray. Kind of frustrating. The product itself is amazing.
Comments about multi-active toner:
I spray this on day and night. Feels so good.I am in the sun a lot and my face tends to be dry.and this spray nourishes and my face drinks it up like a sponge
Comments about multi-active toner:
I simply enjoy using this product after evening face cleaning. The formula is very pleasant. I tried similar spray products from other companies (Clinique, Kiehls) and this one is the best.
Comments about multi-active toner:
I use this toner day and night and absolutely love it!
Comments about multi-active toner:
This toner is not only good for hydration under my moisturiser, but I also spray it on top of my make up as a final setting spray. It's dual action!
Comments about multi-active toner:
I received this in my aesthetics kit. & let me say this was one of my favorite products of anything I've ever tried. Don't look at the price and think it's too much because it really pays for itself vs all the others products you'd blow money on to attempt to achieve what this one gives. It also is a large bottle so it lasts so long. Which is nice because i save by not having to buy as often
Comments about multi-active toner:
I bought a small size version of this toner and it was amazing. It has a great smell and also feels great on the skin right after cleansing. Makes it easier to put serums or moisturizers right after to the damped skin. But the pump is a pain in the a. I actually want to re purchase it again, and was planing to buy the big size this time, but the pump is horrible. That is the only reason I think I'm not going to continue buying this product :( because the pump just simply doesn't worth the price. Still the product itself is pretty nice tho.
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Do you have questions about this product?
Get answers from Dermalogica Skin Therapists and our community.
Q:should I apply this before or after my serum?
1 answer
Q:I normally use the clearing mattifier before the active moist,when should I apply the multi-active toner?
1 answer
Q:What is the usual due date/best before date for this product? In other words, for how long can I use one bottle?
1 answer
Q:I use this regularly but now I'm concerned because I've read that lavender can damage skin cells, and it's listed as the third ingredient.
1 answer
Q:Stinging: Is It normal for the multi active toner to sting my face when I use it?
3 answers
A:It's the lavender. Lavender is an essential oil and essential oils don't belong on the skin. They say they put 30 years of research in their products, but the numerous studies and publications about lavender oil seem to be lost on them. While it's anti-bacterial, it's also a known irritant. I can't use the toner for a very long time. It takes a few days until my skin tsarts to burn.


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Host a Mexican Fiesta!
Take time out of your schedule to enjoy friends and family. Turn dinner into a fun Mexican fiesta! We simple layered orange burlap over a basic red tablecloth for our table covering. Then we found fun sombrero shaped melamine plates and cactus shaped margarita glasses! Along with cupcakes topped with Mexican Flag picks, we served up delicious Mexican Pie! Enjoy the recipe below!
Delicious cookies shaped like peppers were made by Bee's Knees Creative! They were a simple yet super cute dessert to pair with the cupcakes! The cupcakes were set inside a large sombrero fitted on a tall glass candlestick. It's a super easy centerpiece idea!
Make a Fiesta Basket:
How quick and easy it is to turn an ordinary plastic plant liner into an extraordinary centerpiece! All you need is a plastic plant liner, hay, and Elmer's glue. Hay baskets make lively centerpieces and unusual serving containers.
Here's What You Need:
Plastic plant liner, deep dish style
Hay (An inexpensive way to buy a small amount of hay is to purchase a hay wreath and take it apart.)
Elmer's glue and scissors
Wired ribbon for the handle, 3-inches wide and 20 to 24-inches long
Silk sunflowers or daisies and ribbon for bow
Here's What To Do:
1. Cut the hay, with scissors, into shorter pieces.
2. Cover the plastic plant liner generously with Elmer's glue. Spread a trash bag over your work area before beginning this messy project.
3. Sprinkle the hay all over the glue-saturated liner and let dry overnight.
4. Spread more glue on the hay covered liner and add more hay. Let it dry again overnight to enable the hay to build up on the container.
5. Cut the ribbon for the handle and hot glue it to the basket. Glue the sunflowers along the handle and add the bow as the final touch.
1 pound ground beef
¼ pound ground pork
1 garlic minced
1 onion chopped
1 16-ounce can whole kernel corn, drained
1 10-ounce can of diced tomatoes & green chilies, drained
1 teaspoon salt
2 teaspoons chili powder
2 eggs beaten
1 cup yellow cornmeal
1 cup milk
1 cup sharp cheddar cheese, grated
Sauté the beef, pork, garlic and onion until tender in a large sauce pan. Stir in the corn, tomatoes, salt, and chili powder. Bring to a boil and then pour into a large casserole dish. In a separate bowl, combine the eggs, cornmeal, and milk. Mix well and spoon over the meat mixture. Sprinkle the cheese on top and bake at 350 for 45 minutes. Ole!
Yields: 8 servings
Design + Concept: Phronsie Dial
Photography: Courtney Dial
Cookies: Bee's Knees Creative


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South Carolina group rallying for gay marriage
COLUMBIA, S.C. (AP) -- Supporters of gay marriage are holding a rally in Columbia as the U.S. Supreme Court takes up the issue.
SC Equality's rally is scheduled for Tuesday afternoon on the Statehouse steps in Columbia. Similar events took place Monday in Greenville and Charleston.
The U.S. Supreme Court this week is hearing two cases on gay marriage. On Tuesday, the court hears a challenge to California's voter-approved ban on same-sex marriage.
On Wednesday, justices, hear arguments concerning the Clinton-era Defense of Marriage Act. The federal law defines marriage as the union of a man and a woman and therefore keeps legally married gay Americans from collecting a range of federal benefits that generally are available to married people.


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And Batman vs. Joker Throwdown Game...
Joining Funko's blind boxed Mystery Minis series comes this 24 figure set of Horror Movie characters. Each figure in the Horror Movie Mystery Minis collection stands 2.5" tall and includes such classic scream greats as Freddy Krueger, Json Voorhees, and Hannibal Lector. Look for these in stores August 15th.
In DC Comic news, Funko announces the Batman vs. Joker Throwdown Game, in stores now.
Here is a breakdown of Throwdown:
~ Board and Pieces come in 12" Vinyl Figural Packaging
~ Each Game comes with two 2.5" Collectible Vinyl Figure Game Pieces (Batman & Joker)
~ Beat your opponent by using Combat Cards, Battle Cards, Boost Coins and Battle Dice
~ Easy to Play
Watch for booster packs to collect more Combat Cards and Collectible Game Piece Characters.
To insure your action figure collection, get in touch with Collectibles Insurance, the official insurance company of the Figures.com network. Say "Figures.com" to get 5% off your first term premiums.
To buy action figures, take a look at BigBadToyStore.com, AlterEgoComics.com, Toynk.com, BriansToys.com, ToyWiz.com, and MonkeyDepot.com.


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Martin Scorsese saw his first stereoscopic film in 1953—Andre de Toth's House of Wax. One year later, he saw Hitchcock's Dial M For Murder. The 3D in that film, which enhanced the narrative, left a lasting impression on the filmmaker. So it was natural that Scorsese would use 3D to that effect in Hugo.
In one scene, in which the Station Inspector (Sacha Baron Cohen) is interrogating Hugo (Asa Butterfield), a wide interocular setting makes him seem more menacing and intimidating. Likewise, 3D creates a feeling of vertigo during a chase sequence up a staircase in the walls of the station.
"There's something about Scorsese using the latest 3D technology to push the boundaries of filmmaking in 2011 to make a film about the very first technology ever used to put magic on the screen over a hundred years ago," Emily Mortimer, who played flower shop owner Lisette, said. Baron Cohen agreed. "It felt like it was the logical extension of filmmaking—that if Méliès was alive, he would have definitely been using 3D," he said. "That was the interesting thing—the whole debate in cinema about whether 3D is a gimmick or not. Scorsese really showed that it was a logical development of the filmmaking process, and that was fascinating."
Though Hugo takes place in Paris, filming was mostly done in England's Shepperton Studios. Scorsese brought on researcher Marianne Bower, who looked at historical photographs, films, and documents to lend authenticity to the sets, which were constructed to scale in the studio.
At 150 feet long, 120 feet wide and 41 feet high, the train station set filled an entire soundstage—Sir Ben Kingsley, who played Méliès, admitted to walking around the set between takes and admiring the detail. Even the station's clocks that Hugo (Asa Butterfield) repaired were actually built. "They would bring the clocks down from the ceiling and we would go inside of them," Butterfield says. "In the hanging clock tower, there was this big spinning thing, and a lot of the time I would stand up and it would smack me in the head. And the work on the clocks was incredible—you could actually wind them, and they had weights on."
The experience was overwhelming for Brian Setzer, who wrote the novel the film is based on. "When I visited the set for the first time, I was taken from the entrance to the graveyard—where posters were peeling off the wall and vines were dying up it—through the entire graveyard, where there were all these beautiful, hand-sculpted graves," he says. "As you exited the graveyard, you came to a full-size cobblestone street and the full block of buildings was there: A fully stocked wine shop on one end where you probably could have gotten drunk, and on the other end a building that had been bombed during World War I that was being held up by some timber. You walked inside the building, down an actual Parisian apartment building hallway—which I was told was designed after the staircase in The 400 Blows—and then up into a full-scale apartment. I had the great thrill of being put into the last scene of the movie. We spent a lot of the day filming the last tracking shot in the kitchen, waiting for the action to do the 3-minute tracking shot again. The camera never goes into the kitchen, but we would open the cabinet doors and it was fully stocked, and we were talking about what we could cook. And inside the wall, which the camera could certainly never see, were period light switches."
The 13 Scariest Monsters in Movie History


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Public School Employees' Insurance Benefits—ESSB 5940
ESSB 5940 RSS Feed
The Public School Employees' Insurance Benefits Bill, ESSB 5940, requires several changes to K–12 public school employee health benefits. These changes are effective July 11, 2012. OSPI will be the lead for communication and coordination of information regarding the new law and its requirements.
Frequently Asked Questions | OSPI Presentation (May 16, 2012) | Video Conference Events
Here are some of the changes districts can expect from ESSB 5940:
School district and health plan providers
The Office of Insurance Commissioner
Office of the Insurance Commission Data Reporting
Under ESSB 5940, the Office of the Insurance Commissioner (OIC) is required to report on health benefits provided to school district employees, on a district-by-district basis; information regarding health benefit plan provisions, premiums, claims costs, and administrative costs will be provided by insurance carriers.
The first such report will be submitted to the state legislature in December 2013 and subsequent reports will be submitted yearly thereafter.
Treinen Associates Inc. (TAI) has been commissioned by the OIC to collect School District Health Benefit Data as specified in ESSB 5940 and to report on the collected data to the legislature in December 2013.
OIC's K-12 Health Benefit Data Collection Web site
provides additional information for school districts and insurance carriers.
K-12 Health Benefits Data Collection Project - sponsored by the Washington State Office of the Insurance Commissioner (OIC)
For further information, please
visit the OIC web site about this project.
To contact the project team that is executing the OIC K-12 Health Benefits Data Collection Project, please send an e-mail to
ESSB 5940 Frequently Asked Questions
Update: December 4, 2012 (updates for this week are indicated in red below)
Section 2
Section 3
Sections 4 and 5
Related links
ESSB 5940 as Passed Legislature (PDF)
ESSB 5940 Bill Report
John Bowden
Updated 9/20/2017
Old Capitol Building, PO Box 47200, 600 Washington St. S.E., Olympia, WA 98504-7200 360-725-6000 TTY 360-664-3631
Contact Us | A-Z Index | Site Info | Staff Only | Education Data System (EDS)


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Mike Lerner and Maxim Pozdorovkin come from different trajectories.Lerner is an Academy Award-nominated producer who has been a documentary filmmaker for 25 years. His previous work includes "Afghan Star," which won the World Cinema Documentary Audience Award at the 2009 Sundance Film Festival. His "Hell and Back Again" won the documentary Jury Prize at the 2011 Festival.Pozdorovkin is a Russian native and is making his Sundance Film Festival directing debut. But the duo co-directed and co-produced "Pussy RiotA Punk Prayer," a film screening in the World Cinema Documentary competition in the Sundance Film Festival.The story is ripped from the headlines in a tale that captured the attention of all of Russia and to a lesser extent the rest of the world. On February 21, 2012, the punk group staged a performance in Moscow's Cathedral of Christ the Savior and sang "Mother Mary, Banish Putin!" before they were stopped by church security officials. The women said their protest was directed at the Orthodox Church's support for Vladimir Putin.Three members of Pussy Riot were convicted of hooliganism, and each was sentenced to two years imprisonment.The two filmmakers, like many around the world, were shocked by the severe sentences."I had heard about Pussy Riot before the Cathedral performance and was awe-struck by the bravado of their previous performances," said Pozdorovkin. "When I heard that they performed in the country's main cathedral, considered to be a holy site by believers, I knew that a major reaction would be forthcoming. That being said, I could not foresee that their 'Punk Prayer' would ... lead to a jail sentence for the group's members.""I first heard about the Pussy Riot action ... and I thought, 'Wow, who the hell are these people and what do they want?' Lerner said. "Then I learned of the Cathedral action and their subsequent arrest and I knew that this was going to be one of the most powerful and important stories of the decade."Pozdorovkin was attracted to the story because he felt a personal connection to the young women in Pussy Riot. "One of the first things that drew me to the story of Pussy Riot was the sense of a shared past with the characters," he said. "We had lived through similar times, listened to the same loud records, read the same poets and philosophers. I have found myself at family dinner tables arguing that Russian society could benefit from a feminist upheaval. The parents of the three members of Pussy Riot recalled having similar arguments with their daughters."The older Lerner was motivated to tell Pussy Riot's story through one of the most powerful weapons he knew: film. "Today we are so bombarded by news and snippets of information, I think a documentary is the only way to really understand the human realities behind massively important and complex events such as the situation with Russian democracy right now," he said. "What attracts me to stories [in my films]is how these important stories about global politics can be told in an intimate, human and perhaps even entertaining way. " Pozdorovkin added, "It is a universal story of a younger generation making itself heard by any means necessary."Despite different filmmaking experiences, Lerner and Pozdorovkin were friends and decided to make the film together based on what they could each bring to the tale. "This seemed like the perfect story on which to collaborate, " Pozdorovkin said. "When I first met Mike, we got along immediately having similar taste in film, music, and politics. It's hard to imagine a better foundation for a partnership." Lerner said, "The working process with Mr. Pozdorovkin evolved very organically. Obviously, as a native Russian, he has a highly evolved sense of the complexities of the situation and I as an outsider [who] tends to see the more universal aspects – and a combination of both of these positions I think gives a very balanced and accessible telling of what is a highly idiosyncratic tale."After gaining extraordinary access to the members of Pussy Riot and their families and friends, the story became clear, and Pozdorovkin argued that the narrative has relevance to American society in 2013. "The film offers a multi-faceted view of Russia today,"he said. "As was the case with the Occupy movement in the US, it shows the Russian government siding with the conservative elements of society ."Lerner too saw the parallels between Russia and his homeland. "Nadia, Masha and Katia are three of the most remarkable women I have ever encountered," he said. "I am convinced that they will play an important role in the development of democracy and freedom of expression in their country. Their influence on the film is to confirm how important their story is, not only for Russia but for the rest of the world, struggling as it is, with the problems of freedom, gender equality and justice." But, in a way, the film documents a strain that is distinctly Russian. "The members of Pussy Riot are intellectuals who see themselves as continuing a Russian artistic and cultural lineage," Pozdorovkin said. "Familiarity with this heritage no doubt enriches one's experience of the story."
"Pussy Riot A Punk Prayer"World Cinema DocumentaryScreenings:Friday, Jan. 18. 8:30 p.m. • Prospector Square Theatre, 2175 Sidewinder Dr., Park CitySaturday, Jan. 19, 6:45 p.m. • Broadway Centre Cinema 3, 111 E. Broadway (300 South), Salt Lake CitySunday, Jan. 20, 1 p.m. • Redstone Cinema 2, 6030 North Market St., Park CityWednesday, Jan. 23, 9 a.m. • Temple Theatre, Located on Highway 224, Park CityThursday, Jan. 24, 6 p.m. • Egyptian Theatre, 328 Main St., Park City
David Burger


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Inspections, Compliance, Enforcement, and Criminal Investigations
Impact Instrumentation, Inc. - Close Out Letter 01/09/2013
Department of Health and Human Services
|Public Health Service
Food and Drug Administration
|Central Region
Waterview Corporate Center
10 Waterview Blvd., 3rd Floor
Parsippany, NJ 07054
Telephone (973) 331-4902
January 9, 2013
VIA United Parcel Service
Leslie H. Sherman
Impact Instrumentation, Inc.
27 Fairfield Place
West Caldwell, NJ 07006
Dear Mr. Sherman:
The Food and Drug Administration has completed an evaluation of your firm's corrective actions in response to our Warning Letter Number 10-NWJ-18, dated September 30, 2010. Based on our evaluation, it appears that you have addressed the violation(s) contained in this Warning Letter. Future FDA inspections and regulatory activities will further assess the adequacy and sustainability of these corrections.
This letter does not relieve you or your firm from the responsibility of taking all necessary steps to assure sustained compliance with the Federal Food, Drug, and Cosmetic Act and its implementing regulations or with other relevant legal authority. The Agency expects you and your firm to maintain compliance and will continue to monitor your state of compliance. This letter will not preclude any future regulatory action should violations be observed during a subsequent inspection or through other means.
CAPT Joseph F. McGinnis
Director, Compliance Branch
New Jersey District


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Peacock can't escape sixth in loss to Mariners
Allows four runs after going five scoreless; Hernandez hits first homer
HOUSTON -- Brad Peacock held onto a cutting fastball for too long, and suddenly, whatever he had going for him left in a hurry.
For five innings, Peacock worked the Mariners, pitching on both sides of the plate, mixing in offspeed pitches, throwing his slider. He kept the scoreless Mariners off-balance, giving up just three hits entering the sixth.
And then he threw that cutter.
It hit Robinson Cano and put runners on first and second. He wouldn't record another out in the Astros' 5-2 loss, as the Mariners completed a sweep against Houston on Wednesday at Minute Maid Park.
"The best thing we've got going is that the Seattle Mariners are leaving town," manager Bo Porter said. "We won't have to play them tomorrow."
Peacock gave up one hit in each of the first and second innings, before working quickly in the next three. He walked one batter in those first five innings and struck out five. For Peacock, it was as good as a start will get, especially against a Mariners team that scored 23 runs in the series' first two games.
"You're talking about five innings of complete control," Porter said. "Making quality pitches, shutting them out for five innings."
Then Peacock gave up his third hit, to James Jones in the sixth, and his quality start evaporated. He hit Cano with the cutter and walked Kyle Seager to load the bases with one out before throwing a wild pitch that allowed the Mariners to score their first run. Logan Morrison then doubled to score two more, giving the Mariners a 3-2 lead.
After giving up an RBI single to John Buck that made it 4-2, Peacock was pulled for Anthony Bass, who made his first Major League appearance since going to the disabled list on May 11.
"I don't really know what happened there in the sixth, I just kind of lost it," Peacock said. "Don't really know why or how."
Peacock said he's lost his command in a couple of games this season, but never this drastically.
Bass went on to give up one run in 1 2/3 innings of his first game back, and the Mariners' 5-2 lead after that was plenty. Houston was held to two hits in its first seven innings by Mariners starter Chris Young, who earned his eighth victory.
The first hit was a third-inning home run to right field by Marwin Gonzalez. The second came from Enrique Hernandez, who hit his first career homer into the Crawford Boxes in left in his second Major League game and his first start. Hernandez's homer followed up his 2-for-2 performance in his first big league game on Tuesday. Hernandez was starting at designated hitter in place of Chris Carter, and finished by going 1-for-3.
Porter said he's not sure where, but Hernandez will play in Thursday's game against the Angels.
"He's swinging a good bat and that's why he was in the lineup today, and he'll be in the lineup tomorrow," Porter said.
The Astros will take the offensive production wherever they can get it, as the team has struggled to score runs in a stretch where they've lost five of their last six series. They hadn't been swept in a series of three or more games since losing to Oakland, April 18-20. They did lose both games of a two-game series at Washington in mid-June.
Mike Vernon is an associate reporter for MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.


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Bronson Arroyo can't just get away with "throwing" he has to "pitch". Chapman can just "throw" for the time being, provide value, and learn how to pitch later.
The main adjustment he needs to make to convert to a starter is endurance. And from what I hear he trains hard and is a freakish athlete.


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Event: Nandita Das was snapped with husband Subodh Maskara at the opening of the play 'Between The Lines'. Nandita has directed the play.
Guest List: Nandita Das, Subodh Maskara
Bollywood celebs Yami Gautam and Bhumi Pednekar sizzled the ramp at IIJW Day 2.
Bollywood celebs Nawazuddin Siddiqui, Divya Dutta, Sudhir Mishra, Javed Akhtar, Shabana Azmi, Swara Bhaskar among others were snapped at Jagran Film Festival Award Ceremony.
Bollywood actor Aamir Khan celebrated Navratri festival in Vadodra.
Bollywood actress Sridevi's daughter Jahnavi Kapoor was spotted outside dance class.
Bollywood celebs Sidharth Malhotra, Arbaaz Khan and Ileana D'Cruz were spotted at Bandra.


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Ex-BC DB Al Louis-Jean works out for reps from Bears, Pats
Published: April 4th, 2014 | Tags: Al Louis-Jean, Boston College, Chicago Bears, New England Patriots
Boston College cornerback Al Louis-Jean worked out Thursday in front of representatives from two NFL teams — the Chicago Bears and New England Patriots — at Brockton (Mass.) High School. The workout took place outdoors and run on FieldTurf, and there were 10-15 mile-per-hour wind gusts.
Louis-Jean (6-foot-1 3/8, 187 pounds) ran the 40-yard dash in 4.68 seconds against the wind and 4.53 seconds with the wind. He had a 32 1/2-inch vertical jump and a 10-foot-5 broad jump. He ran the short shuttle in 4.41 seconds and the three-cone drill in 7.03 seconds. Louis-Jean, who has 32 3/4-inch arms, did eight reps of 225 pounds on the bench press. Louis-Jean is a free-agent pickup possibility following the conclusion of the 2014 NFL Draft.


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BARDSTOWN - A tough setback in the middle of three games just before Christmas for the North Bullitt Eagles made it a long tournament for the green and gold in the Bearno's Holiday Classic at Bethlehem High School.
The Eagles, who have won just once this season in seven games, opened against the host team and playing without Travis Ridley the green and gold got off to a horrible start and never got back in the game as they lost 64-48.
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Cutting Edge Custom Motorcycles and Products. TV Appearances, Getting into trouble…
Bagger Nation.com / Paul Yaffe originals.com / @Bagger Nation / http://www.facebook.com/pages/Paul-Yaffes-Bagger-Nation/60311872127
SuperTrapp Racing, Parts Unlimited, Global Motorsports, Dirty Tequila, Jakk'd Beverage, Full Throttle Saloon, Rockford Fosgate, Hideaway Grill, Unbareable Clothing, Paisano Publicatons, Easyrider Magazine, Maverick Publishing, American Bagger Magazine
Mattel making Hot wheels of my bikes. Nascar Bikes, How do I pick just one?
Funk, Classic Rock, Love to dance to Country w my wife Suzy
Bagger Nation Road Glide, 65 Coupe DeVille layed out w 22's, MB SL 500
The clarity and the fact that I can't hurt it no matter how hard I crank her up! Love that bass response!
You can learn more about him and follow his career here:
6.5" 2-Way Component System
Marine Hide Away Black Box AM/FM Stereo
Black/Chrome Waterproof Wired Controller
Punch 300 Watt BRT Full-Range 4-Channel Amplifier
Power 6"x9" 3-Way Full-Range Speaker
Punch 300 Watt BRT Mono Amplifier
Prime 10" R2 2-Ohm DVC Shallow Subwoofer


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Apartments In Albuquerque, New Mexico
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The Arbors Apartment Community
4501 Shepard Rd NE, Albuquerque, NM, 87110
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Silver SW Pacheco Lofts in Santa Fe, Albuquerque, NM, 87102
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1311 Louisiana Blvd. NE, Albuquerque, NM, 87110
304 Whispering Sands Ct. SE
304 Whispering Sands Ct. SE, Albuquerque, NM, 87123
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Bentonville, Ark., Wal-Mart Stores today maintained its September sales forecast and said 18 of its locations remained closed in areas hit by Hurricane Katrina. On a recorded message, the retailer said it still expects a 2% to 4% increase in same-store September sales, although it reiterated that the forecast is subject to the impact of Katrina and rising oil prices.
Of the 18 shuttered Wal-Mart locations, 15 are in Louisiana. The chain, which had closed as many as 126 stores in the path of Hurricane Katrina, said that 89 facilities have reported damage. It said nine have major damage, 41 moderate damage and 39 minor damage or merchandise lost.
Wal-Mart said it has made contact with more than 65% of its 34,000 workers who were affected by the storm. The discounter said it would relocate employees from closed stores who wish to work to other locations.
"Wal-Mart is committed to providing work for displaced associates who want to work in open stores," the company said in a release.
Wal-Mart, which so far has contributed $17 million to relief efforts, is using its vast information systems and in-store technology to help employees and the general public access information and relief services in the aftermath of the hurricane. The chain has activated an on-line Emergency Contact Registry whereby customers and its associates can e-mail, post and search for messages regarding family and loved ones using the hiring-center kiosks, connection-center kiosks and gift-registry kiosks in any Wal-Mart location.


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Throughout the retail industry and beyond, Walmart has earned a reputation as a leader in executing sustainable improvements that deliver positive results for consumers, communities and the company's bottom line. Andrea Thomas, who joined Walmart in 2007, was appointed the company's first senior VP sustainability in August 2010. Thomas talked with Chain Store Age contributing editor Connie Gentry about what sustainability means at Walmart and how the company leverages its scale to make the biggest possible impact for global good.
Sustainability leadership is an emerging position in many retail organizations. Will you please explain your role at Walmart?
The sustainability role at Walmart is interesting because it is a rotating responsibility. Walmart taps someone from another business area to lead sustainability, with the intention that after two or three years that person will move elsewhere in the company and another Walmart executive will assume the sustainability role. Although it's not a career destination, it's a very interesting job. There is interaction internally across virtually all departments, and an equal amount of interaction externally with communities, government agencies, NGOs [non-governmental organizations, typically associated with the United Nations] and other entities. Getting to know all the people who are coming together to work on sustainability is fascinating. Next month it will be two years since I began this rotation, and I expect to spend at least one to two more years in this role because there is a lot of work that still needs to happen.
Tell us about your background and how it helped to lead sustainability.
Before joining Walmart, I spent 13 years at Pepsico and a couple of years at Hershey. So I dealt with Walmart and other retailers from the manufacturing side. In my early years at Pepsico, I worked in the restaurant division; and while that's not retail per se, it involved working with many store locations and it had a lot of the same flavor to it as a retail organization.
Initially I came to Walmart to work with private brands, food and consumables, then I moved into sourcing general merchandise. For sustainability, it is very helpful to have an understanding of store operations, logistics and our supply chain. About 90% of our carbon footprint comes through our supply chain.
I've spent most of my career working with innovations on the CPG side, balancing new products and understanding all the pieces of the supply chain. With all the products in our stores, it's very important to understand where products come from and identify opportunities to do things more efficiently and more environmentally pointed.
How is sustainability integrated into the Walmart culture?
Walmart is all about lowering costs so we can lower prices, attract additional traffic and build customer loyalty. When you think about the principals of sustainability, the emphasis is on doing more with less, being more efficient, and using fewer natural resources. For a retailer, this is particularly true as you think about how to develop stores and supply chains. In those respects, sustainability is very supportive of the Walmart productivity loop. From the very beginning, our priority was to help every department and associate understand the principals of sustainability, how sustainability supports the company's productivity loop, and that sustainability needs to be embraced throughout the organization.
In addition to my team of 14 people, there are others who don't report directly to me but, within their department, their job is to support our sustainability efforts. We also created Sustainable Value Networks throughout the company so people working in various jobs have the opportunity to think about how we should address sustainable opportunities within the business.
What are some of the things your sustainability team is responsible for?
The team supports and liaises with the external resources and expertise that reside outside the company, including the NGOs, and with internal associates who focus on sustainability. We develop scorecards, lead discussions that need to take place to address sustainability issues, and conduct milestone meetings to communicate what Walmart is doing.
How do you define sustainability at Walmart?
Before we talk about sustainability, you have to step back and look at our company mission: Saving people money so they can live better. Sustainability is one aspect of how to live better, but it's not the only part. In my role, I also work on Walmart's healthy foods initiative and I partner closely with our Walmart Foundation to promote women's economic empowerment and community programs around hunger. These initiatives all come together to help achieve the "living better" goal and Walmart certainly has a broader definition of sustainability than a lot of companies; but frankly we don't get caught up in the semantics.
Under the sustainability umbrella, we look at anything to do with the environment, communities, and economic sustainability that will help us continue to serve our customers well into the future. We maintain a broad definition because it is more about how we can make a broad impact than how we fit into a very specific definition.
Across such a broad spectrum, how do you prioritize where to focus sustainability efforts?
Our visionary goals were set in the 21st Century Leadership speech that Lee Scott, then CEO, gave in October 2005, and include three main aspirational goals around waste, energy and products. One is to be supplied by100% renewable energy, to create zero waste, and the third is to have products that sustain people and the environment. Those are big, broad and far-reaching, but it's easy to categorize what fits under each goal and identify ways that the business touches each aspect. For instance, waste falls under operations and transportation supports product getting to the stores which is a big energy piece.
On the product side we have projects around sustainable agriculture and the Sustainability Index. We've set goals around agriculture because it touches so many areas of our business. Food, obviously, but also the cotton used in apparel and home products or wood that goes into furnishings and hardlines. The Sustainability Index helps us understand the supply chain and recognize areas we need to start working on and thinking about. Some goals are to educate us, so we can experiment and learn ways to be more energy efficient in our stores.
Other goals are broad and have a lot of scale, such as creating zero waste which is one area where we have already made excellent progress. In our U.S. operations, we have diverted 80% of waste away from landfills. Some of our goals are global or may focus on a particular region. For example, within sustainable agriculture we have specific goals about product sourced from Brazil and we also have a global goal for using sustainable palm oil in our private brands. We can't do everything everywhere, so we try to focus on the things that are uniquely connected either to our business or where we do business.
What did you do to achieve diverting 80% of the company's waste out of landfills?
First we encouraged our people to focus on waste reduction and understand its importance. In the past, each store paid to have its waste hauled to the landfill. We highlighted the fact that there is value to the waste and we helped our store teams develop recycling programs with their communities and identify other places for that waste to go – so waste disposal changed from being an expense to a profit center in the stores. And most of our stores now have what we call a Super Sandwich Baler, which stacks and crushes the recyclable waste so it can be easily picked up and transported.
We also started using recycled material across our supply chain and we convinced vendors to use recycled materials as well. We always look for ways to connect the waste stream to actual products that we sell or use within our operations, and we have several closed-loop examples. For instance, we send the cardboard cases that market-size pizza comes in to the company that makes our pizza boxes so it can be recycled into another use.
In another example, we're focusing on ways to avoid wasting perishable items. The Walmart Foundation donated refrigerated trucks that now deliver fresh items that are still edible but can't be sold to organizations that feed the hungry.
What about the remaining 20% of waste that isn't being recycled or reused?
A portion of that remaining 20% is there because some stores are in communities that don't have as many abilities to recycle. And then there is the waste that customers bring into the store. We are still trying to determine whether we should sort that waste or not. It just doesn't make sense at this point to send associates into the restrooms to separate waste in trash cans. But it does make sense for us to have associates in the produce section who can sort the damaged produce that we won't sell and send it to animal feed. That's proved to be a good idea and we're doing.
Walmart also promotes renewable energy usage, including your 100th solar installation in the U.S., as well as installations in Canada and China. What is the outlook for renewable energy?
Solar and wind are two sources of renewable energy that can provide micro-sources of energy. They are easily implemented on either a large scale or a small scale. We have wind farms in Mexico that are running 350 stores and then we have single stores with windmills in the parking lot that generate energy for that one location. The same applies to solar – our stores have big rooftops that allow us to easily install solar panels. Solar technology changes all the time and we're starting to see solutions that provide benefit in a concentrated space, so we are exploring how to expand the "small" solar and we're experimenting with renewable energy sources, like fuel cells.
However, renewable energy has to reach a point that it doesn't cost more than non-renewable energy. The scale that Walmart brings, and our ability to partner with others to find funding, lets us play a role to help bring renewable energy to the place that it is cost neutral.
Are there sustainability initiatives that create cost but are still worth doing?
Maybe – we have to look at the longer term benefit and at our ability to commercialize it. We will absolutely invest in learning; but if it's too difficult to scale a sustainable project or if the capital investment doesn't pay off for us, then we probably won't continue with it.
Of all the sustainable milestones Walmart has achieved, what do you think is most notable?
That's a hard one. Sustainability is not about one single accomplishment. For us, the most notable aspect is the ability to get all parts of the business working on sustainability, thinking about it, and talking about it. That comes from both top-down leadership and a bottom-up passion. We have 2.2 million associates and it's really exciting that we've been able to get them involved in understanding sustainability and serving our customers in a more sustainable way. At Walmart, we have a unique opportunity to make an impact on a global scale as we learn and focus on sustainable areas.
It certainly sounds like you are leading the sustainability group with a lot of personal passion.
Absolutely! Once you understand sustainability, and the more you learn about it, you can't turn that part of your brain off. Wherever I go, I'm constantly thinking about where a product is made, all the places it touches and how things can be done better, in a way that makes sense. I see tremendous opportunity and impact from the work we are doing with the Sustainability Consortium, which is all about working together as an industry. By making some small changes as an industry, but doing it with the kind of scale that a large retailer can bring, it's amazing to think what can happen.
In places like Africa, I've seen the impact we have on families and communities when we buy things from small, local farmers. Ultimately, it's about our role as a citizen in the communities where we trade, and that's the most powerful aspect of sustainability.
To learn more about sustainability at Walmart, check out the company's blog: Walmartgreenroom.com.
Green Speak From Wal-Mart
Throughout the retail industry and beyond, Walmart has earned a reputation as a leader in executing sustainable improvements that deliver positive results for consumers, communities and the company's bottom line. Andrea Thomas, who joined Walmart in 2007, was appointed the company's first senior VP sustainability in August 2010. Thomas talked with Chain Store Age contributing editor Connie Gentry about what sustainability means at Walmart and how the company leverages its scale to make the biggest possible impact for global good.


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Taking into account that times change and whatnot. Who is the best?
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Taking into account that times change and whatnot. Who is the best?
How could you leave off Darnell Hillman?
Of that group I voted for Wilkins but I would have given serious consideration to Hillman or Dawkins
Sorry bout that. I added an Other vote just for that reason now.
Hillman was really before my time but I should've thought of Dawkins.
I guess I was thinking in terms of contest more than anything. Ah well, that'll teach me
Definently Wilkins. Everytime him and Jordan clashed, he kicked Jordan's *** (yes even in 88, Dominique was robbed big time), and while Julius was VERY good at dunking, he was just a little too early and was in his older years by the times he was in the dunk contest. If he started 5-10 years later, he would've been the best ever probably.
One of the most underrated dunkers of our time (now) is Rasheed Wallace. The guy can SOAR to the air, and catches the most ridiculous alley-oops around, yes better than K-Mart. One time, a saw a game with Portland in Charlotte, and Stoudamire from about the OPPOSITE free-throw line, fired an alley-oop to Sheed, he catches it ONE HANDED and slams it down. My mouth was like .
"It's just unfortunate that we've been penalized so much this year and nothing has happened to the Pistons, the Palace or the city of Detroit," he said. "It's almost like it's always our fault. The league knows it. They should be ashamed of themselves to let the security be as lax as it is around here."
----------------- Reggie Miller
The bar gets raised each and every year.
Looking back at the dunks by MJ and Wilkins that seemed unbelievable 15 years ago, now they don't seem so great.
I think Vince carter is the best.
I would have to say Dominique and David Thompson.
The best exercise of the human heart is reaching down and picking someone else up.
Fred Jones
Don't ask Marvin Harrison what he did during the bye week. "Batman never told where the Bat Cave is," he explained.
Perhaps tbe most amazing act any human has ever done, but the dunks were not that great.Other...Spud Webb
Agreed. In that order.I would have to say Dominique and David Thompson.
Connie Hawkins.
Spud Webb put on the greatest single dunk contest performance ever, but
Dominique is the best dunker over all, IMO.
"Just look at the flowers ........ BANG"
I say spud webb..
it has timing and athletic ability ..
and being so small, makes the dunk look so good..
Is this question focused just on the "dunk contest"? Because for in-game dunking (and by that, I mean in traffic but still breathtaking) Dominique and Julius have to be #1 and #1A. Other guys only looked good in dunk contests or on unguarded breakaways, which I don't think is a big deal.
Why do the things that we treasure most, slip away in time
Till to the music we grow deaf, to God's beauty blind
Why do the things that connect us slowly pull us apart?
Till we fall away in our own darkness, a stranger to our own hearts
And life itself, rushing over me
Life itself, the wind in black elms,
Life itself in your heart and in your eyes, I can't make it without you


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Treating Thymus Cancer
Making treatment decisions
After a thymic tumor is found and tests have been done to get a sense of its likely stage, your cancer care team will discuss your treatment options with you. Factors important in choosing a treatment include the type and stage of the cancer, whether or not it is resectable (able to be completely removed with surgery), and whether you have any other serious medical problems. Because thymic cancer is rare, it has been hard to do large studies looking at treatments and comparing one against another. That's why in many cases the best way to treat this cancer is not always clear
Your health care team may include: a thoracic surgeon, radiation oncologist, medical oncologist, pulmonologist, a neurologist, as well as nurse practitioners, nurses, psychologists, social workers, rehabilitation specialists, and other health professionals.
Selecting a treatment plan is an important decision, and you should take the time to think about all of your choices. If time permits, it is often a good idea to seek a second opinion. A second opinion can provide more information and help you feel more confident about the treatment plan chosen.
The main treatments for thymus cancer are:
For information about some of the most common approaches used based on the extent of the disease, see Treatment of Thymus Cancers by Extent and Type of Tumor.


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Despite earlier refusing a request from the feds to recall 1,560,000 Jeeps in the U.S., parent company Chrysler Group LLC has said it has "resolved its differences" with the National Highway Traffic Safety Administration and will indeed recall the cars in question. The recall involves some of the 1993-1998 Jeep Grand Cherokees and 2002-2007 Jeep Libertys, due to a possible problem with the fuel tank that could result in leakage or a fire in a rear-impact crash.
The announcement of the car recall comes after an increase in signatures on a petition on Change.org demanding the recall. The petition, which received more than 127,000 signatures, was started by Jenelle Embrey, who witnessed a mother and her teenage son burn to death in their 1998 Jeep Grand Cherokee in an October 2012 crash. The NHTSA began investigating the Jeep models in 2010 as a result of a request by the Center for Auto Safety, a consumer group that monitors accident data and takes consumer complaints.
Affected cars will get a visual inspection and the addition of a Chrysler-designed tow hitch if they are not already equipped with a hitch and if the structure can support the installation. According to Chrysler, the Chrysler-designed tow hitch will help "better manage crash forces in low-speed impacts." Chrysler maintains that the cars in the recall are not defective and are among the safest cars in their segment.
Do you own one of the cars in the recall? Do you think they're safe?
Tara Baukus Mello writes the cars blog as well as the weekly Driving for Dollars column, providing both practical financial advice for consumers as well as insight into the latest developments in the automotive world. Follow her on Facebook here or on Twitter @SheDrives.


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The Humboldt County Board of Supervisors will meet Tuesday to discuss a proposed ad hoc committee for the Williamson Act Program.
The Williamson Act is intended to preserve agricultural and open space lands by discouraging conversion to urban uses.
The board directed staff earlier this year to assist in the development of the committee, which will evaluate the Williamson Act Program's overall costs and benefits, according to a staff report.
The committee was expected to include a mix of county staff, elected officials and public members, and the supervisors will review recommendations for committee members on Tuesday.
The committee is scheduled to meet on Dec. 19 for the first time.
In other business, the board will review Williamson Act land conservation contracts for three properties around the county.
The minimum term for a land conservation contract is 10 years.
Two properties are up for new enrollment in the Williamson Act. A third is an addition to a currently enrolled property.
The board is also expected to authorize the public works director to advertise and distribute a request for qualifications for architecture and engineering services for the Juvenile Hall Replacement Project.
The full agenda can be viewed online at http://co.humboldt.ca.us/board/agenda/questys.
If you go:
What: Board of Supervisors meeting.
When: 9 a.m. Tuesday.
Where: Supervisors' chamber, first floor, Humboldt County Courthouse, 825 Fifth St.


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MyChart Login
Home > Health & Wellness > Health Library > Colon Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI]
This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
Cancer of the colon is a highly treatable and often curable disease when localized to the bowel. Surgery is the primary form of treatment and results in cure in approximately 50% of the patients. Recurrence following surgery is a major problem and is often the ultimate cause of death.
Incidence and Mortality
Estimated new cases and deaths from colon cancer in the United States in 2016:[1]
Gastrointestinal stromal tumors can occur in the colon. (Refer to the PDQ summary on Gastrointestinal Stromal Tumors Treatment for more information.)
Anatomy of the lower gastrointestinal system.
Risk Factors
Groups that have a high incidence of colorectal cancer include those with hereditary conditions. Together, these groups account for 10% to 15% of colorectal cancers. These groups include the following:
More common conditions with an increased risk include the following:
These high-risk groups account for only 23% of all colorectal cancers. Limiting screening or early cancer detection to only these high-risk groups would miss the majority of colorectal cancers.[6] (Refer to the PDQ summaries on Colorectal Cancer Screening and Colorectal Cancer Prevention for more information.)
Because of the frequency of the disease, ability to identify high-risk groups, slow growth of primary lesions, better survival of patients with early-stage lesions, and relative simplicity and accuracy of screening tests, screening for colon cancer should be a part of routine care for all adults aged 50 years and older, especially for those with first-degree relatives with colorectal cancer. (Refer to the PDQ summary on Colorectal Cancer Screening for more information.)
Prognostic Factors
The prognosis of patients with colon cancer is clearly related to the following:
These three characteristics form the basis for all staging systems developed for this disease.
Other prognostic factors include the following:
Many other prognostic markers have been evaluated retrospectively for patients with colon cancer, though most, including allelic loss of chromosome 18q or thymidylate synthase expression, have not been prospectively validated.[9,10,11,12,13,14,15,16,17,18] Microsatellite instability, also associated with HNPCC, has been associated with improved survival independent of tumor stage in a population-based series of 607 patients younger than 50 years with colorectal cancer.[19] Patients with HNPCC reportedly have better prognoses in stage-stratified survival analysis than patients with sporadic colorectal cancer, but the retrospective nature of the studies and possibility of selection factors make this observation difficult to interpret.[20]
Treatment decisions depend on factors such as physician and patient preferences and the stage of the disease, rather than the age of the patient.[21,22,23]
Racial differences in overall survival (OS) after adjuvant therapy have been observed, without differences in disease-free survival, suggesting that comorbid conditions play a role in survival outcome in different patient populations.[24]
Follow-up and Survivorship
Limited data and no level 1 evidence are available to guide patients and physicians about surveillance and management of patients after surgical resection and adjuvant therapy. The American Society of Clinical Oncology and the National Comprehensive Cancer Network recommend specific surveillance and follow-up strategies.[25,26]
Following treatment of colon cancer, periodic evaluations may lead to the earlier identification and management of recurrent disease.[27,28,29,30] The impact of such monitoring on overall mortality of patients with recurrent colon cancer, however, is limited by the relatively small proportion of patients in whom localized, potentially curable metastases are found. To date, no large-scale randomized trials have documented an OS benefit for standard, postoperative monitoring program.[31,32,33,34,35]
CEA is a serum glycoprotein frequently used in the management of patients with colon cancer. A review of the use of this tumor marker suggests the following:[36]
The optimal regimen and frequency of follow-up examinations are not well defined because the impact on patient survival is not clear and the quality of data is poor.[33,34,35]
Factors Associated with Recurrence
Diet and exercise
No prospective randomized trials have demonstrated an improvement in outcome with a specific diet or exercise regimen; however, cohort studies suggest that diet or exercise regimen may improve outcome. The cohort studies contain multiple opportunities for unintended bias, and caution is needed when using the data from them.
Two prospective observational studies were performed with patients enrolled on CALGB-89803 (NCT00003835), which was an adjuvant chemotherapy trial for patients with stage III colon cancer.[37,38] In this trial, patients in the lowest quintile of the Western dietary pattern compared with those patients in the highest quintile experienced an adjusted hazard ratio (HR) for disease-free survival of 3.25 (95% confidence interval [CI], 2.04–5.19; P < .001) and an OS of 2.32 (95% CI, 1.36–3.96; P < .001). Additionally, findings included that stage III colon cancer patients in the highest quintile of dietary glycemic load experienced an adjusted HR for OS of 1.76 (95% CI, 1.22–2.54, P < .001) compared with those in the lowest quintile. Subsequently, in the Cancer Prevention Study II Nutrition Cohort, among 2,315 participants diagnosed with colorectal cancer, the degree of red and processed meat intake before diagnosis was associated with a higher risk of death (relative risk [RR], 1.29; 95% CI, 1.05–1.59; P = .03), but red meat consumption after diagnosis was not associated with overall mortality.[39][Level of evidence: 3iiA]
A meta-analysis of seven prospective cohort studies evaluating physical activity before and after a diagnosis of colorectal cancer demonstrated that patients who participated in any amount of physical activity before diagnosis had a RR of 0.75 (95% CI, 0.65–0.87; P < .001) for colorectal cancer-specific mortality compared with patients who did not participate in any physical activity.[40] Patients who participated in a high amount of physical activity (vs. a low amount) before diagnosis had a RR of 0.70 (95% CI, 0.56–0.87; P = .002). Patients who participated in any physical activity (compared with no activity) after diagnosis had a RR of 0.74 (95% CI, 0.58–0.95; P = .02) for colorectal cancer-specific mortality. Those who participated in a high amount of physical activity (vs. a low amount) after diagnosis had a RR of 0.65 (95% CI, 0.47–0.92; P = .01).[40][Level of evidence: 3iiB]
A prospective cohort study examined the use of aspirin after a colorectal cancer diagnosis.[41] Regular users of aspirin after a diagnosis of colorectal cancer experienced an HR of colon cancer-specific survival of 0.71 (95% CI, 0.65–0.97) and an OS of 0.79 (95% CI, 0.65–0.97).[41][Level of evidence: 3iiA] One study evaluated 964 patients with rectal or colon cancer from the Nurse's Health Study and the Health Professional Follow-up Study.[42] Among patients with PI3K-mutant colorectal cancer, regular use of aspirin was associated with an HR for OS of 0.54 (95% CI, 0.31–0.94; P = .01)[42][Level of evidence: 3iiiA]
Related Summaries
Other PDQ summaries containing information related to colon cancer include the following:
Histologic types of colon cancer include the following:
Treatment decisions should be made with reference to the TNM classification [1] rather than to the older Dukes or the Modified Astler-Coller classification schema.
The American Joint Committee on Cancer (AJCC) and a National Cancer Institute–sponsored panel recommended that at least 12 lymph nodes be examined in patients with colon and rectal cancer to confirm the absence of nodal involvement by tumor.[2,3,4] This recommendation takes into consideration that the number of lymph nodes examined is a reflection of the aggressiveness of lymphovascular mesenteric dissection at the time of surgical resection and the pathologic identification of nodes in the specimen. Retrospective studies demonstrated that the number of lymph nodes examined in colon and rectal surgery may be associated with patient outcome.[5,6,7,8]
AJCC Stage Groupings and TNM Definitions
The AJCC has designated staging by TNM classification to define colon cancer.[1] The same classification is used for both clinical and pathologic staging.[1]
Primary Surgical Therapy
Standard treatment for patients with colon cancer has been open surgical resection of the primary and regional lymph nodes for localized disease.
The role of laparoscopic techniques [1,2,3,4] in the treatment of colon cancer has been examined in two studies.
Evidence (laparoscopic techniques):
Surgery is curative in 25% to 40% of highly selected patients who develop resectable metastases in the liver and lung. Improved surgical techniques and advances in preoperative imaging have allowed for better patient selection for resection.
Adjuvant Chemotherapy
The potential value of adjuvant chemotherapy for patients with stage II colon cancer is controversial. Pooled analyses and meta-analyses have suggested a 2% to 4% improvement in OS for patients treated with adjuvant fluorouracil (5-FU)–based therapy compared with observation.[8,9,10] (Refer to the Stage II Colon Cancer Treatment section of this summary for more information.)
Prior to 2000, 5-FU was the only useful cytotoxic chemotherapy in the adjuvant setting for patients with stage III colon cancer. Since 2000, capecitabine has been established as an equivalent alternative to 5-FU and leucovorin. The addition of oxaliplatin to 5-FU and leucovorin has been shown to improve OS compared with 5-FU and leucovorin alone. (Refer to the Stage III Colon Cancer Treatment section of this summary for more information.)
Chemotherapy regimens
Table 8 describes the chemotherapy regimens used to treat colon cancer.
Adjuvant Radiation Therapy
While combined modality therapy with chemotherapy and radiation therapy has a significant role in the management of patients with rectal cancer (below the peritoneal reflection), the role of adjuvant radiation therapy for patients with colon cancer (above the peritoneal reflection) is not well defined. Patterns-of-care analyses and single-institution retrospective reviews suggest a role for radiation therapy in certain high-risk subsets of colon cancer patients (e.g., T4, tumor location in immobile sites, local perforation, obstruction, and residual disease postresection).[11,12,13,14,15,16]
Evidence (adjuvant radiation therapy):
Adjuvant radiation therapy has no current standard role in the management of patients with colon cancer following curative resection, although it may have a role for patients with residual disease.
Stage 0 colon cancer is the most superficial of all the lesions and is limited to the mucosa without invasion of the lamina propria. Because of its superficial nature, the surgical procedure may be limited.
Standard Treatment Options for Stage 0 Colon Cancer
Standard treatment options for stage 0 colon cancer include the following:
Current Clinical Trials
Check the list of NCI-supported cancer clinical trials that are now accepting patients with stage 0 colon cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI website.
Because of its localized nature, stage I colon cancer has a high cure rate.
Standard Treatment Options for Stage I Colon Cancer
Standard treatment options for stage I colon cancer include the following:
The role of laparoscopic techniques [1,2,3,4] in the treatment of colon cancer was examined in a multicenter, prospective, randomized trial (NCCTG-934653 [NCT00002575]) comparing laparoscopic-assisted colectomy (LAC) with open colectomy.
Check the list of NCI-supported cancer clinical trials that are now accepting patients with stage I colon cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Standard Treatment Options for Stage II Colon Cancer
Standard treatment options for stage II colon cancer include the following:
The role of laparoscopic techniques [1,2,3,4] in the treatment of colon cancer was examined in a multicenter, prospective, randomized trial (NCCTG-934653 [NCT00002575]) comparing laparoscopic-assisted colectomy (LAC) to open colectomy.
Treatment Options Under Clinical Evaluation
Adjuvant chemotherapy
The potential value of adjuvant chemotherapy for patients with stage II colon cancer remains controversial. Although subgroups of patients with stage II colon cancer may be at higher-than-average risk for recurrence (including those with anatomic features such as tumor adherence to adjacent structures, perforation, complete obstruction),[5,6,7] evidence is inconsistent that adjuvant 5-fluorouracil (5-FU)–based chemotherapy is associated with an improved OS compared with surgery alone.[8]
Features in patients with stage II colon cancer that are associated with an increased risk of recurrence include the following:
The decision to use adjuvant chemotherapy for patients with stage II colon cancer is complicated and requires thoughtful consideration by both patients and their physicians. Adjuvant therapy is not indicated for most patients unless they are entered into a clinical trial.
Evidence (adjuvant chemotherapy):
Based on these data, the American Society of Clinical Oncology issued a guideline stating "direct evidence from randomized controlled trials does not support the routine use of adjuvant chemotherapy for patients with stage II colon cancer."[13]
Check the list of NCI-supported cancer clinical trials that are now accepting patients with stage II colon cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Stage III colon cancer denotes lymph node involvement. Studies have indicated that the number of lymph nodes involved affects prognosis; patients with one to three involved nodes have a significantly better survival than those with four or more involved nodes.
Standard Treatment Options for Stage III Colon Cancer
Standard treatment options for stage III colon cancer include the following:
Surgery for stage III colon cancer is wide surgical resection and anastomosis.
Chemotherapy regimens prior to 2000
Prior to 2000, 5-FU was the only useful cytotoxic chemotherapy in the adjuvant setting for patients with stage III colon cancer. Many of the early randomized studies of 5-FU in the adjuvant setting failed to show a significant improvement in survival for patients.[6,7,8,9] These trials employed 5-FU alone or 5-FU-semustine (methyl-CCNU).
Evidence (5-FU alone and 5-FU-semustine):
Chemotherapy regimens after 2000
Capecitabine is an oral fluoropyrimidine that undergoes a three-step enzymatic conversion to 5-FU with the last step occurring in the tumor cell. For patients with metastatic colon cancer, two studies have demonstrated the equivalence of capecitabine to 5-FU-leucovorin.[22,23]
For patients with stage III colon cancer, capecitabine provides equivalent outcome to intravenous 5-FU and leucovorin.
Evidence (capecitabine):
Oxaliplatin has significant activity when combined with 5-FU-leucovorin in patients with metastatic colorectal cancer.
Evidence (oxaliplatin):
FOLFOX has become the reference standard for the next generation of clinical trials for patients with stage III colon cancer.[26]
Eligible patients should be considered for entry into carefully controlled clinical trials comparing various postoperative chemotherapy regimens.[27]
Check the list of NCI-supported cancer clinical trials that are now accepting patients with stage III colon cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Stage IV colon cancer denotes distant metastatic disease. Treatment of recurrent colon cancer depends on the sites of recurrent disease demonstrable by physical examination and/or radiographic studies. In addition to standard radiographic procedures, radioimmunoscintography may add clinical information that may affect management.[1] Such approaches have not led to improvements in long-term outcome measures such as survival.
Treatment Options for Stage IV and Recurrent Colon Cancer
Treatment options for stage IV and recurrent colon cancer include the following:
Treatment of Liver Metastasis
Approximately 50% of colon cancer patients will be diagnosed with hepatic metastases, either at the time of initial presentation or as a result of disease recurrence. Although only a small proportion of patients with hepatic metastases are candidates for surgical resection, advances in tumor ablation techniques and in both regional and systemic chemotherapy administration provide for a number of treatment options. These include the following:
Hepatic metastasis may be considered to be resectable based on the following:[5,7,13,14,15,16]
For patients with hepatic metastasis considered to be resectable, a negative margin resection resulted in 5-year survival rates of 25% to 40% in mostly nonrandomized studies, such as the NCCTG-934653 (NCT00002575) trial.[5,7,13,14,15,16] Improved surgical techniques and advances in preoperative imaging have allowed for better patient selection for resection. In addition, multiple studies with multiagent chemotherapy have demonstrated that patients with metastatic disease isolated to the liver, which historically would be considered unresectable, can occasionally be made resectable after the administration of chemotherapy.[17]
Neoadjuvant chemotherapy for unresectable liver metastases
Patients with hepatic metastases that are deemed unresectable will occasionally become candidates for resection if they have a good response to chemotherapy. These patients have 5-year survival rates similar to patients who initially had resectable disease.[17] There is no consensus on the best regimen to use to convert unresectable isolated liver metastases to resectable liver metastases.
Local ablation
Radiofrequency ablation has emerged as a safe technique (2% major morbidity and <1% mortality rate) that may provide for long-term tumor control.[18,19,20,21,22,23,24] Radiofrequency ablation and cryosurgical ablation [25,26,27,28] remain options for patients with tumors that cannot be resected and for patients who are not candidates for liver resection.
Other local ablative techniques that have been used to manage liver metastases include embolization and interstitial radiation therapy.[29,30] Patients with limited pulmonary metastases, and patients with both pulmonary and hepatic metastases, may also be considered for surgical resection, with 5-year survival possible in highly-selected patients.[12,31,32]
Adjuvant or neoadjuvant chemotherapy for resectable liver metastases
The role of adjuvant chemotherapy after potentially curative resection of liver metastases is uncertain.
Evidence (adjuvant or neoadjuvant chemotherapy for resectable liver metastases):
In the era before the use of FOLFOX (folinic acid [LV], 5-fluorouracil [5-FU], and oxaliplatin) and FOLFIRI (5-FU and irinotecan), two trials attempted to randomly assign patients after resection of liver metastases to 5-FU/LV or observation, but both studies were closed early because of poor accrual.
In the era of multiagent chemotherapy, two subsequent studies evaluated its role in the adjuvant setting following resection of liver metastases from colorectal cancer.
There is no level 1 evidence demonstrating that perioperative or postoperative chemotherapy improves OS for patients undergoing resection of liver metastases. Nevertheless, on the basis of post hoc subset analyses of the EORTC study, some physicians feel perioperative or postoperative therapy is reasonable in this setting.
Intra-arterial chemotherapy after liver resection
Hepatic intra-arterial chemotherapy with floxuridine for liver metastases has produced higher overall response rates but no consistent improvement in survival when compared with systemic chemotherapy.[2,37,38,39,40,41] A meta-analysis of the randomized studies, which were all done in the era when only fluoropyrimidines were available for systemic therapy, did not demonstrate a survival advantage.[42]
Evidence (intra-arterial chemotherapy after liver resection):
Two trials evaluated hepatic arterial floxuridine in the adjuvant setting after liver resection.
Further studies are required to evaluate this treatment approach and to determine whether more effective systemic combination chemotherapy alone may provide similar results compared with hepatic intra-arterial therapy plus systemic treatment.
Several studies show increased local toxic effects with hepatic infusional therapy, including liver function abnormalities and fatal biliary sclerosis.
Treatment of Stage IV and Recurrent Colon Cancer
Treatment of patients with recurrent or advanced colon cancer depends on the location of the disease. For patients with locally recurrent and/or liver-only and/or lung-only metastatic disease, surgical resection, if feasible, is the only potentially curative treatment.
Chemotherapy and targeted therapy
Currently, there are ten active and approved drugs for patients with metastatic colorectal cancer that are used alone and in combination with other drugs:
When 5-FU was the only active chemotherapy drug, trials in patients with locally advanced, unresectable, or metastatic disease demonstrated partial responses and prolongation of the time-to-progression (TTP) of disease [45,46] as well as improved survival and quality of life for patients receiving chemotherapy, compared with the best supportive care.[47,48,49] Several trials have analyzed the activity and toxic effects of various 5-FU-leucovorin regimens using different doses and administration schedules and showed essentially equivalent results with a median survival time in the 12-month range.[50]
Prior to the advent of multiagent chemotherapy, two randomized studies demonstrated that capecitabine was associated with equivalent efficacy when compared with the Mayo Clinic regimen of 5-FU-leucovorin.[51,52][Level of evidence: 1iiA]
Three randomized studies demonstrated improved response rates, PFS, and OS when irinotecan or oxaliplatin was combined with 5-FU-leucovorin.[53,54,55]
Evidence (irinotecan):
Since the publication of these studies, the use of either FOLFOX or FOLFIRI is considered acceptable for first-line treatment of patients with metastatic colorectal cancer.
When using an irinotecan-based regimen as first-line treatment of metastatic colorectal cancer, FOLFIRI is preferred.[58][Level of evidence: 1iiDiii]
Randomized phase III trials have addressed the equivalence of substituting capecitabine for infusional 5-FU. Two phase III studies have evaluated FUOX versus CAPOX.[59,60]
When using an oxaliplatin-based regimen as first-line treatment of metastatic colorectal cancer, a CAPOX regimen is not inferior to a FUOX regimen.
Before the availability of cetuximab, panitumumab, bevacizumab, and aflibercept as second-line therapy, second-line chemotherapy with irinotecan in patients treated with 5-FU/LV as first-line therapy demonstrated improved OS when compared with either infusional 5-FU or supportive care.[61,62,63,64]
Similarly, a phase III trial randomly assigned patients who progressed on irinotecan and 5-FU/LV to bolus and infusional 5-FU/LV (LV5FU2), single-agent oxaliplatin, or FOLFOX4. The median TTP for FOLFOX4 versus LV5FU2 was 4.6 months versus 2.7 months (stratified log-rank test, 2-sided P < .001).[65][Level of evidence: 1iiDiii]
Bevacizumab is a partially humanized monoclonal antibody that binds to vascular endothelial growth factor. Bevacizumab can reasonably be added to either FOLFIRI or FOLFOX for patients undergoing first-line treatment of metastatic colorectal cancer.
Evidence (bevacizumab):
Based on these studies, bevacizumab can reasonably be added to either FOLFIRI or FOLFOX for patients undergoing first-line treatment of metastatic colorectal cancer. A major question was whether the use of bevacizumab after first-line therapy was warranted when bevacizumab was used as a component of first-line therapy. At the 2012 American Society of Clinical Oncology Annual Meeting, data was presented from a randomized, controlled trial.[71] In the trial, 820 patients with metastatic colorectal cancer, after progressing on first-line chemotherapy that included bevacizumab, were randomly assigned to chemotherapy without bevacizumab or chemotherapy with bevacizumab. Patients who received bevacizumab experienced an improved OS compared with the patients who did not receive bevacizumab. Median OS was 11.2 months for patients who received bevacizumab plus chemotherapy and 9.8 months for patients who received chemotherapy without bevacizumab (HR, 0.81; 95% CI, 0.69–0.94; unstratified log-rank test, P = .0062). Median PFS was 5.7 months for patients who received bevacizumab plus chemotherapy and 4.1 months for those who received chemotherapy without bevacizumab (HR, 0.68; 95% CI, 0.59–0.78; unstratified log-rank test, P < .0001).[71][Level of evidence: 1iiA]
Evidence (FOLFOXIRI):
Cetuximab is a partially humanized monoclonal antibody against the epidermal growth factor receptor (EGFR). Because cetuximab affects tyrosine kinase signaling at the surface of the cell membrane, tumors with mutations causing activation of the pathway downstream of the EGFR, such as KRAS mutations, are not sensitive to its effects. The addition of cetuximab to multiagent chemotherapy improves survival in patients with colon cancers that lack a KRAS mutation (i.e., KRAS wild type). Importantly, patients with mutant KRAS tumors may experience worse outcome when cetuximab is added to multiagent chemotherapy regimens containing bevacizumab.
Evidence (cetuximab):
Aflibercept is a novel anti-VEGF molecule and has been evaluated as a component of second-line therapy in patients with metastatic colorectal cancer. In one trial, 1,226 patients were randomly assigned to receive aflibercept (4 mg/kg IV) or placebo every 2 weeks in combination with FOLFIRI.[79] Patients who received aflibercept plus FOLFIRI had a significantly improved OS relative to placebo plus FOLFIRI (HR, 0.817; 95.34% CI, 0.713–0.937; P = .0032) with median survival times of 13.50 months versus 12.06 months, respectively. Aflibercept also significantly improved PFS (HR, 0.758; 95% CI, 0.661–0.869; P < .0001), with median PFS times of 6.90 months versus 4.67 months, respectively. On the basis of these results, the use of FOLFIRI plus aflibercept is an acceptable second-line regimen for patients previously treated with FOLFOX-based chemotherapy.[79][Level of evidence: 1A] Whether to continue bevacizumab or initiate aflibercept in second-line therapy has not been addressed as yet in any clinical trial, and there are no data available.
Panitumumab is a fully humanized antibody against the EGFR. The U.S. Food and Drug Administration approved panitumumab for use in patients with metastatic colorectal cancer refractory to chemotherapy.[80] In clinical trials, panitumumab demonstrated efficacy as a single agent or in combination therapy, which was consistent with the effects on PFS and OS with cetuximab. There appears to be a consistent class effect.
Evidence (panitumumab):
Regorafenib is an inhibitor of multiple tyrosine kinase pathways including vascular endothelial growth factor (VEGF). In September 2012, the FDA granted approval for the use of regorafenib in patients who had progressed on prior therapy. The safety and effectiveness of regorafenib were evaluated in a single, clinical study of 760 patients with previously treated metastatic colorectal cancer.[85] Patients were randomly assigned in a 2:1 fashion to receive regorafenib or placebo in addition to best supportive care. Patients treated with regorafenib had a statistically significant improvement in OS (6.4 months in the regorafenib group vs. 5.0 months in the placebo group; HR, 0.77; 95% CI, 0.64–0.94; one-sided P = .0052).[85,86]
Treatment options under clinical evaluation for stage IV and recurrent colon cancer include the following:
Check the list of NCI-supported cancer clinical trials that are now accepting patients with stage IV colon cancer and recurrent colon cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
General Information About Colon Cancer
Updated statistics with estimated new cases and deaths for 2016 (cited American Cancer Society as reference 1).
Editorial changes were made to this summary.
This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® - NCI's Comprehensive Cancer Database pages.
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of colon cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewers for Colon Cancer Treatment are:
Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's Email Us. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.
Levels of Evidence
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
Permission to Use This Summary
PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as "NCI's PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary]."
The preferred citation for this PDQ summary is:
National Cancer Institute: PDQ® Colon Cancer Treatment. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://www.cancer.gov/types/colorectal/hp/colon-treatment-pdq. Accessed <MM/DD/YYYY>.
Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in Visuals Online, a collection of over 2,000 scientific images.
Based on the strength of the available evidence, treatment options may be described as either "standard" or "under clinical evaluation." These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
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More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website's Email Us.
Last Revised: 2016-01-29
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