Researchers have revealed the impacts of several new developments in screening and treating patients with biliary tract cancer and colorectal cancer—including the development of patient-derived organoids to test chemotherapy response, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce the risk of early-onset adenomas, and the implementation of lower screening ages for colorectal cancer—according to three new studies presented at Digestive Disease Week 2023.
Personalized Drug Screening in Patient-Derived Organoids of Biliary Tract Cancer
Chemotherapy is often the only treatment option for patients with biliary tract cancer. Because it is typically discovered at a late stage, biliary tract cancer is one of the most lethal cancers. However, existing tools cannot effectively predict which chemotherapy drugs will work best in individual patients in the limited amount of time available. In the new study, researchers tested the organoids derived from 72 patients with seven chemotherapy agents. The researchers then identified the genetic signatures of the organoids in response to the different agents and developed gene-panel tests to predict the responses to treatment. The screening results were first validated in mice that were grafted with the same tumors, and then confirmed in 92% (n = 12/13) of the patients treated with the chemotherapy agents identified by this process. The researchers concluded that organoids may offer high accuracy in personalized chemotherapy screening in patients with biliary tract cancer and that gene-panel testing may help select effective agents for individual patients.
NSAID Use and Risk of Early-Onset Adenomas
The incidence of early-onset colorectal cancer in patients aged younger than 50 years of age has been rising at an alarming rate. Emerging data suggest that aspirin use may be associated with a lower risk of early-onset colorectal cancer. However, investigators remain uncertain about whether the regular use of aspirin and other NSAIDs could also be associated with a lower risk of early-onset adenomas with greater malignant potential. In the new study, investigators analyzed the NSAID usage data of 32,058 patients from the Nurses’ Health Study II. The patients involved in the study had at least one lower endoscopy before the age of 50 from 1991 to 2015. The investigators noted that they found 1,247 early-onset adenomas—including 290 high-risk cases. They further found that regular NSAID use was associated with a lower chance of developing both high-risk and low-risk adenomas. They emphasized that their new findings demonstrated the need to further evaluate NSAIDs as promising agents for the prevention of early-onset colorectal cancer, given the favorable risk-benefit profile in younger patients.
Factors Contributing to Mortality in Patients With Colorectal Cancer
The colorectal cancer mortality rate continues to decline with advancements in screening and management strategies. Despite this downward trend, colorectal cancer remains the one of the leading causes of cancer-related mortality in the United States. In the new study, investigators examined the causes of mortality in 576 patients who underwent surgery for colorectal cancer between 2004 and 2018. The investigators found that the mortality rate for colorectal cancer gradually decreased over time, whereas the mortality rate from other causes such as other cancers or systemic diseases increased over time. The investigators further identified the patients who were more likely to die from colorectal cancer compared with other causes—including younger patients, patients with fewer comorbidities, and patients with distant metastatic disease. The investigators highlighted that their findings supported the idea that the recent modification to the screening age for colorectal cancer—reduced from age 50 to age 45—may be a step in the right direction to catch and treat the disease in its early stages.
