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According to the American Cancer Society, colorectal cancer is the second-leading cause of cancer-related death in the United States. In 2023, the disease is expected to cause an estimated 52,550 deaths. Studies show that receiving a clinician recommendation is the strongest and most consistent...
This is Part 3 of New Directions in Metastatic Colorectal Cancer, a three-part video roundtable series. Scroll down to watch the other videos from this Roundtable. In this video, Drs. Michael Overman, Laura Goff, and Katrina Pedersen discuss later-line treatment options for metastatic colorectal cancer. The patient is a 64-year-old male with metastatic ascending colon moderately differentiated adenocarcinoma. On CT scan, he has liver, lung, and retroperitoneal lymph node metastases. Molecular testing demonstrates proficient mismatch repair, HER2 IHC negative; a 100-gene next-generation sequencing panel demonstrates KRAS G13D, PIK3CA, CCND2, and ATM mutations. The patient has a good performance status and is initiated on FOLFOXIRI/bevacizumab with partial response, then develops disease progression on fluorouracil/bevacizumab maintenance therapy. The faculty review the next steps for this patient and the importance of quality-of-life considerations when making treatment decisions. They also discuss the evolving third-line landscape, highlighting the recent SUNLIGHT trial that evaluated the addition of bevacizumab to TAS-102.
This is Part 2 of New Directions in Metastatic Colorectal Cancer, a three-part video roundtable series. Scroll down to watch the other videos from this Roundtable. In this video, Drs. Michael Overman, Laura Goff, and Katrina Pedersen discuss second-line treatment options for metastatic colorectal cancer. The patient is a 46-year-old female with locally advanced, poorly differentiated rectal adenocarcinoma who received neoadjuvant chemoradiation followed by resection, which revealed a ypT4N1 tumor. She received adjuvant FOLFOX for eight cycles; 5 months after completion of therapy, a restaging CT scan revealed more than 10 growing pulmonary nodules, all < 1 cm. In the conversation that follows, the faculty discuss the many treatment options available in the second-line setting, the factors that impact decision-making, and the emerging role of HER2 amplification/overexpression as an actionable target in metastatic colorectal cancer.
This is Part 2 of New Directions in Metastatic Colorectal Cancer, a three-part video roundtable series. Scroll down to watch the other videos from this Roundtable. In this video, Drs. Michael Overman, Laura Goff, and Katrina Pedersen discuss second-line treatment options for metastatic colorectal cancer. The patient is a 46-year-old female with locally advanced, poorly differentiated rectal adenocarcinoma who received neoadjuvant chemoradiation followed by resection, which revealed a ypT4N1 tumor. She received adjuvant FOLFOX for eight cycles; 5 months after completion of therapy, a restaging CT scan revealed more than 10 growing pulmonary nodules, all < 1 cm. In the conversation that follows, the faculty discuss the many treatment options available in the second-line setting, the factors that impact decision-making, and the emerging role of HER2 amplification/overexpression as an actionable target in metastatic colorectal cancer.
This is Part 1 of New Directions in Metastatic Colorectal Cancer, a three-part video roundtable series. Scroll down to watch the other videos from this Roundtable. In this video, Drs. Michael Overman, Laura Goff, and Katrina Pedersen discuss front-line treatment options for metastatic colorectal cancer. The patient is a 77-year-old male with a history of resected prostate cancer who developed rectal bleeding. He had a colonoscopy in 2016 that revealed a transverse T3N1 adenocarcinoma that was subsequently resected. After four cycles of FOLFOX, he developed chest pain that led to a CT scan demonstrating left supraclavicular adenopathy. A biopsy is performed, and CT scan shows liver and adrenal metastases. In the conversation that follows, the faculty discuss the next steps for this patient, the importance of mismatch repair testing in the decision-making process, and the role of monotherapy vs combination therapy.
ASCO EXPERT Peter Paul Yu, MD, FACP, FASCO, commented on these GALAXY trial findings. He noted the results of this current study and others planned will establish the role of circulating tumor DNA (ctDNA) monitoring for risk of recurrence and guidance for adjuvant therapy. Dr. Yu is...
Postoperative molecular residual disease detected by circulating tumor DNA (ctDNA) at 4 weeks after resection has emerged as the strongest prognostic risk factor for disease-free survival in patients with resected colorectal cancer. This finding was observed regardless of BRAF V600E status and...
On August 2, 2023, the fixed combination of trifluridine, a nucleoside metabolic inhibitor, and tipiracil, a thymidine phosphorylase inhibitor, was approved for use with bevacizumab for metastatic colorectal cancer previously treated with fluoropyrimidine-, oxaliplatin-, and irinotecan-based...
In the final analysis of the phase III LEAP-017 study, the combination of lenvatinib plus pembrolizumab failed to improve outcomes over the standard of care in previously treated patients with metastatic colorectal cancer that lacked high microsatellite instability or mismatch repair deficiency...
Cholesterol-lowering statins may reduce colorectal cancer incidence and mortality in patients with ulcerative colitis, according to a recent study published by Sun et al in eClinicalMedicine. The findings also suggested that statin use may be associated with a lower risk of all-cause mortality in...
Researchers have identified new strategies to help physicians predict which patients with advanced colorectal cancer may benefit from immunotherapy, according to a recent study published by Saberzadeh-Ardestani et al in Clinical Cancer Research. The findings demonstrate the potential of using...
In a Canadian retrospective cohort study reported in JAMA Network Open, Castelo et al found that a greater interval between date of presentation and treatment initiation was not associated with an increased risk of poorer survival among patients with colorectal cancer diagnosed before age 50. The...
In the French phase II SAMCO-PRODIGE 54 trial reported in JAMA Oncology, Julien Taïeb, MD, PhD, and colleagues found that second-line avelumab improved progression-free survival vs standard chemotherapy in patients with mismatch repair–deficient and/or microsatellite instability (dMMR/MSI)...
In the Italian phase II noncomparative PANDA trial reported in the Journal of Clinical Oncology, Lonardi et al found that regimens adding panitumumab to modified FOLFOX (fluorouracil, leucovorin, and oxaliplatin; mFOLFOX) and to fluorouracil/leucovorin were active in the first-line treatment of...
New research published by Ou et al in JNCCN—Journal of the National Comprehensive Cancer Network evaluated how an important analysis on adjuvant chemotherapy for advanced colon cancer impacted prescribing patterns. The IDEA collaboration included more than 12,000 patients with stage III colon...
Researchers have compared the efficacy of surgical and nonsurgical interventions for patients with malignant bowel obstructions, according to a recent study published by Krouse et al in The Lancet Gastroenterology & Hepatology. The new findings may help to inform clinical decision-making in the ...
The American College of Physicians (ACP) suggested screening asymptomatic, average-risk adults for colorectal cancer at age 50 years, according to updated clinical guidelines published by Qaseem et al in the Annals of Internal Medicine. New ACP Clinical Guidelines Colorectal cancer has the fourth...
On August 2, the U.S. Food and Drug Administration (FDA) approved trifluridine and tipiracil (Lonsurf) with bevacizumab for patients with metastatic colorectal cancer previously treated with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy, an anti-VEGF biological therapy, and, if ...
About 80% of geriatric female colorectal cancer survivors may experience a range of gastrointestinal symptoms years after receiving a diagnosis and treatment for their tumors, according to a recent study published by Han et al in PLOS ONE. Background While depression, anxiety, and fatigue are...
Patients who reside in lower-income communities may be less likely to undergo colorectal cancer screenings with computed tomography (CT) colonography than those who reside in higher-income communities, according to a new study published by Christensen et al in the American Journal of ...
In an analysis reported in JAMA Network Open, Robertson et al found U.S. veterans most frequently cited a preference for stool testing as a reason for declining participation in the CONFIRM trial, which compared the effect on colorectal cancer mortality with annual colonoscopy vs annual fecal...
In a modeling study reported in JAMA Oncology, Kalyta et al found that reducing the starting age for colorectal cancer screening with the biennial fecal immunochemical test (FIT) in Canada would result in reduction in colorectal cancer burden at a “modest cost.” As stated by the investigators:...
In a study reported in JAMA Network Open, KC et al identified factors involved with primary cancer mortality vs noncancer mortality among long-term survivors of breast, prostate, and colorectal cancers. Study Details The study included data on 627,702 patients in the Surveillance, Epidemiology,...
In a study reported in JAMA Oncology, Katipally et al found that an integrated clinical-molecular classification of colorectal cancer metastases to the liver distinguished risk groups for survival outcomes. Study Details The investigators had previously defined three biologically distinct molecular ...
New research could warrant reconsideration of current screening guidelines to include a poorly recognized cause of Lynch syndrome, according to a novel study published by Hitchins et al in JNCCN–Journal of the National Comprehensive Cancer Network. The findings suggest that the guidelines leave a...
In a study of real-world prospective data—GOSAFE—reported in the Journal of Clinical Oncology, Montroni et al found that the majority of patients aged ≥ 70 years undergoing colorectal cancer surgery showed maintained or improved quality of life and achieved functional recovery during follow-up....
In a study reported in the Journal of Clinical Oncology, Seagle et al identified the prevalence of germline colorectal cancer susceptibility gene variants according to race and ethnicity among patients with early-onset colorectal cancer. Study Details The study involved patients aged 15 to 49 years ...
Patients with intermediate-risk rectal cancer who received neoadjuvant chemotherapy with selective use of pelvic chemoradiation therapy had disease-free survival that was noninferior to the standard approach using pelvic chemoradiation, according to findings from the randomized phase III PROSPECT...
In a Korean study reported in the Journal of Clinical Oncology, Jin et al found that increased alcohol intake may be associated with an increased risk of early-onset colorectal cancer. Study Details The study involved data from 5,666,576 individuals aged 20 to 49 years from the Korean National...
In the German phase II FIRE-4.5 trial reported in the Journal of Clinical Oncology, Stintzing et al found that the addition of cetuximab vs bevacizumab to FOLFOXIRI (fluorouracil, leucovorin, oxaliplatin, and irinotecan) did not improve objective response rate in the first-line treatment of...
In the Dutch Colorectal Cancer Group phase III CAIRO5 study reported in The Lancet Oncology, Bond et al investigated first-line systemic treatment strategies in patients with initially unresectable colorectal cancer liver metastases. The researchers found that FOLFOXIRI (leucovorin, fluorouracil,...
Researchers have identified seven potential risk factors for early-onset colorectal cancer in male patients and developed a novel risk evaluation model, according to a recent study published by Imperiale et al in Cancer Prevention Research. The findings may help 45- to 49-year-old patients accept...
In the phase III FRESCO-2 trial reported in The Lancet, Dasari et al found that the VEGFR-1,2,3 inhibitor fruquintinib prolonged survival vs placebo in patients with refractory metastatic colorectal cancer. Study Details In the double-blind trial, 691 patients from sites in 14 countries were...
A report from the German OCUM study published by Ruppert et al in the Journal of Clinical Oncology details long-term locoregional recurrence outcomes with risk-adapted neoadjuvant chemoradiotherapy plus total mesorectal excision and total mesorectal excision alone in patients with rectal cancer....
Commenting on this study on clinical genomic profiling for colorectal cancer, Lisa Newman, MD, MPH, FACS, FASCO, Chief of the Section of Breast Surgery and leader of the Multidisciplinary Breast Oncology Programs at Weill Cornell Medicine and NewYork-Presbyterian, commended the authors for...
Black individuals have a higher incidence of colorectal cancer than White individuals, and their outcomes are worse. Undoubtedly, reasons for this are multifaceted, but the disparity in outcomes may be partly explained by genomic differences, documented in a large retrospective study presented at...
Researchers have revealed that the KDM5D gene on the Y chromosome, which is upregulated in KRAS-mutated colorectal cancer, may be responsible for increasing tumor cell invasiveness and reducing antitumor immunity in male patients, according to a recent study published by Li et al in Nature. The new ...
Targeted therapy with fruquintinib may improve overall survival and progression-free survival in patients with refractory metastatic colorectal cancer, according to a novel study published by Dasari et al in The Lancet. Background According to the American Cancer Society, colorectal cancer is the...
In an analysis from the PROSPECT trial (Alliance N1048) reported in the Journal of Clinical Oncology, Ethan Basch, MD, MSc, FASCO, and colleagues identified patient-reported outcome patterns among those receiving neoadjuvant FOLFOX (fluorouracil, leucovorin, oxaliplatin) or pelvic chemoradiation...
In a Chinese study reported in JAMA Oncology, Mo et al found that longitudinal measurement of circulating tumor DNA (ctDNA) methylation permitted early detection of disease recurrence in patients undergoing surgery for stage I to III colorectal cancer. Study Details In the prospective cohort...
Although redlining was outlawed more than 50 years ago, individuals who currently live in historically redlined areas may be less likely to be screened for breast cancer, colorectal cancer, and cervical cancer than individuals who live in areas not associated with redlining practices, according to...
Cathy Eng, MD, of Vanderbilt-Ingram Cancer Center, and Thejus Jayakrishnan, MD, of the Cleveland Clinic Taussig Cancer Institute, discuss significant differences in the citrate cycle, a core pathway of cellular metabolism associated with colorectal cancer. Metabolomic differences impacted by environmental exposures (arginine biosynthesis and dietary red meat) were also noted, suggesting possible links with younger age of onset in this disease (Abstract 3510).
Smitha Krishnamurthi, MD, of the Cleveland Clinic, and Deb Schrag, MD, MPH, of Memorial Sloan Kettering Cancer Center, discuss phase III findings from the PROSPECT trial, which showed FOLFOX chemotherapy with selective use of radiation therapy and sensitizing fluoropyrimidine (5FUCRT) is noninferior to 5FUCRT for the neoadjuvant treatment of patients with locally advanced rectal cancer, prior to low anterior resection with total mesorectal excision (Abstract LBA2).
Cathy Eng, MD, of Vanderbilt-Ingram Cancer Center, and Lars Henrik Jensen, MD, PhD, of the Danish Colorectal Cancer Center South and the University Hospital of Southern Denmark, discuss phase III results from the Scandinavian NeoCol trial, which showed that neoadjuvant chemotherapy is not superior to standard upfront surgery in terms of disease-free and overall survival in patients with colon cancer, although there are certain circumstances when this approach may have more favorable outcomes (Abstract LBA3503).
A novel study is shedding light on factors that may affect treatment response in patients with young-onset colorectal cancer. Researchers uncovered differences in transcriptional metabolic profiles and other drivers of disease, as well as immune profiles, between younger and older patients with...
Patients with locally advanced rectal cancer with tumors that respond to chemotherapy may safely forgo radiation therapy before surgery, based on the findings of the PROSPECT trial. These data were presented by Deborah Schrag, MD, FASCO, MPH, at the 2023 ASCO Annual Meeting (Abstract LBA2) and...
Thierry Conroy, MD, of the Institut de Cancérologie de Lorraine, discusses phase III findings from the PRODIGE 23 trial, showing that neoadjuvant chemotherapy with mFOLFIRINOX followed by chemoradiotherapy, surgery, and adjuvant chemotherapy improved all outcomes, including overall survival, in patients with locally advanced rectal cancer compared with standard chemoradiotherapy, surgery, and adjuvant chemotherapy (Abstract LBA3504).
Sebastian Stintzing, MD, of the Charité Universitätsmedizin Berlin, discusses results from the phase III FIRE-4 study, which showed that liquid biopsy is clinically relevant in verifying mutational status in patients with metastatic colorectal cancer and is efficacious in first-line treatment of FOLFIRI and cetuximab for patients with RAS wild-type disease (Abstract 3507).
Researchers have found that the bacteria, fungi, and viruses within the tumors of patients with colorectal cancer varied significantly depending on whether they were diagnosed with early-onset or late-onset disease, according to new findings presented by Weinberg et al at the 2023 ASCO Annual...
Delays in cancer screenings during the COVID-19 pandemic may have resulted in lower reported incidences of colorectal, lung, and breast cancers, reflecting potentially high rates of undiagnosed cancer and later-stage diagnoses, according to a new study published by Romatoski et al in the Journal of ...