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Future Management of Metastatic Colorectal Cancer

Insights From: Tanios Bekaii-Saab, MD, Mayo Clinic; Johanna C. Bendell, MD, Sarah Cannon Research Institute
Published: Tuesday, Oct 16, 2018



Transcript:

Tanios Bekaii-Saab, MD:
Overall, I think this is a great time for colorectal cancer. I think we’ve made significant strides. I think back in the days where we only had 5-FU [fluorouracil], the average survival was 12 months. Today, it’s not unusual to talk about median survivals of 3 to 4 years, which only happened in the span of a decade and a half. So, that’s significant improvement. When we start breaking down the groups, some of these groups can see survivals up to 5 or 7 years. And now we’re starting to understand a little bit more about how to integrate the role of surgery and radiation in certain subgroups of patients.

And as I said, we’re also looking at piecemealing that cancer into other subgroups other than the MSI [microsatellite instability]–high and the HER2-amplified and the BRAF mutated. As we understand more and more how to target each one of those, we start focusing on targeting the smaller subgroups.

There’s one subgroup of patients that actually has a very rare fusion in NTRK, so NTRK fusions, that seems to respond exquisitely to agents that target NTRK. Of these NTRK inhibitors, one of them was just approved on the market recently. The responses that we see with these NTRK inhibitors with those NTRK fusions are very similar to what we see with PD-1 inhibitors and MSI-high populations.

We know that these subgroups exist, and we know that we can target those subgroups as long as we can find the right target and the right agent to go after the target. I’m very optimistic. In the next 5 to 10 years, we’ll more than double the survival of patients with colorectal cancer. I’m hoping that we’re still talking about 8 to 10 years’ median overall survival and understand a little bit more what every piece of that cancer means and how we’re going to target every subgroup.

Johanna C. Bendell, MD: In the next few years, I see this as a very exciting time for patients with metastatic colorectal cancer. The field of drug development, particularly for these patients, is booming, looking at immunotherapies, immunotherapy combinations, personalized cancer vaccines, solid tumor CAR [chimeric antigen receptor] T-cell options, and other targeted therapies that are trying to hit other targets on the colorectal cancer cells, both in the form of antibody-drug conjugates and direct targeting of the cancer cells. I think there’s so much hope and promise for our patients with metastatic colorectal cancer, and what we need to do as clinicians is continue to support these patients, drive them to clinical trials, and do molecular profiling so we’re able to learn more specifically about the patient’s tumor. We also need to bring these data together to learn about certain subgroups of patients with metastatic colorectal cancer.

Transcript Edited for Clarity.
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Transcript:

Tanios Bekaii-Saab, MD:
Overall, I think this is a great time for colorectal cancer. I think we’ve made significant strides. I think back in the days where we only had 5-FU [fluorouracil], the average survival was 12 months. Today, it’s not unusual to talk about median survivals of 3 to 4 years, which only happened in the span of a decade and a half. So, that’s significant improvement. When we start breaking down the groups, some of these groups can see survivals up to 5 or 7 years. And now we’re starting to understand a little bit more about how to integrate the role of surgery and radiation in certain subgroups of patients.

And as I said, we’re also looking at piecemealing that cancer into other subgroups other than the MSI [microsatellite instability]–high and the HER2-amplified and the BRAF mutated. As we understand more and more how to target each one of those, we start focusing on targeting the smaller subgroups.

There’s one subgroup of patients that actually has a very rare fusion in NTRK, so NTRK fusions, that seems to respond exquisitely to agents that target NTRK. Of these NTRK inhibitors, one of them was just approved on the market recently. The responses that we see with these NTRK inhibitors with those NTRK fusions are very similar to what we see with PD-1 inhibitors and MSI-high populations.

We know that these subgroups exist, and we know that we can target those subgroups as long as we can find the right target and the right agent to go after the target. I’m very optimistic. In the next 5 to 10 years, we’ll more than double the survival of patients with colorectal cancer. I’m hoping that we’re still talking about 8 to 10 years’ median overall survival and understand a little bit more what every piece of that cancer means and how we’re going to target every subgroup.

Johanna C. Bendell, MD: In the next few years, I see this as a very exciting time for patients with metastatic colorectal cancer. The field of drug development, particularly for these patients, is booming, looking at immunotherapies, immunotherapy combinations, personalized cancer vaccines, solid tumor CAR [chimeric antigen receptor] T-cell options, and other targeted therapies that are trying to hit other targets on the colorectal cancer cells, both in the form of antibody-drug conjugates and direct targeting of the cancer cells. I think there’s so much hope and promise for our patients with metastatic colorectal cancer, and what we need to do as clinicians is continue to support these patients, drive them to clinical trials, and do molecular profiling so we’re able to learn more specifically about the patient’s tumor. We also need to bring these data together to learn about certain subgroups of patients with metastatic colorectal cancer.

Transcript Edited for Clarity.
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