Dr. Bekaii-Saab on Challenges With Precision Medicine in CRC

Tanios Bekaii-Saab, MD
Published: Tuesday, Dec 18, 2018



Tanios Bekaii-Saab, MD, professor of medicine, Mayo Clinic, discusses the challenges of bringing a targeted treatment approach into the clinic for patients with colorectal cancer (CRC).

As researchers across all tumor types gain a better understanding of biology and potential targets, precision medicine is a medical model that is starting to make headway in the space. The concept is that this form of therapy will only impact the malignancy and spare unaffected organs.

There are still not many opportunities for the use of precision medicine in the clinic for CRC, Bekaii-Saab notes, other than for those who express microsatellite instability high (MSI-H) or NTRK fusions. MSI-H patients can be treated with PD-1 inhibitors and NTRK fusions can be targeted with NTRK inhibitors.

There are several challenges to bringing these emerging agents into practice, he adds. With gastrointestinal cancers, point of entry into a study is typically through 2 or more very nonspecific histology agnostic platforms, Bekaii-Saab says. As an example, he mentions NCI-MATCH, which is a precision medicine cancer treatment clinical trial in which patients are assigned to receive treatment based on the genetic changes found in their tumors through the use of genomic sequencing and other tests.

Although NCI-MATCH shows that this approach is feasible, says Bekaii-Saab, it does not focus on organs, and because of that, it cannot be used as a potential avenue leading to agent approvals. However, through other single trials other agents are making their way into the clinic. For example, agents targeting FGFR in patients with cholangiocarcinoma are not yet approved, but they are on their way.
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Tanios Bekaii-Saab, MD, professor of medicine, Mayo Clinic, discusses the challenges of bringing a targeted treatment approach into the clinic for patients with colorectal cancer (CRC).

As researchers across all tumor types gain a better understanding of biology and potential targets, precision medicine is a medical model that is starting to make headway in the space. The concept is that this form of therapy will only impact the malignancy and spare unaffected organs.

There are still not many opportunities for the use of precision medicine in the clinic for CRC, Bekaii-Saab notes, other than for those who express microsatellite instability high (MSI-H) or NTRK fusions. MSI-H patients can be treated with PD-1 inhibitors and NTRK fusions can be targeted with NTRK inhibitors.

There are several challenges to bringing these emerging agents into practice, he adds. With gastrointestinal cancers, point of entry into a study is typically through 2 or more very nonspecific histology agnostic platforms, Bekaii-Saab says. As an example, he mentions NCI-MATCH, which is a precision medicine cancer treatment clinical trial in which patients are assigned to receive treatment based on the genetic changes found in their tumors through the use of genomic sequencing and other tests.

Although NCI-MATCH shows that this approach is feasible, says Bekaii-Saab, it does not focus on organs, and because of that, it cannot be used as a potential avenue leading to agent approvals. However, through other single trials other agents are making their way into the clinic. For example, agents targeting FGFR in patients with cholangiocarcinoma are not yet approved, but they are on their way.



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