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Improving Outcomes in CRC

Panelists: Johanna C. Bendell, MD, Sarah Cannon Research Institute; Cathy Eng, MD, FACP, The University of Texas MD Anderson Cancer Center; John L. Marshall, MD, The Ruesch Center for the Cure of GI Cancers ; Michael A. Morse, MD, Duke Cancer Institute; Dale R. Shepard, MD, PhD, FACP, Taussig Cancer Institute, Cleveland Clinic
Published: Monday, May 07, 2018



Transcript: 

John L. Marshall, MD: This has been a fabulous discussion. Before we go, I’ll put you each on the hot seat. Johanna, I’m going to give it to you, first. For our audience, what do you think is really important in colorectal cancer?

Johanna C. Bendell, MD: I’m going to look to the future. In terms of drug development, we are at the cusp of a renaissance for patients with colon cancer. It’s been a long time—the years in the desert, as you have alluded to in your discussions. I think we’re about there. Things are going to start to happen. Things are going to start to move. There’s a rapid acceleration looking at, particularly, these immunotherapies, but potentially other targeted agents, as well, like the RING finger protein 43. So, people are moving forward rapidly in colon cancer. I think that we’re going to start making a dent in this disease pretty soon.

John L. Marshall, MD: Perfect. Cathy?

Cathy Eng, MD, FACP: I think that it’s really important that people recognize that young patients can develop colorectal cancer. When they have symptoms, they need to be investigated. I think that’s been completely underrecognized. A lot of people tell individuals that it’s just a change in bowel habits. They are told that they ate something wrong or it’s due to a hemorrhoid. This is going to be a bigger issue. It needs to be addressed. Now, they are presenting very late. So, that’s a grave concern to me. And, obviously, we need to figure out why these patients are developing this disease.

John L. Marshall, MD: Perfect. Michael?

Michael A. Morse, MD: We call it colon cancer as if it’s 1 disease. Now, we’re talking about left-sided versus right-sided colon cancer. That’s still not enough of a distinction. We have molecular subtyping. We need to get to the point, like in breast cancer and other cancers, where we think of these as different diseases. And we have to have pathways that fit those particular patient populations. Will this require new drugs that target other elements of these pathways that we can’t target right now? The Wnt/β-catenin pathway is a good example. It’s probably a massive driver of the majority of colon cancers. The drugs are in clinical trials, but it’s been very hard to drug that target so far.

John L. Marshall, MD: And will we ever target RAS? Dale, I didn’t mean to put you in the really tough seat of anchoring this, but what have they left you?

Dale R. Shepard, MD, PhD, FACP: We’re making good progress. There are good things for the future. We’re literally eeking out a little bit of benefit with these patients. We’ve been talking about metastatic disease. If we didn’t have this issue, it would be a lot easier to treat. For as much time and energy that we’re putting in—for these good therapies, sometimes with very small populations of metastatic disease—we also need to be thinking about the other end. We need to think about prevention. We need to think about screening. There are so many people that don’t get the necessary screening. We know that survival is so much greater, if you find an early tumor instead of a late tumor. It would be fantastic for this to be the last panel discussion that we have on metastatic disease, if we could catch more patients, early.

John L. Marshall, MD: That’s just a great point. It’s a difficult disease, and we’re learning how complicated and difficult it is. Thank you so much for joining in on this discussion. And on behalf of our panel, we thank you for joining us. We hope that you’ve found this Peer Exchange® discussion to be insightful and informative.

Transcript Edited for Clarity 

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Transcript: 

John L. Marshall, MD: This has been a fabulous discussion. Before we go, I’ll put you each on the hot seat. Johanna, I’m going to give it to you, first. For our audience, what do you think is really important in colorectal cancer?

Johanna C. Bendell, MD: I’m going to look to the future. In terms of drug development, we are at the cusp of a renaissance for patients with colon cancer. It’s been a long time—the years in the desert, as you have alluded to in your discussions. I think we’re about there. Things are going to start to happen. Things are going to start to move. There’s a rapid acceleration looking at, particularly, these immunotherapies, but potentially other targeted agents, as well, like the RING finger protein 43. So, people are moving forward rapidly in colon cancer. I think that we’re going to start making a dent in this disease pretty soon.

John L. Marshall, MD: Perfect. Cathy?

Cathy Eng, MD, FACP: I think that it’s really important that people recognize that young patients can develop colorectal cancer. When they have symptoms, they need to be investigated. I think that’s been completely underrecognized. A lot of people tell individuals that it’s just a change in bowel habits. They are told that they ate something wrong or it’s due to a hemorrhoid. This is going to be a bigger issue. It needs to be addressed. Now, they are presenting very late. So, that’s a grave concern to me. And, obviously, we need to figure out why these patients are developing this disease.

John L. Marshall, MD: Perfect. Michael?

Michael A. Morse, MD: We call it colon cancer as if it’s 1 disease. Now, we’re talking about left-sided versus right-sided colon cancer. That’s still not enough of a distinction. We have molecular subtyping. We need to get to the point, like in breast cancer and other cancers, where we think of these as different diseases. And we have to have pathways that fit those particular patient populations. Will this require new drugs that target other elements of these pathways that we can’t target right now? The Wnt/β-catenin pathway is a good example. It’s probably a massive driver of the majority of colon cancers. The drugs are in clinical trials, but it’s been very hard to drug that target so far.

John L. Marshall, MD: And will we ever target RAS? Dale, I didn’t mean to put you in the really tough seat of anchoring this, but what have they left you?

Dale R. Shepard, MD, PhD, FACP: We’re making good progress. There are good things for the future. We’re literally eeking out a little bit of benefit with these patients. We’ve been talking about metastatic disease. If we didn’t have this issue, it would be a lot easier to treat. For as much time and energy that we’re putting in—for these good therapies, sometimes with very small populations of metastatic disease—we also need to be thinking about the other end. We need to think about prevention. We need to think about screening. There are so many people that don’t get the necessary screening. We know that survival is so much greater, if you find an early tumor instead of a late tumor. It would be fantastic for this to be the last panel discussion that we have on metastatic disease, if we could catch more patients, early.

John L. Marshall, MD: That’s just a great point. It’s a difficult disease, and we’re learning how complicated and difficult it is. Thank you so much for joining in on this discussion. And on behalf of our panel, we thank you for joining us. We hope that you’ve found this Peer Exchange® discussion to be insightful and informative.

Transcript Edited for Clarity 
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