Metastatic Colorectal Cancer: Ongoing Challenges and Future Directions in Care


Closing out their panel on metastatic colorectal cancer, expert oncologists consider ongoing challenges and future evolutions within the treatment landscape.


John L. Marshall, MD: Last question I have, again, a personal kind of question. Our EMR [electronic medical record] is not good at storing molecular data, and so I spend a lot of time in every clinic, going through and making sure I have the latest. I actually make it in red in my HPI [history of present illness]. Literally what I do is I type it in. Does anybody have a better [solution]? You live in a tech world, you might have it right. Does anybody have a good answer to how you’re managing your molecular data?

Stacey Cohen, MD: We don’t, and the problem is you’re right. You need it to be there electronically, it needs to be a searchable field so that if you don’t know it one day, you could look for it later. It ends up in this PDF of scanned [files].

John L. Marshall, MD: That someone scanned into some other file.

Stacey Cohen, MD: And how do you know to look for it there if you didn’t have it? And so I think it’s a real problem and I would love that there were some more global efforts, especially that could come along with these trials, of inputting ways to do it. And I know it’s been talked about for NCTN [National Clinical Trials Network] trials of coming up with these predesigned things. It’s hard because you have to redo it on every single institutional level, but I think it’s worth the commitment. I encourage everyone to do it.

John L. Marshall, MD: I have a meeting with the president when we get back. So [the] point is we want the EMR fixed with molecular data. I think the quality of care would go up.

Tanios Bekaii-Sabb, MD, FACP: It’s not a problem that the EMR can accept the PDF, but can it accept that data? If there was a way that the initiating entity and the receiving entity can speak to each other—but there are a lot of firewalls. One way we’ve done it, other than doing it the exact way you do it—except I bold it, I don’t [make it red]. But 1 way we’ve done it with the liquids and we’re moving to the tissue is the PDFs actually have a link in the lab section, so I know where to look for it, I click it, it gives me the PDF, I don’t have to go look into media or whatever other place where it’s hiding. And the problem is even with AI [artificial intelligence] right now, it’s pretty challenging to go to these PDFs that are embedded somewhere. They’re not easily searchable so you can’t extract that data and dump it into the record.

John L. Marshall, MD: We just ask ChatGPT and it will tell us.

Tanios Bekaii-Sabb, MD, FACP: ChatGPT has helped a lot of folks actually.

Cathy Eng, MD, FACP: We actually have it built in; it’s new. It’s being built into our system, but the problem is it’s with 1 particular company so if you have data from another vendor, you do the manual search again.

John L. Marshall, MD: You’re doing a blood and a tissue, and it’s not coming in. Anyway, thank you guys very much for taking time out of everybody’s busy schedule, and thank you all for this rich and informative discussion. Before we conclude, I’m going to give our panel 1 last chance for some final thoughts from each of you on how future perspectives and colorectal cancer [CRC] are going to change our world going forward, any practice pearls you want to share with our community-based colleagues who are treating colon cancer. Cathy, I’ll give you first word.

Cathy Eng, MD, FACP: I just want to kindly remind people to acknowledge the symptoms, and I always bring this up [with] early-onset colorectal cancer patients and hopefully if they’re having any symptoms, they are being screened appropriately. And get NGS [next-generation sequencing] testing completed and MSI [microsatellite instability] testing completed.

John L. Marshall, MD: Very good.…Dr Saab?

Tanios Bekaii-Sabb, MD, FACP: I think in simple terms, test early and test consistently. That’s the best way for us to provide our patients with the best opportunities in terms of planning, not just for standard of care, but also for some of the important clinical trials that are bringing a lot of the effective therapies to the first line. Hopefully they turn out to be positive.

John L. Marshall, MD: Dr Parikh?

Aparna R. Parikh, MD: I echo my colleagues’ sentiments. My additional point is that it’s really tremendous to see the moves we made in biomarker segments, but these biomarker segments are still small. We have a long way to go to actually move the needle for the far majority of our colorectal cancer patients.

John L. Marshall, MD: Don’t get frustrated. Keep testing and you’ll find them.

Aparna R. Parikh, MD: Keep testing on them, exactly.

John L. Marshall, MD: Dr Cohen, you get the last word.

Stacey Cohen, MD: I think it’s been so great thinking about all of the molecular subgroups and I want to not lose sight of the other bigger picture, which is don’t forget about germline testing. Germline testing matters. Younger patients are being diagnosed and we want to make sure that they’re getting all the right care, including fertility preservation options, and all of the social counseling. Colorectal cancer is really fun, it’s really complicated now, there’s just a lot of things that are on our plate, but we can all do it.

John L. Marshall, MD: And we’re all getting better at it. So thank you all once again for joining us today and to our viewing audience, thank you for joining us. We hope you found this OncLive® Peer Exchange discussion to be useful and valuable to the treatment of your patients with CRC.

Transcript edited for clarity.

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