Post-Conference Perspectives: Sequencing in the Current mCRC Paradigm - Episode 5

Overcoming Challenges in the Management of mCRC


Howard S. Hochster, MD, FACP: I think the biggest challenge today in colon cancer treatment is, can we find some way to trick the immune system into being more reactive in colon cancer? It seems like there are some tumors where T cells are in the tumors and they’re ready to go, and they’re just being held back by PD-1, such as in melanoma, and when you give them the anti-PD-1 antibodies, they can work very well. And then there are some where the cells are there but they need to be activated more. And then there’s colon cancer, where the cells aren’t even there yet. So we have to find a way to improve the immunogenicity of colon cancer and get the cellular immune system to start recognizing the tumor antigens better so that we can take advantage of the new immunotherapy. At Rutgers, we’re doing a study with some of our surgeons on resectable lung metastases using vaccination to see if we can boost the T cells into being more reactive. Those approaches, I think, are the future of where we want to go with immunotherapy in colon cancer.

For this particular meeting today at GI ASCO, I think there will be more interesting immunotherapy data coming out for some of the GI [gastrointestinal] tumors: esophageal, gastric, HCC [hepatocellular carcinoma]. There are very interesting data today looking at how to incorporate immunotherapy in later lines of therapy. In terms of colon cancer, I think we’ll be seeing more on understanding the molecular basis in terms of some additional studies on these large prospective randomized phase III trials like CALGB/SWOG 80405.

Transcript Edited for Clarity