BETHESDA, MdA new National Cancer Institute report lays out a
decade-long research plan aimed at answering major questions in
The report, Conquering Colorectal Cancer: A Blue Print for the
Future, by NCIs Colorectal Cancer Progress Review Group emerged
from a meeting during which some 180 participants assessed what is
known about colorectal cancer and made recommendations for improving
the research effort against the disease.
The report consists of two sets of recommendations, one aimed at
priority scientific questions and the other at overarching and
Priority Scientific Questions
1. Biology. The report identified two high-priority areas for
investigation: defining the biologic controls for the development of
normal and abnormal colo-rectal epithelial development and defining
the pathways of progression of colorectal neoplasia.
2. Etiology. The report emphasized three etiology research
priorities. First, population-based epidemiologic studies that link
genetic polymorphisms, diet and lifestyle variables, and endogenous
factors with the molecular characteristics of colorectal cancer.
Second, validation of early and intermediate biomarkers of exposure
to environmental influences and genetic polymorphisms.
Third, the resequencing of single nucleotide polymorphism-containing
genes involved in carcinogen or hormone metabolism, DNA repair, cell
growth control, and immune response, and assessment of their
functional polymorphisms in molecular epidemiologic studies in
diverse ethnic populations using high-throughput genotyping methods.
3. Prevention. The report gave priority to defining pathways
for nutritional and chemopreven-tive intervention; validating in
human trials the usefulness of surrogate endpoint biomarkers
identified in animal models; and initiating studies of combined
lifestyle and chemopreventive interventions.
4. Early detection and diagnosis. The report gave priority
status to three areas: research into strategies to effectively
implement current recommended methods of early detection; rigorous
clinical evaluation of promising markers and modalities before their
widespread use; and development of new markers and modalities and
improvement in current methods.
5. Treatment and prognosis. The report recommended fostering
uniform delivery of accepted treatments and development of new
regimens for locoregional disease. It also urged expediting new drug
development by identifying intermediate endpoints and surrogate
markers of response. Finally, it sought the comprehensive
characterization of biologic features of both host and cancer to
discover new indicators of prognosis.
6. Cancer control and survivorship. Research should include
studies to identify the best standards of follow-up care after
successful treatment, with a focus on which tests give the most
information about important outcomes such as resectability, survival,
cost, and psychosocial distress.
Researchers need to find ways to identify people at risk of adverse
psychological distress, investigate whether psychosocial factors
affect compliance, and assess the effectiveness of colorectal cancer
screening, prevention, and treatment in the elderly and special populations.
Overarching and Resources Issues
The reports recommendations with regard to overarching
and resources issues include:
1. Genetics. Identify genes that predispose to colorectal
cancer; determine how genetic screening and interventions affect
morbidity, quality of life, and mortality in order to address
counseling issues; and determine whether specific tumor genetic
subtypes exist and how this knowledge can be used to improve drug
development, intervention selection, and prognosis assessment.
2. Environment and lifestyle. Integrate observational
screening and interven-tional approaches into future studies; improve
assessment and characterization of lifestyle and environmental
factors; and improve the biologic coherence of studies by assessing
genetic and environmental factors in studies of the etiology and
pathogenesis of colorectal cancer.
3. Imaging. Apply functional and molecular imaging in
screening, surveillance, and treatment strategies to enhance
monitoring of chemopreventive and chemotherapeutic response; advance
colorectal screening, staging, and surveillance by refining existing
imaging technologies and developing new ones; and rapidly assess the
benefits and risks of emerging imaging technologies.
4. Behavioral and health services. Develop models and methods
that relate to the efficacy, effectiveness, and cost-effectiveness of
intervention strategies, and characterize variations in patterns of
colorectal cancer prevention, screening, diagnostic evaluation, and
Develop and evaluate strategies to improve access to screening,
diagnostic evaluation, treatment, and clinical trials, and increase
participation in clinical trials.
Provide greater interaction among the NCI, the FDA, pharmaceutical
and biotechnology companies, physicians, and patient advocacy groups
in order to foster innovative approaches to drug discovery and