Kristen K. Ciombor, MD, MSCI, gives an overview of the current treatment landscape for patients with metastatic colorectal cancer.
Kristen K. Ciombor, MD, MSCI, recently spoke at an Around the Practice® discussion regarding treatment updates, molecular testing options, and emerging targets in the world of metastatic colorectal cancer (CRC). She discussed these updates with CancerNetwork® and highlighted ongoing research in the space, the importance of multidisciplinary care for patients with CRC, and the most important presentations from the 2023 European Society for Medical Oncology (ESMO) Congress.
At Vanderbilt, we have a lot of clinical trials open. Those like the phase 3 BREAKWATER [NCT04607421] and the phase 3 MOUNTAINEER-03 [NCT05253651] trials are about to open at our institution.1,2 We’re thinking early on in terms of targeted treatment options for patients with CRC. There are good standard-of-care options from the beginning that are targeted: for instance, immunotherapy for patients who have microsatellite instability [MSI]–high [disease]. Then we have a lot of chemotherapy options, even for patients who are not in clinical trials. The good thing is, in CRC, we’re adding more regimens because patients often need a variety of treatments over the years.
Multidisciplinary care is essential in CRC. One of the most fun things about my job is interacting with my colleagues, who are colorectal surgeons, surgical oncologists, pathologists, radiation oncologists, interventional oncologists, and radiologists. All those people are behind the scenes. Sometimes they’re in front of the patients as well, but all of them are working together with me to ensure the care of the patient is optimal.
I’m hoping that we see more treatment options for patients and we identify more patient subtypes that we can target and find actionable alterations for. I also hope that we find more treatments that are durable. We’re seeing that a little bit in immunotherapy and even with some of the trastuzumab [Herceptin]/tucatinib [Tukysa] data. However, I’d like to see more treatment options that are less toxic and more durable in terms of response.
At ESMO, we [presented] some more biomarker data on the phase 2 MOUNTAINEER study [NCT03043313].3 I’m also interested in looking at some updated data in the phase 3 KEYNOTE-811 trial [NCT03615326] in the esophageal space.4 I know it’ll be a great meeting, as they always are.
I think the biggest takeaway for me is that there are so many options in the HER2- amplified space in CRC, which is nice to see. It takes some thought. It is specific to CRC because how we treat HER2-positive breast cancer is not how we treat HER2-positive CRC. The nuances of the data are key. Knowing how to apply those in each individual patient is important.
I have an ongoing phase 2 ECOG study, ECOG-ACRIN [EA]2201 [NCT04751370], which is looking into the rectal cancer space for [patients]with MSI-high, locally advanced rectal cancer being treated with immunotherapy.5 [Patients are given] nivolumab [Opdivo] and ipilimumab [Yervoy] plus or minus 4 courses of radiation. We’re currently at the interim analysis, and we’re looking forward to seeing the results of that soon.