Unmet Needs and Future Perspectives on Colorectal Cancer


A panel of expert oncologists offer closing thoughts on the future treatment landscape and unmet needs in colorectal cancer.


Cathy Eng, MD, FACP, FASCO: We’ve had a really great discussion today. But before we close, I’d love to get the opinion of all of you regarding unmet needs and colorectal cancer and future perspectives. So, Dr Kamath, I’m going to give you the first opportunity to answer that question of what you believe is an unmet need and future perspectives.

Suneel Kamath, MD: Definitely. I think to me the biggest unmet need, and it’s shocking in 2023 to still be talking about, is the need to do biomarker testing consistently. There’s literature that seems like it was from the 1990s, and it was just published last year showing the testing rates are 60% or 70% in many settings. And I think it’s just something we have to do, and we have to learn to do it consistently. Especially as a number of targets evolve, like we’ve discussed here with HER2 [human epidermal growth factor receptor 2]. It’s just something we must do early and do it consistently. I think by far that’s the greatest unmet need in my mind.

Cathy Eng, MD, FACP, FASCO: Thank you. And Dr Foote.

Michael Foote, MD: Yes. I really envision a world where I believe very strongly that circulating tumor DNA [ctDNA] is going to really help guide our management decisions. Maybe provocatively, I could even say we might not need scans anymore. We might just go off of molecular burden of disease or what sub-clone tends to be the most active at any current time. It’s very difficult to study that sort of thing but I think being able to use circulating tumor DNA intelligently is a really big topic of discussion in our field. And I think the trials that we talked about today are going to be huge steps forward for that.

Cathy Eng, MD, FACP, FASCO: And Dr Dasari.

Arvind Dasari, MD, MS: So, I’m going to take a step back and say today we’ve talked about treating patients with colorectal cancer that’s established or progressed, but perhaps a key unmet need is screening and preventing this. And I wish all of us would be out of business. So, I think we need increased and more efficient screening.

Cathy Eng, MD, FACP, FASCO: And last, but not least, Dr Parikh.

Aparna Parikh, MD: That was a good one. Earlier, I was like, is he going to mention early detection or earlier stage disease? But I think on the back end what is still striking to me is our home run for colorectal cancer, we just talked about it with SUNLIGHT (NCT04737187), which is still a 3-month OS [overall survival] benefit. And it’s bevacizumab, and we’re talking about bevacizumab is the gift that keeps on giving, but the gift is still a small gift. And so yes, the biomarkers are incredible.

I think the KRAS G12C story was exciting and now we have other G12C and pan-KRAS and pan-RAS, and that could revolutionize colorectal cancer treatment. But I’m still hopeful whether it’s ADCs [antibody-drug conjugate] or new ways of thinking about immunotherapy that maybe we’ll be able to get that needle for the far majority of patients who don’t have the biomarkers beyond that 3-month OS benefit.

Cathy Eng, MD, FACP, FASCO: And I’m going to give myself a little bit of spotlight for a second. So, my unmet need is still focusing on our early onset patient population and how we need to recognize that patients do need to be screened starting at the age of 45, as you mentioned. But also recognizing that when a patient has symptoms that do not resolve, they need to be screened. And the reality is, we are seeing many patients in their 20s and 30s who have sporadic development of colorectal cancer. So, please reach out to your primary care doctor, your gynecologist, any physician, or your acute care clinic around the corner if you’re having any symptoms that do not resolve because we’d rather diagnose you earlier than with stage IV disease.

So, thank you to our faculty for joining us in this lively discussion on the treatment of patients with metastatic colorectal cancer, brought to you by Cancer Network. And thank you to our viewing audience. We hope you found this interactive discussion to be informative and beneficial to your clinical practice. Thank you so much.

Transcript edited for clarity.

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