Leading expert in colorectal cancer, Dr. David Kerr, MD, explains how the future of colon cancer treatment hinges on wider adoption of molecular prognostic markers, better patient selection for chemotherapy, and the development of new medications targeting pathways like WNT signaling. He emphasizes the critical role of a multidisciplinary team approach for advanced diagnostic decisions and aggressive treatment of metastatic disease using surgery and ablation, while also highlighting the current challenges of tumor resistance to immunotherapy and the urgent need for novel therapeutic agents.
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Future of Colorectal Cancer Treatment: Precision Medicine and New Therapies
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- Molecular Prognostic Markers in Colorectal Cancer
- Immunotherapy Challenges in Colon Cancer
- New Medication Pathways: WNT and Epigenetics
- Optimizing Existing Chemotherapy and Medications
- Advanced Imaging Techniques for Diagnosis
- Multidisciplinary Team Approach to Care
- The 5- to 10-Year Treatment Horizon
Molecular Prognostic Markers in Colorectal Cancer
Precision medicine in colorectal cancer is advancing through the wider adoption of molecular prognostic markers. Dr. David Kerr, MD, states that genomic profiling of tumors will become standard practice. These markers are crucial for better patient selection, particularly for adjuvant chemotherapy in both colon and rectal cancer.
This approach uses clever molecular biology to match existing chemotherapy medications with the patients for whom they will work best. The integration of these sophisticated models is a key trend in personalizing colon cancer treatment and improving outcomes.
Immunotherapy Challenges in Colon Cancer
Colorectal cancer has proven therapeutically challenging for immune checkpoint modulation. Dr. David Kerr, MD, explains that while people are excited about immunotherapy for cancers like melanoma and lung cancer, it only works on a small subset of colorectal tumors. The majority of colon cancer tumors are immune-evasive and resistant to this form of treatment.
This resistance makes colorectal cancer a difficult situation to resolve and underscores the desperate need for new medications that can overcome this biological hurdle.
New Medication Pathways: WNT and Epigenetics
New medication candidates acting on specific molecular pathways represent a significant future advance. Dr. David Kerr, MD, highlights promising research into the WNT signaling pathway and enzymes involved in the epigenetic control of tumors. He predicts that within the next five years, we will see new drugs developed to target these mechanisms.
This research into the fundamental biology of colorectal cancer aims to provide new targets for therapy and help prevent cancer recurrence by better understanding the tumor microenvironment.
Optimizing Existing Chemotherapy and Medications
Teaching old medications new tricks is a valuable strategy for improving colon cancer therapy. Dr. David Kerr, MD, points to the potential of aspirin use in conjunction with molecular markers as having good potential. This concept involves the more intelligent use of conventional chemotherapy, supported by molecular tumor markers.
The goal is to maximize the efficacy of existing treatments while the search for novel agents continues, ensuring patients receive the most effective personalized medicine available now.
Advanced Imaging Techniques for Diagnosis
Better imaging is critical for the aggressive treatment of metastatic colorectal cancer. Dr. David Kerr, MD, notes that we will use PET-CT more to accurately stage disease and monitor response. This advanced imaging supports more invasive procedures like radiofrequency ablation and surgery for metastases by enabling better patient selection.
Improved radiotherapy techniques also allow for delivery to precise tumor fields more safely, though Dr. Kerr considers this a marginal source of benefits compared to other advances.
Multidisciplinary Team Approach to Care
A multidisciplinary approach is paramount for making optimal diagnostic and treatment decisions. Dr. David Kerr, MD, emphasizes that this team setting is most important for managing complex metastatic colorectal cancer cases. It brings together surgical, medical, and radiation oncologists with diagnostic experts to create a comprehensive treatment plan.
This collaborative model ensures that patient selection for aggressive treatments is thorough and that care is coordinated, which is a cornerstone of the best colorectal cancer treatment centers.
The 5- to 10-Year Treatment Horizon
The future of colorectal cancer treatment on a 5- to 10-year horizon involves a combination of biological discovery and clinical application. Dr. David Kerr, MD, discusses the evolution of treatment, noting that while there have been few new medications in the last decade, the field is poised for change. The main challenges remain overcoming therapeutic resistance and developing effective new agents.
Dr. Anton Titov, MD, concludes that this important work will require extensive international cooperation, impacting not only downstream discoveries but also upstream factors of health policy and cancer care organization for patients worldwide.
Full Transcript
Dr. Anton Titov, MD: What is the future in colorectal cancer treatment? There are so many advances. There is targeted colon cancer therapy, colon cancer diagnostics, and precision medicine.
Dr. Anton Titov, MD: How do we see colon cancer treatment evolve in the next several years? Maybe on a 5- to 10-year horizon. What are the main challenges for colon cancer therapy and rectal cancer treatment? Where will most advances be in treatment of colorectal cancer patients?
Dr. David Kerr, MD: Colorectal cancer has proven therapeutically challenging. Sometimes we look at adjuvant chemotherapy for colorectal cancer. There were no new colon cancer treatment medications in the last 10 or 12 years. The majority of colorectal cancer tumors are resistant to tumor modulation. Colon cancer is resistant to immunotherapy.
People are excited about immune therapy for lung cancer, melanoma, and renal cancer. Immune checkpoint modulation medications work in those cancers. But immune modulation works maybe on a small subset of colorectal cancer tumors. Most colon cancer tumors are immune-evasive. Colorectal cancer treatment is a difficult situation to resolve.
We will see more sophisticated modeling of prognostic molecular markers for colorectal cancer. We discussed genomic profiling of colon cancer tumors. We will see wider adoption of molecular prognostic markers in colorectal cancer.
We will use molecular tumor markers in selecting patients for adjuvant chemotherapy of colon cancer and rectal cancer.
There are interesting molecular pathways in colorectal cancer tumors. WNT signaling and enzymes involved in epigenetic control of colon cancer tumors. We will see in next five years new medication candidates that act on these molecular pathways in colorectal tumors.
There are colon cancer treatment opportunities in "teaching old medications new tricks". Aspirin use with molecular markers in colon cancer treatment has good potential.
We will see more use of molecular tumor markers in conventional chemotherapy of colon cancer. We will use clever molecular biology. It will match existing chemotherapy medications with colon cancer patients for whom chemotherapy treatments would work best.
We will see better imaging of colorectal cancer tumors. We will use PET-CT more. We now treat metastatic colorectal cancer much more aggressively in a multidisciplinary team setting. We use radiofrequency ablation and surgery to treat metastatic colorectal cancer.
I think we need to better select patients for these very invasive procedures to treat colon cancer. We will see better use of diagnostic imaging and molecular markers.
We will support colon cancer treatment decisions better. Radiotherapy of colon cancer has improved. It is not a very large improvement. We can deliver radiotherapy to precise colon cancer tumor fields. We use radiation therapy more safely to treat colorectal cancer. It is a marginal source of benefits now. We will see more improvement in radiation therapy for colon cancer.
Dr. Anton Titov, MD: Better understanding of the biology of colorectal cancer will bring new targets for medications to treat colorectal cancer. Better understanding of the microenvironment of colon cancer tumor will help in prevention of cancer recurrence.
Dr. David Kerr, MD: Multidisciplinary approach is most important for better diagnostic decisions and patient selection for treatment of colorectal cancer. But we desperately need new medications to treat colorectal cancer. Now I do not see new medications on the horizon at all.
Dr. Anton Titov, MD: It is very important work in colorectal cancer. It will require a lot of international cooperation too. Thank you very much for this very stimulating discussion about colon cancer treatment. It's very exciting research that you are doing together with your international colleagues.
Your work in public health aspects of cancer treatment is especially important. Because colon cancer therapy success depends not only on "downstream" discoveries to treat colon cancer. It also depends on "upstream" factors of health policy and cancer care organization. This is important for all colorectal cancer patients around the world.
Thank you very much for this conversation. Hopefully we will be able to return to you in the future!
Dr. David Kerr, MD: Thanks again! Colorectal cancer best treatment options will include precise tumor profiling and selection of chemotherapy based on tumor mutations. Multidisciplinary team.