Colorectal Cancer

The present and future benefits of telehealth in oncology can be observed through Tahoe For­est Cancer Center and its affiliation with the UC Davis Cancer Center, use of other remote clinics, and participation in virtual tumor boards. Even though there are roadblocks to telehealth reaching more locations and more patients, the potential benefit warrants the time needed to get over those hurdles.

In an interview with Targeted Oncology at the 2019 Ruesch Center Symposium, Benjamin Weingberg, MD, shared key points from his discussion on mining the microbiome in patients with colorectal cancer and summarized the treatment landscape for patients with metastatic disease. He also discussed an upcoming basket trial that uses liquid biopsies to place patients on treatment plans that will be most effective for their individual needs.

Recent study results suggest that guideline recommendations for biomarker testing in metastatic colon cancer are not consistent with real-world care. A retrospective review of the COTA Real World Data database showed suboptimal adherence to testing guidelines for RAS, BRAF, and microsatellite instability (MSI)/mismatch repair deficiency in this patient population.

The FDA has accepted a supplemental new drug application for the combination of encorafenib and cetuximab for the treatment of patients with advanced&nbsp;BRAF&nbsp;V600E-mutant metastatic colorectal cancer, following 1 or 2 lines of therapy, Pfizer, Inc. reported in a press release.<br /> &nbsp;

Historically, colorectal cancer has been viewed as a common cancer among elderly patients. The average age at diagnosis of patients with colorectal cancer in the United States is 67 years,&nbsp;in which a screening colonoscopy remains the gold standard of care for prevention and is recommended for all individuals &gt;50 years of age.

New results from the KEYNOTE-164 trial have shown that patients with previously treated microsatellite instability-high DNA mismatch repair advanced or metastatic colorectal cancer who received pembrolizumab responded well to the drug.

A retrospective study has shown that only 40% of patients with metastatic colorectal cancer received biomarker testing prior to treatment, as recommended in the National Comprehensive Cancer Network guidelines. As a result, patients receive less effective therapies and experience serious adverse events, according to a press release from Guardant Health.

Benjamin Weinberg, MD, discusses&nbsp;his treatment decisions for patients with metastatic colorectal cancer and the role of cetuximab in this patient population.

In an interview with&nbsp;Targeted Oncology, Fr&eacute;d&eacute;ric Lehmann, MD, discussed the results for the alloSHRINK trial that were presented at the SITC 34^thAnnual Meeting. The allogenic CAR T-cell therapy, CYAD-101, in association with FOLFOX chemotherapy showed promising antitumor activity in patients with refractory mCRC.

Immotherapuetic agents have grown in popularity for treating mismatch repair&ndash;deficient (dMMR) metastatic colorectal cancer, becoming the standard of care in the second line, <strong>Howard Hochster, MD</strong>, told an audience at the 2019 Gastrointestinal Oncology Conference. Furthermore, ongoing clinical trials suggest that these agents may play a larger role in treating CRC going forward.

In patients whose solid<strong> </strong>tumors harbor a mutation in <em>KRAS </em>G12C, therapy with MRTX849 has produced promising responses and acceptable toxicity across 3 tumors types, according to data presented at the 2019 American Association for Cancer Research&ndash;National Cancer Institute&ndash;European Organization for Research and Treatment of Cancer International Conference on Molecular Targets and Cancer Therapeutics.

Precision and personalized medicine targeting driver mutations has revolutionized cancer care in the past decade. Targeted therapy has entered the world of colorectal cancer research with the identification of mutations in KRAS and BRAF genes.

The emergence of resistance mutations in patients with cancer who receive targeted therapies is an expected development that will require new diagnostic methods of identifying the mechanisms through which these alterations occur, according to Fei Dong, MD, during the 2019 Association for Molecular Pathology Annual Meeting.<br /> &nbsp;

In an interview with&nbsp;<em>Targeted Oncology</em>, Benjamin Weinberg, MD, discussed the treatment options available for the various subpopulations in mCRC.<br /> &nbsp;

Heinz-Josef Lenz, MD, FACP, discusses the advances in immunotherapy for treatment of metastatic colorectal cancer.

Scott Kopetz, MD, PhD, explains how prognoses for patients with colorectal cancer differ based on whether their cancer is left-sided or right-sided and discusses how knowledge of these differences have led to the development of more agents to treat both groups of patients.

The combination of onvansertib, a third-generation adenosine triphosphate inhibitor, with FOLFIRI and bevacizumab achieved positive responses in patients with metastatic colorectal cancer in the second-line setting, according to the results of a phase Ib/II reported in a press release from Trovagene, Inc.<br /> &nbsp;

The FDA has approved a supplemental New Drug Application for a single dose of aprepitant injectable emulsion for intravenous use in patients receiving moderately emetogenic chemotherapy. The approval expands the dose for aprepitant to include a 130 mg single-dose regimen for the prevention of acute and delayed chemotherapy-induced nausea and vomiting.<br /> &nbsp;

In an interview with Targeted Oncology, Tanios Bekaii-Saab, MD, discussed the results of the BACCI and MOUNTAINEER studies, which showed promise for the use of PD-1/PD-L1 combinations over single-agent treatment in patients with metastatic&nbsp;colorectal cancer.&nbsp;

Treatment targeting molecular pathways such as <em>BRAF, </em>HER2<em>,</em> and <em>RAS</em> has typically been reserved for later lines of therapy for patients with metastatic colorectal cancer. Benjamin A. Weinberg, MD, said that agents targeting these pathways are not yet ready for the upfront setting, but data from ongoing trials suggest that these agents may eventually have a role to play in first- and second-line treatment.

Immunotherapeutic agents have grown in popularity for treating mismatch repair&ndash;deficient metastatic colorectal cancer, becoming the standard of care in the second line, Howard Hochster, MD, told an audience at the 2019 Gastrointestinal Oncology Conference. Furthermore, ongoing clinical trials suggest that these agents may play a larger role in treating CRC going forward.

In a presentation at the 2019 ESMO Congress on a case series of 7 pretreated patients with <em>NRG1</em>-positive tumors, Stephen Liu, MD, and colleagues discussed the efficacy of afatinib and explained that afatinib may be a potential treatment option for <em>NRG1</em>-positive tumors across multiple cancer types.

In an interview with <em>Targeted Oncology</em>, Kasi, assistant professor of oncology and senior associate consultant in the Division of Hematology/Oncology at the University of Iowa, Holden Comprehensive Cancer Center, discussed the current role and utility of liquid biopsy in colorectal cancer, and what he&rsquo;s looking forward to bringing up during the 2019 ISGIO Annual Conference.

The addition of direct oral oral anticoagulants for the management of venous thromboembolism in patients with cancer is the latest change to previous guidelines issued by the American Society of Clinical Oncology.

Using a measure known as the growth modulation index, patients with TRK fusion&ndash;positive cancers who were treated with larotrectinib had a clinically meaningful improvement in progression-free survival compared with the time to progression on their prior treatment, an analysis of patients enrolled in 1 of 3 clinical trials has found.

Three clinical trials presented at the 2019 ESMO Congress show that the tropomyosin receptor kinase&nbsp;inhibitor larotrectinib continues to show anti-tumor activity, including long-lasting objective responses and low toxicity, according to results from an integrated analysis.

Best practices for targeting colon cancer was the topic of discussion during a&nbsp;Targeted Oncology live case-based peer perspectives presentation led by John H. Strickler, MD.

Gulam A. Manji, MD, PhD, discusses the need to identify mutations that may be actionable in patients with colorectal cancer. The identification of such mutations can further impact patient survival and improve efficacy, says Manji, in both CRC and other gastrointestinal cancers.

The FDA has expanded the indication for the Cologuard noninvasive screening test for colorectal cancer to include eligible patients with an average risk of developing colorectal cancer who are between the ages of 45 and 49.

In an interview with Targeted Oncology, Stacey Stein, MD, discussed what attendees can expect to learn about at the 2019 ISGIO Annual Conference in terms of the treatment landscape for CRC. She also highlighted some of the recent advancements that physicians treating CRC should be aware of heading into this meeting.