Stein Reviews the Latest Advancements in the Treatment of CRC to be Discussed at ISGIO

Stacey Stein, MD

Stacey Stein, MD

As the 2019 International Society of Gastrointestinal Oncology (ISGIO) Annual Conference heads into its 16th year, experts look forward to hearing more on the latest data to come out this year for the treatment of patients with colorectal cancer (CRC). Some of these advancements include data on targeting mutations such as BRAF or HER2.

Triplet regimens, for instance, have become an area of focus. For instance, the presentation of the phase III BEACON CRC trial presented promising data for a triplet regimen at the 2019 ESMO World Congress on Gastrointestinal (GI) Cancer. The combination of encorafenib (Braftovi), binimetinib (Mektovi), and cetuximab (Erbitux) demonstrated a significant improvement in the overall survival for patients with BRAF V600E—mutant metastatic CRC (mCRC) who had been previously treated.

Attendees at this year’s ISGIO meeting can look forward to hearing more on these data, as well as other recent trials that have helped make an impact in the treatment landscape of CRC.

Currently, clinical trials are assessing ways to target HER2 amplifications. Studies are also investigating sequencing approaches for the targeted therapies and immunotherapies that are currently available for patients with CRC. Research has indicated that 4% of CRC cases have microsatellite instability—high (MSI-H) disease, so treatments for this subgroup of patients is also under investigation.

“ISGIO is a relatively small meeting…but it’s really a nice place to take data from all of the different realms of GI cancer and have them in small presentations with a mix of debates and cases that allow for some real discussion and audience participation,” said Stacey Stein, MD.

In an interview with Targeted Oncology, Stein, assistant professor of medicine at Yale Cancer Center, 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.

TARGETED ONCOLOGY:How have you seen the landscape of CRC evolve over the last few years?

Stein:There haven’t been many new chemotherapy drugs in the last several years. I think studies have mostly been looking at sequencing drugs and thinking about subgroups of patients. [We’re] thinking about the differences between left- and right-sided colon cancer and thinking about smaller groups of patients with specific mutations that might be amenable to other treatments. For instance, there’s been new data with triplet therapy for patients with BRAF mutations. Certainly, it’s been exciting that we were able to identify that 4% of patients with mCRC have MSI-H, and they benefit from immunotherapy.

We are chipping away at small groups to find patients that may benefit from other treatments. Additionally, there are studies that have been looking at HER2-directed therapy for the subset of patients with CRC and HER2 amplification.

One of the biggest challenges is that immune therapy has been the largest change in oncology, the addition of immunotherapy to different disease treatments. In CRC, except for the 4% of patients with MSI-H disease, we don’t have immunotherapy options for the other 96% of patients.

TARGETED ONCOLOGY:What challenges are clinical trials attempting to address now in CRC?

Stein:There are definitely different groups where we are making progress, and new clinical trials are coming up. For instance, the BRAF mutations have [shown some] successes in terms of benefit with triplet therapy, as well as with the HER2 amplification. The largest question that ongoing clinical trials are trying to answer are how do we get the majority of patients with mCRC to have some sort of response to some kind of an immunotherapy combination? There are many trials looking at different strategies and combination therapies to try to address that. There are studies open with CAR T-cell therapy, and there are studies open now with novel immunotherapy combinations. That’s an active part of the phase I teams looking for studies for these patients.

TARGETED ONCOLOGY:What particular advances have you seen over the last 12 months that attendees at the 2019 ISGIO Annual Conference can look forward to hearing more on?

Stein:Some of the practice-changing data that I think are important to disseminate is the importance of thinking about BRAF-targeted treatments, thinking about HER2, and identifying HER2. Often when patients have tumor profiling, that is select just for a colorectal panel and not necessarily the full molecular panel. Traditionally, HER2 has not been a part of that panel, so I think it is important that everybody begins to screen for HER2 amplification.

I think the other study that is a little bit older but there are certainly some ongoing presentations on the data come from the IDEA study, thinking about adjuvant therapy for patients with stage II and III CRC. We’ve identified a low-risk group of patients with stage III disease who seem to get equivalent benefit with less adverse effects when getting 3 months of adjuvant therapy over 6 months. That will be a good discussion at this meeting over which patients we should be thinking about 3-month therapy for and how we can apply that to the stage II patients.

TARGETED ONCOLOGY:As the meeting heads into its 16th year, what are you most looking forward to at this year’s meeting?

Stein:The meeting is nice because it’s a small meeting with a narrow focus on GI cancers. There are a lot of great speakers coming in for the meeting, and it really allows for some good debate and audience participation. I think more than just getting to hear the presentations at larger meetings, this meeting really allows for a robust discussion of some of the nuances of the data and what certain experts are doing in their practice.

We also have some nice cases that are presented by some fellows and junior faculty that get to some of the real-world patient conundrums that we often see. We also get to discuss those in detail.

To learn more or register for ISGIO, please visit:http://www.isgio.org/.