Colorectal Cancer Alliance staff, patient advocates, board of directors, and medical scientific advisors were on-hand at the 2018 Gastrointestinal Cancers Symposium (ASCO GI) in San Francisco, a three-day meeting for oncologists and others in the field to discuss and learn more about the latest cancer science. Several presentations or articles in the conference’s daily news reports focused on colorectal cancers specifically, although a recurring theme of the conference was the need for more research.
Panel discusses the current understanding of young-onset colorectal cancer
A general session provided an overview of young-onset colorectal cancer. Joseph J.Y. Sung, MD, began by highlighting the overall decline of colorectal cancer incidence since the mid-1970s, but increases in certain subgroups that include people under age 55 in the years since. The presentation noted that Americans born around 1990 face double the risk of colon cancer and quadruple the risk of rectal cancer compared with adults born around 1950.
Fay Kastrinos, MD, in a presentation about screening, prevention, and health disparities, noted that since the implementation of population-wide screening, the incidence of colorectal cancer in the US has declined–especially among those older than 50. Yet one-in-ten new cases occur in people under age 50, suggesting a potential need for earlier screening. Evaluation and modeling by the U.S. Preventive Services Task Force, however, show modest benefits to implementing an earlier recommended screening age. Kastrinos notes that many questions remain about the origin of the disease in young-onset patients, requiring further study.
Irit Ben-Aharon, MD, discussed treatment-induced sequelae, psychosocial needs, and unique cancer biology. Among the data presented was a small study finding that FOLFOX-induced amenorrhea during chemotherapy tends to increase with age among premenopausal women. Dr. Ben-Aharon called for further investigation into how to counsel young-onset patients on fertility preservation, quality of life, and survivorship issues.
Howard S. Hochster, MD, discussed a study about whether young-onset colorectal cancer is biologically different from colorectal cancer in older people. Analysis of 22,000 patients showed no difference in gene expression patterns across age groups. Dr. Hochster said identifying the risk of recurrence in young-onset patients is important, as some may be overtreated.
New research: Aspirin use and colorectal cancer survival
A question-and-answer article with Shuji Ogino, MD, PhD, MS, appeared in the conference’s daily news reports, discussing his journal article, “Aspirin Use and Colorectal Cancer Survival According to Tumor CD274 (Programmed Cell Death 1 Ligand 1) Expression Status.” Dr. Ogino explains that the anti-tumor benefits of aspirin are well-documented, and his research shows potentially stronger benefits for patients with CD274 (PD-L1)-low tumors than in CD274-high tumors. Currently, this population-based data provide evidence supporting not only use of aspirin for patients with CD274 (PD-L1)-low colorectal cancers, but will also inform future clinical trials that investigate adjuvant aspirin therapy in targeted patients, including patients with CD274-low colorectal cancer, and patients receiving CD274-PDCD1 (PD-1) immune checkpoint inhibitors. This was the first to support the synergism of aspirin-mediated antitumor pathways and immune checkpoint blockade in human populations. Ogino’s research appears in the Journal of Clinical Oncology.
New ASCO guidelines for addressing sexual problems
Sex and cancer is a “conspiracy of silence,” according to Julia H. Rowland, PhD, of the National Institutes of Health. As such, new ASCO guidelines implores healthcare providers to initiate discussions about sexual function with patients early in the treatment process. Common sexual problems for cancer survivors include decreased desire, arousal disorders, pain (largely in women), and erectile dysfunction in men.
Adjuvant chemotherapy following neoadjuvant treatment in rectal cancer lacks data
In the daily news reports, a group of doctors wrote about the lack of data supporting the use of adjuvant chemotherapy in patients with advanced rectal cancer receiving neoadjuvant therapy. They noted that while adjuvant therapy is well-established in colon cancer cases, treatment in rectal cases continues to evolve. Still, individual factors—such as tumor stage, pathologic characteristics, and post-operative performance—must be taken into account on a patient-by-patient basis to determine appropriate treatment. They note, importantly, that while colon and rectal cancers are often grouped together, they have important differences when it comes to treatment and patterns of recurrence.
Updates to CancerLinQ and CancerLinQ Discovery
CancerLinQ is a platform containing growing amounts of real-world cancer information. The national initiative, involving numerous nonprofits and federal agencies, will allow cancer providers to improve the quality and value of their care by aggregating and analyzing cancer patient medical records and measuring their care against that of their peers and recommended guidelines. CancerLinQ Discovery, meanwhile, is open for research proposals. Any research in the cancer field can access distinct sets of aggregated, de-identified patient data with the purpose of investigating specific research questions.
Report: More than one marker of efficacy can be found
Another question-and-answer article, this one with Steven M. Sorscher, MD, appeared in the conference’s daily news reports, discussing his journal article, “First Case Report of a Dramatic Radiographic Response to a Checkpoint Inhibitor in a Patient With Proficient Mismatch Repair Gene Expressing Metastatic Colorectal Cancer.” Based on Dr. Sorscher’s case report, doctors can now consider next-generation sequencing of tissue or cell-free DNA from patients whose tumors have progressed through standard therapy. The report shows that once a predictive marker of efficacy is identified, it does not rule out the possibility of finding other independent markers of efficacy. The report appears in JCO Precision Oncology.
Colorectal cancer cases are increasing in India, but why?
“We believe the growing number of cancers can be attributed to the Westernization of our diet, which has become more reliant on fast foods, meat, and fatty foods, as well as a more sedentary lifestyle,” said Shailesh V. Shrikhande, MD, in a question-and-answer article. “The role of genetics has not yet been fully investigated.”