At this year’s annual meeting of the American Society of Clinical Oncology, over 400 abstracts related to colorectal cancer (CRC) were presented. Here’s a glimpse into some of the early-age onset CRC research and how biological factors such as hyperlipidemia and the presence of circulating tumor cells may influence prognosis.

 

Early-Age Onset CRC:

  1. EAO-CRC, Infertility, and Sexual Dysfunction: The rates of early-age onset colorectal cancer (EAO-CRC), defined by the incidence of CRC in individuals under 50 years, have been increasing in the U.S. This pattern is even more concerning when considering the negative impact of CRC treatments on fertility and sexual function. Laura Diane Porter and team set out to explore the needs of EAO-CRC patients as they relate to fertility and sexual dysfunction by analyzing data from a questionnaire filled out by 884 EAO-CRC patients and survivors aged 20-50 years. Results from the questionnaire showed that 37% of women and 16% of men were left infertile after their treatments, but only 31% were referred to a reproductive endocrinologist. Additionally, more than 25% of respondents indicated they would have pursued alternate treatments had they known about the negative sexual effects of CRC treatment. These results indicate a need for providers to engage in transparent, supportive conversations with EAO-CRC patients about the impact of CRC treatment on fertility and sexual function

  2. Screening Guidelines for Patients with a Family History of CRC: As the rates of EAO-CRC increase, it is important to consider whether screening guidelines (SGs) accurately aim to detect and prevent it. Currently, there are established SGs on hereditary EAO-CRC, but screening for those with non-hereditary EAO-CRC who are at an increased CRC risk due to a family history of it remains poorly studied. Researcher Y. Nancy You and team aimed to define the proportion of individuals with non-hereditary EAO-CRC who also have a family history of CRC. Additionally, they set out to determine whether SGs could have helped prevent/detect EAO-CRC in this cohort. 329 EAO-CRC patients were analyzed for familial history of CRC, defined as having a first- or second-degree relative with CRC. Results showed that 27% of these individuals had a family history of CRC, and that half of the patients were screened for and diagnosed with EAO-CRC at an age earlier than the current SGs suggest for people with a family history of EAO-CRC. This indicates that refining current SGs for individuals with a family history of CRC can potentially aid in preventing/detecting EAO-CRC.

 

Biological Factors:

  1. Relationship Between CTCs and TILs in Patients with CRC: Circulating tumor cells (CTCs) are cells that have separated from a primary tumor to circulate in the bloodstream. The number of CTCs in the blood affects the risk and rate of metastasis, according to the abstract presented by Inna A. Novikova and team. The team wanted to investigate the association between CTCs and tumor infiltrating leukocytes (TILs), a type of immune cell that recognizes and kills cancer cells by moving from the blood into a tumor. The study included 299 patients with stage II-IV CRC. The number of CTCs in their blood was counted using a blood test, and their TILs were identified via histological processing of their tumor material. Results showed that in patients with moderate to strong lymphocytic infiltration, there was a notable absence of CTCs. Conversely, the presence of CTCs was most often seen in cases of weak lymphocytic infiltration. These results indicate that there is a relationship between CTC levels and the intensity of lymphocytic infiltration, which “can be used as a new prognostic approach.”

  2. Hyperlipidemia and CRC: Hyperlipidemia is a condition in which there are high levels of fat particles (lipids) in the blood. According to the abstract presented by Zahid Tarar and team, recent studies have shown that lipids play a role in tumor metastasis. Thus, the team set out to investigate the effect of hyperlipidemia in patients with a history of CRC, specifically in regard to mortality, hospital length of stay, and cost. Using the National Inpatient Sample Database for the year 2018, the team identified 34,792 patients with a history of CRC and hyperlipidemia. After conducting various analyses, the team found that patients with hyperlipidemia had lower odds of CRC-related mortality. Additionally, hyperlipidemia did not affect hospital length of stay or cost. The team postulated that statin therapy prescribed for patients with hyperlipidemia could have played a role in the lower odds of mortality seen for these patients. Thus, further research into hyperlipidemia’s effects on CRC should be conducted, and future studies should look specifically into the potential protective effects of statins in relation to CRC mortality. 

 

The American Society of Clinical Oncology held their annual meeting from June 4-8, 2021, where over 400 abstracts related to colorectal cancer (CRC) were presented. We at the Colon Cancer Foundation highlight some notable ones related to technological advancements, socioeconomic factors, and clinical care below. 

 

Technological Advancements:

  1. Using AI to Predict CRC progression: What if artificial intelligence (AI) could be used to predict disease progression and mortality in patients with metastatic CRC? That is the question Carlos Maria Galmarini presents in their abstract. By using patient datasets from two randomized phase III clinical trials, Galmarini and team created synthetic “fingerprints” (SFs) for each patient by integrating 44 various clinical features. These SFs were subsequently inputted into a deep learning framework (DLF) to categorize patients based on similarities. The SF/DLF system was able to categorize metastatic CRC into different subtypes based on clinical features that correlate with higher risk of disease progression and mortality, indicating that AI could prove beneficial to the cancer community. 

 

  1. Using miRNA and Machine Learning to Detect Cancer: Circulating microRNA (miRNA) have been associated with certain types of cancers, and their expression profiles are theorized to be cancer biomarkers. As such, Juntaro Matsuzaki and team investigated whether the combination of a novel diagnostic blood test and machine learning techniques could be used as a tool for the early detection of cancer. By processing the serum samples from individuals without cancer and comparing it to individuals with breast, colorectal, lung, stomach, and pancreatic cancer respectively, the team analyzed the entire miRNA expression profile of the samples using next generation sequencing. The expression profile was then used to train machine learning models. The diagnostic model showed an 88% accuracy for all five cancer types, indicating that circulating miRNAs can be useful biomarkers for the early detection of these cancers. 

 

Socioeconomic Factors:

  1. Intersection of Race & Rurality in CRC Surgical Treatment & Outcomes: It is widely known that racial disparities exist when it comes to CRC care, but the intersection of rurality and race on surgical treatments and outcomes among patients with nonmetastatic CRC has not been fully explored. To fill this knowledge gap, Niveditta Ramkumar and team studied 57, 710 Medicare patients who underwent surgery for non-metastatic CRC between 2016 and 2018. The patients were categorized by their race and area of residence, which was classified as metropolitan, micropolitan, and small/rural. Results showed that Hispanic patients and other minorities living in non-metropolitan areas had higher odds of facing 90-day surgical complications compared to individuals living in metropolitan areas. There was no such disparity found for white patients. Additionally, patients from minority groups had higher odds of 90-day mortality in rural areas compared to metropolitan areas, while white patients had lower odds. These results indicate the necessity to further explore the intersection of race and rurality when it comes to CRC treatment and outcomes so that specific guidelines can be enacted to protect patients belonging to vulnerable socioeconomic groups. 

 

  1. Impact of Socioeconomic Status on CRC Care: Socioeconomic factors are known to affect CRC care at all levels, but the research surrounding this topic is limited and conflicting. Therefore, Rajan Shah and team set out to explore how socioeconomic status (SES) affects CRC stage at presentation, receipt of diagnostic imaging and treatment, and overall survival. To meet this end, the team identified and analyzed data from 39,802 colon cancer and 13,164 rectal cancer patients in Canada using the Ontario Cancer Registry. In both cohorts, patients of lower SES were more likely to present at a higher stage, less likely to receive MRIs and other diagnostic tests and treatments, and had a less likely chance of overall survival. These results indicate the importance of focusing on CRC patients of lower SES to eradicate disparities in CRC care. 

 

Clinical Care:

  1. Access to Cancer Care for Medicaid Patients: According to the abstract presented by Victoria A. Marks, one in five Americans are insured with Medicaid. However, the large number of Medicaid patients does not necessarily indicate an increased access to care at Medicaid facilities. Thus, the team investigated the acceptance of Medicaid patients with new cancer diagnoses at various facilities across the U.S. They evaluated access to cancer care for a variety of cancer types (colorectal, breast, urologic, and skin) at hospitals accredited by the Commission on Cancer, and used data from the American Hospital Association and Centers for Medicare & Medicaid Services to study Medicaid access. Results showed that Medicaid acceptance was lowest in for-profit facilities and comprehensive cancer community centers. In hospitals that accepted Medicaid, only 68% of them accepted all four cancer types. These results suggest there are disparities that need to be addressed in regard to cancer care access for Medicaid patients, both between and within facilities. 

 

  1. Influence of Fellowship Training on CRC Post-Operative Outcomes: Christopher Thomas Aquina and team set out to investigate the relationship between fellowship training and surgical outcomes in CRC patients. Using two New York-based patient databases, the team identified patients who underwent stage I-III colorectal adenoma resection between 2004 and 2014. They analyzed the relationship between patient surgical outcomes and surgeon certification via the American Board of Colorectal Surgery. High volume colon surgeons (HVCS) were identified as those who performed more than 15 colon cancer resections annually, and high volume rectal surgeons (HVRS) were identified as those who performed more than 10 annual rectal resections. Results showed that patients with board-certified, HVC/HVR surgeons had better outcomes post-surgery and were associated with improved survival following resection. This suggests that individuals seeking CRC resections should go to board-certified, HVC/HVR surgeons for the best chance of recovery and survival. 

 

 

 

Advancements in screening, diagnosis and treatment of colorectal cancer have come a long way in the past two decades, but the need to continue to spread awareness of the disease among young people and continued industry-wide collaboration and investment is necessary to offset the growth in incidence under the age of 50. Those were among the key topics of the 7th annual Early-Age Onset Colorectal Cancer Summit.

The three-day conference, which was held online in a virtual format because of ongoing Covid-19 precautions, concluded on Sunday, May 16. It was organized by the Colon Cancer Foundation, a New York-based 501(c)3 non-profit organization dedicated to reducing colorectal cancer incidence and death. (Presentations from all three days can be viewed online andCME and MOC credit will be available for 30 days.)

At the outset of the third day of the summit, a panel of distinguished experts addressed the case study of a 28-year-old colon cancer patient from a broad-spectrum approach, offering input on patient perspective, nurse navigation, genetics, medical oncology and new therapeutics, surgery, financial burden/toxicity, radiation oncology, psychological needs, pediatrics and palliative care.

The female patient in the opening panel discussion was described as presenting with a multi-year history of chronic constipation for which she took laxatives. Six months prior to visiting an emergency room, she started experiencing a change in symptoms with tenesmus, rectal pain, bowel urgency with intermittent rectal pressure deep in the pelvic region that worsened with prolonged standing.

At the ER, she had an abdominal/pelvic CT scan that showed presence of a moderate amount of stool in the ascending colon, a thick-walled appearance of the rectum about 6cm from the anal verge down to the anal canal/anorectal junction. Those abnormal symptoms prompted a colonoscopy that showed a non-circumferential mass in the distal rectum to the anal verge. A biopsy returned as invasive moderately differentiated adenocarcinoma.

The patient was described as healthy with a BMI of 22 and had no other medical history and was not taking any medications. The only colorectal family history she had was that her father had several polyps removed after the age of 50.

1. Spreading the message about early-age onset colorectal cancer to young people is crucial so symptoms aren’t overlooked or disregarded.

Often young people ignore or miscategorize their symptoms or are too busy to visit their doctor or aren’t concerned because of a lack of family history or because they lack general awareness about colorectal cancer. In some situations, the initial symptoms have disregarded after being attributed to hemorrhoids or other common benign conditions.

“About 70 to 80 percent of our patients that have colon or rectal cancer do not have a family history of the disease, even if someone in the family had a colonscopy and had polyps removed. I always think it’s important to get pathology of the polyps of family members and also to make sure the parents and siblings of the patients have had colonoscopies.”
Zsofia Stadler, MD, Associate Professor, Clinical Director, Clinical Genetics Service, Memorial Sloan Kettering Cancer Center

“It typically takes about 270 days from the onset of symptoms to diagnosis in young patients because. Most of the time, their symptoms are dismissed as something benign like an upset GI tract that everyone has. As a result, they usually are not given the medical attention that they deserve.”
Manju George, MVSc, PhD, Scientific Director, Paltown Development Foundation.

2. The top priority with younger colorectal cancer patients is curing the cancer, but there other quality-of-life issues are critical.

An ensuing pelvic MRI confirms a tumor that arises from the right lateral wall at the level of the levator. The distal edge of the tumor is at 2cm from the anal verge and the tumor abuts the internal sphincter. It is at clinic stage III (mrT3aN1b). In this kind of case with a distal tumor, sphincter preservation is very unlikely, and local recurrence is higher for distal tumors than for proximal tumors.

All three modalities of treatment would likely be considered for this patient: chemotherapy because she’s at risk of distant spread, radiation for local control and the distal location and an abdominal perineal resection surgery to maximize disease control. But quality of life priorities that must be considered include maintaining fertility and avoiding a permanent colostomy.

“This is a great case because it’s so illustrative of so many issues, but it’s also a terrible case because when you see cases like this you know the discussions are going to be very difficult and there is no perfect solution and compromises are going to need to be made.”

Harvey Mamon, MD, PhD, Associate Professor, Radiation Oncology, Harvard Medical School, Director of GI Radiation Oncology, Brigham And Women’s Hospital, Chief, Division of Gastrointestinal Radiation Oncology

3. Fertility preservation options should be discussed as soon as possible after diagnosis.

When a patient has more time to consider egg harvesting or freezing sperm, they can consider it and accomplish it without significantly delaying the onset of their cancer treatments.

“We do want to see these patients as soon as possible, not only because it gives them more options and more time for options. When we talk to patients about fertility preservation, we want them to take a more bird’s-eye view instead of just whether or not they want to freeze their eggs or sperm. They also have to answer questions about whether they can carry a pregnancy after radiation treatment or do genetic testing in the case of a genetic mutation.”

— Terri L. Woodard, MD, Associate Professor Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center

4. Early psychological and social support is necessary for young colorectal cancer patients.

Early referral for a psycho/social assessment is especially important for adolescent and young adult colorectal patients who will have to transition to a permanent colostomy. Reducing the anxiety and depression related to the necessary changes in daily life, family, jobs, social interaction and more

“As clinical social workers and oncology social workers, the No. 1 goal is making sure we meet that patient where they are at and get a sense of who they are, who their support is, if they have any barriers to care based on their socioeconomic status and understanding workplace issues.”

Krista Nelson, LCSW OSW-C BCD FAOS, President of the Association of Community Cancer Centers

“In my experience working with younger patients, it is such an enormous adjustment and really impacts their quality of life and body image and conversation with family and friends and dating and so many different layers of life. Providing support and psychotherapy around anticipating the adjustment and then making the adjustment to life with a colostomy is hugely important.”

Hadley Maya, MSW, LCSW, Center for Young Onset Colorectal Cancer Clinical Social Worker, Memorial Sloan Kettering Cancer Center

For additional topics addressed in Session IV, view the full presentation online.

Other highlights of Day 3 included breakout sessions about “Understanding and Addressing Disparities in Early-Age Onset Colorectal Cancer” and “Integrating Music Therapy in Cancer” followed by the conference-concluding Session V, a panel discussion titled “How Did This Happen? Investigating the Causes of Early Onset Colorectal Cancers.”

Moderated by Stephen Gruber, M.D., that session addressed the future of early-age onset colorectal cancer that included discussions about mining electronic health record data and integration with large-scale genomic analyses, the international colorectal pooling project, how microbiome interactions contribute to the rise of early-age onset colorectal cancer and how diet, smoking and obesity, as well as maternal obesity and gestation growth.

Gruber stressed the need for continued collaboration and specific investment to help further the fight against the increasing trend of colorectal cancer in younger people.

“This is not a rare disease anymore but at each center there’s a relatively small number of cases,” Cynthia Sears, MD, Professor, Johns Hopkins University School of Medicine. “.  If I can dream, we would create a network, a center of communication and a way to contribute, maybe similar to the TCGA Data Portal – a big data set and some parallel sample collection that would allow, hopefully, the exposure questions to really be pursued. I do think it’s the epidemiology, exposures and sufficient population that we need and it’s hard to get it at one institution.”

In closing remarks, Cindy Borassi, president of the Colon Cancer Foundation, thanked the nearly 300 conference attendees and 50 medical professionals who participated in the seventh annual Early-Age Onset Colorectal Cancer Summit. Sponsors for the summit included Quest Diagnostics, Walgreens, Exact Sciences, Colon Cancer Coalition, Colon Cancer Prevention Project, Taiho Oncology, Daiichi-Sankyo, BRACCO Group, DuClaw Brewing Co. and Squatty Potty

“We invite you to join the discussion, collaborate with thousands of health professionals who are interested in solving the early-age onset colorectal cancer issue,” Borassi said. “I would encourage everyone to tell others to watch the videos on the platform, especially primary care physicians as we all know they are a bit part of the key to solving this issue.”

Day 2 Highlights

Day 2 included the Keynote Address of Stephen Gruber, MD, and Session II, a panel discussion called “The Dimensions of the EAO-CRC Problem: Do We Have Accurate, Regular, Up to Date Measurement of Key Metrics Describing the Early Age Onset Colorectal Cancer Public Health Crisis.” That session included an update about the rising early-onset CRC trends and racial disparities, the impact of COVID-19 on CRC screening and an under-19 incidence and mortality report. Session III was a panel discussion that explored “Risk Assessment/Family History Ascertainment” and included discussions about CRC screening guidelines, increased access to genetic testing and patient access to appropriate care.

Day 1 Highlights

On Day 1, Dr. Whitney Jones, MD, founder of the Colon Cancer Prevention Project, moderated an Session I, a panel discussion about “Improving Earliest Possible Diagnosis and Treatment through Timely Recognition of the Symptoms and Signs of Sporadic Young Adult CRC” with additional topics related to the echo chamber of cyclical discussions, incidence rates and mortality rates by 2040, primary care in improving early diagnosis and a colorectal cancer patient testimonial case study.

To watch any of the presentations, register for the Early Age Onset Colorectal Cancer Summit and access the recorded programs.

The U.S. Preventive Services Task Force (USPSTF)—which is made up of an independent expert physician panel who recommend preventive care guidelines—has proposed initiating colorectal cancer (CRC) screening at 45 years for average-risk adults. This is a B grade recommendation. Screening for those between 50 and 75 years remains an A grade recommendation and screening for the 76 to 85 age group is a C grade recommendation.

An A grade recommendation means there is high certainty of a substantial net benefit, a B grade recommendation means that there is a high certainty of a moderate net benefit or a moderate certainty of a moderate net benefit, and a C grade recommendation means the service should be offered based on professional judgement and an individual patient’s situation because there is a moderate certainty of a small net benefit.

Task Force chair Alex Krist, MD, MPH, said, “Unfortunately, not enough people in the U.S. receive this effective preventive service that has been proven to save lives. We hope that this recommendation to screen people ages 45 to 75 for colorectal cancer will encourage more screening and reduce people’s risk of dying from this disease.” The Task Force has particularly recognized the disproportionately high number of CRC incidence and mortality among Black Americans and has urged physicians to offer this screening to their Black patients starting 45 years.

Both direct visualization (colonoscopy, CT colonography, flexible sigmoidoscopy, and flexible sigmoidoscopy with FIT) and stool-based tests (HSgFOBT, FIT, and sDNA-FIT) are included in the screening recommendation.

The draft recommendation is open for public comment till November 23.

A recently published white paper by the American Gastroenterological Association (AGA) titled “Roadmap for the Future of Colorectal Cancer Screening in the United States” states that the development of structured organized screening programs is vital to achieving target colorectal cancer (CRC) screening rates and reductions in CRC morbidity and mortality. The paper includes information shared at the AGA’s Center for GI Innovation and Technology’s consensus conference in December 2018, which outlined the following priorities:

  • Identify barriers to screening uptake
  • Assess the efficacy of available screening diagnostic methods
  • Consider the potential integration of novel diagnostic approaches into screening and surveillance paradigms

 

The paper highlights the following strategies:

Modifications to CRC Screening to Improve Uptake and Outcomes

Although over 1,700 organizations across the 50 states signed onto the “80% by 2018” initiative announced by the National Colorectal Cancer Round Table (NCCRT) in 2014, one-quarter of eligible Americans are yet to undergo CRC screening. Organized screening offers an opportunity for screening improvements by the use of multiple strategies, such as defined target populations, timely access and follow-up, and systematic opportunities for shared decision-making between patients and clinicians. It can also improve efficiency by incorporating noninvasive testing such as annual mailed fecal immunochemical (FIT) tests and colonoscopy alternatives like stool testing. Multiple studies have shown that offering stool testing as an option, in addition to colonoscopy, increases screening uptake, however a diagnostic colonoscopy is still necessary to confirm positive noninvasive test results.

Racial, socioeconomic, and geographic health care disparities also limit screening efficacy. African American and Hispanic American communities and individuals in rural areas in particular face screening barriers, accounting for 42% of the disparity in CRC incidence and 19% of the disparity in CRC mortality between black and white individuals.

The following strategies were discussed to resolve these issues:

  • Incorporate adjunct noninvasive testing to improve screening rates
  • Minimize the ineffective practice of performing re-screening and surveillance colonoscopy sooner than recommended by guidelines
  • Reconsider surveillance strategies for individuals with a history of adenomatous polyps to prevent constraining colonoscopy resources

 

Continued Development of Noninvasive and Minimally Invasive screening Tests

The paper states than an ideal, noninvasive test would “identify lesions with high short-term potential to progress to CRC and should do so with high sensitivity and specificity in a convenient, low-risk, low-cost, and operator-independent manner” that is easy to complete and should achieve high uptake among individuals who are eligible for screening. While an ideal test is yet to be developed, the FIT test and a blood test currently face the least resistance from patients. The researchers propose the development of a noninvasive test that is capable of detecting advanced adenomas and advanced serrated lesions while also being minimally invasive and easy-to-use with a one-time sensitivity and specificity of a minimum of 90%.

 

Improved Personal Risk Assessment for Optimal Programmatic Screening

Current risk assessment guidelines focus on familial and personal colorectal neoplasia risk, but do not acknowledge additional factors such as sex, race, smoking, body mass index, and environmental factors. Family history can be challenging to obtain due to a lack of patient awareness and the health care provider’s limited ability to derive and record the information. The researchers have proposed using patient portals with integrated electronic health record to ensure updated and accurate family health history data and to allow health care providers the ability to accurately assess the patient’s risk by looking at the data in the portal, irrespective of their geographic location. Improved personal risk assessment would help health care professionals select the appropriate CRC screening test method. For example, individuals with a higher risk of advanced adenoma or CRC would be directed to a colonoscopy, while individuals with a lower risk would be directed to a less-invasive screening method.

 

Although initiatives like the 80% by 2018 proposed by the NCCRT are a good step towards increased screening rates, the development of organized screening programs is necessary to further these efforts even more. The desired goal of these screening efforts is testing that is available to at-risk individuals, noninvasive testing methods that are highly accurate and easy to use, increased screening uptake, and reduction in CRC incidence.

 

 

 

 

 

 

 

 

 

At the virtual American Society of Clinical Oncology (ASCO) annual meeting in May/June 2020, promising results from the interim analysis of phase 3 data from the KEYNOTE-177 trial were presented during the plenary session. First-line treatment of a subset of patients with metastatic colorectal cancer (mCRC) with the immunotherapy drug pembrolizumab doubled the median progression-free survival (PFS) compared to patients treated with standard-of-care chemotherapy. This has now led to an FDA approval for the drug.

Trial Results

KEYNOTE-177 was designed as a global, multicenter, open-label, active-controlled, randomized trial that compared treatment of 307 previously untreated patients with microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) mCRC. Mismatch repair is an inherent property of cells that allows them to correct DNA replication errors, and dMMR cell lack this process, resulting in mutations in the DNA. dMMR cells with alterations in short, repetitive DNA sequences are called MSI-H.  Patients were randomized to receive first-line pembrolizumab alone at 200 mg every 3 weeks for up to 2 years or investigator’s choice chemotherapy: FOLFOX (fluorouracil [5-FU], leucovorin, and oxaliplatin) or FOLFIRI (5-FU, leucovorin, and irinotecan) every 2 weeks, with or without bevacizumab or cetuximab.

This was a crossover trial, meaning patients on chemotherapy could cross over to receive pembrolizumab for up to 35 cycles if their disease had progressed. Primary end points were PFS and overall survival (OS); objective response rate (ORR) was the secondary endpoint.

Median PFS was 16.5 months in the pembrolizumab group and 8.2 months in the chemotherapy group. Pembrolizumab showed a 40% reduction in the risk of disease progression (P=0.0002); PFS rates were 55% vs 37% for pembrolizumab vs chemotherapy, respectively, at 12 months, and 48% vs 19%, respectively, at 24 months. ORR were 43.8% and 33.1%, respectively. While the median duration of response was 10.6 months for chemotherapy (2.8-37.5 months), it had not been reached with pembrolizumab (2.3-41.4 months). Complete responses were achieved in 11.1% and 3.9% patients receiving pembrolizumab vs chemotherapy, partial responses were achieved in 32.7% vs 29.2%, respectively.

Only 22% of patients in the pembrolizumab arm had treatment-related adverse events (TRAEs) compared to 66% in the chemotherapy arm. One TRAE death was reported in the chemotherapy arm.

The study is ongoing and OS data are expected to be presented at a later time.

FDA Approval

The above results have led to the FDA approval of pembrolizumab in previously untreated patients with MSI-H/dMMR mCRC. Importantly, this is the first immunotherapy to receive FDA-approval as first line of care in this patient population.

The Coronavirus pandemic has many Americans putting life on hold, bracing for the new normal that is social distancing and staying home during these uncertain times. For many the pandemic has also delayed lifesaving screenings as the Centers for Disease Control and Prevention (CDC) has urged patients to delay any elective surgeries or procedures at this time such as your routine colonoscopy. According to the American Cancer Society, Dr. Rich Wender, Chief Cancer Control Officer for the ACS, stated:

“The American Cancer Society recommends that no one should go to a health care facility for routine cancer screening at this time…Remember, these screening tests save lives. When restrictions lift, it’s important to reschedule any screening test that you’re due to receive…Getting back on track with cancer screening should be a high priority.”

These recommendations have affected those seeking routine colonoscopies, which the American Cancer Society recommends that people at average risk* of colorectal cancer start regular screening at age 45, and every 10 years thereafter. Even with a family history of colorectal cancer or previous instances of cancer and/or polyps, colonoscopies in these instances would still be considered elective non-urgent procedures. Upcoming procedures would need to be rescheduled for the future. Some surveillance colonoscopy could be a higher priority and may need to be performed.

*For screening, people are considered to be at average risk if they do not have:
A personal history of colorectal cancer or certain types of polyps
A family history of colorectal cancer
A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
A confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC)
A personal history of getting radiation to the abdomen (belly) or pelvic area to treat a prior cancer

 

For the latest information related to the Coronavirus pandemic please visit the CDC website.

In the cancer community usually, immune cells in a tumor can improve one’s chances of survival. However, a new study recently found that colorectal cancer patients with too many immune cells may be at risk for disease recurrence and increased risk of death.

New research from City of Hope, an independent research center, published a study in the Journal of Clinical Investigation that offered insight that the standard view of immunology as a positive may adversely affect colorectal cancer patients. 71 patients with colorectal cancer at the City of Hope had immune cells and all of the patients relapsed – all even earlier than those who did not have the immune cells are still relapsed. The researchers hypothesized that the patients’ immune systems were on overdrive.

The study offered new insight into immunotherapy and Immunoscore, which is a recent benchmark that may predict the risk of colon cancer recurring in survivors. City of Hope has identified new recurrence insight based on their studies and hope to apply the same techniques to breast cancer patients and eventually melanoma and lung cancer.

Read more about the study and ask your physician about any questions you may have. 

 

Since the American Cancer Society reduced its screening guidelines for colorectal cancer, it’s no surprise that more young adults are affected by early age onset colon cancer. What is surprising, and just as alarming, is that more young adults are dying from colorectal cancer.

According to the American Cancer Society, the United States has seen a 51% increase in colorectal cancer in those under 50-years-old since 1994. The American Cancer Society reduced its screening guidelines for those at standard risk to 45-years-old because of the rise in early age onset colorectal cancer.

Despite the change in screening standards, mortality rates are increasing for those with early age onset colorectal cancer. According to Colorectal Cancer Alliance research, 67% of young early age onset colorectal cancer patients saw anywhere from two to four doctors before being diagnosed. This means that many patients were slow to recognize their symptoms, which can aid in early detection. 

Early symptoms may include: 

  • A change your bowel habits
  • Diarrhea and constipation
  • Frequent gas, bloating or cramps

 

Learn more about the common symptoms of colorectal cancer and educate your loved ones on how to get screened on our blog. If you have any questions, please reach out to us in the comments.

 

With the recent announcement of lowering the standard screening age to 45-years-old, it’s no surprise that colon cancer is on the rise among young adults in developed countries. Despite rates decreasing in older adults  due to increased screening, early-age onset colorectal cancer continues to affect Americans nationwide.

According to the study, colon cancer rates remained the same in 14 countries, fell in three countries and rose in 19 countries. Italy, Austria and Lithuania were the only countries to see a decrease in colon cancer rates among those under 50-years-old.

In America, and most of the other 19 countries were colon cancer rates increased, researchers indicated that the increase in diagnoses occurred in the mid 1990s. While there is no specific reason indicated in the study for the increase, many scientists agree that lifestyle choices often play a role in developing colon cancer. Increasing your exercise and reducing processed meat may decrease your chance of developing cancer.

However, the best thing that you can do is make sure that you get screened and encourage your loved ones too. If you are concerned about you or a loved one developing colon cancer, learn more about early-onset colon cancer. You should get screened at 45-years-old if you have an average risk and earlier if you have a family history of colorectal cancer.

For more information on early-age onset colorectal cancer, please reach out to us at info@coloncancerchallenge.org or (914) 305-6674.