Innovative approaches in the management of gastrointestinal cancers

Innovative approaches in the management of gastrointestinal cancers

Molecular characterisation of tumour subtypes and immunotherapy are key areas attracting researchers’ efforts that may shape the future of clinical practice, according to ESMO President Prof. Andrés Cervantes 

The management of gastrointestinal cancers – which today account for one in four cancer cases globally - has progressively evolved to a more molecular-based approach. Whilst precision oncology has been opening new opportunities of care for patients, it is also leading to new challenges for medical oncologists. With its new disease-oriented scientific congress dedicated to the malignancies of the gastrointestinal tract, just announced, ESMO confirms its commitment to serve professionals worldwide to make global research progress in the field, as ESMO President Prof. Andrés Cervantes highlights. The first ESMO Gastrointestinal Cancers Congress will take place in Munich, Germany, 26-29 June 2024.

How does a more central role of precision oncology in the management of gastrointestinal cancers impact on the daily clinical routine of medical oncologists today?

Precision oncology has revealed that gastrointestinal cancers are a very heterogeneous group of diseases and has moved their treatment from an organ-based to a molecular approach targeting different subtypes. In colorectal cancer, for example, molecular testing has proven to be successful and key to selecting treatments. This is the case of microsatellite instability tumours, which are only 4% of all cases and can benefit from immunotherapy in first line rather than conventional therapies, BRAF-mutant tumours and the small HER2 subgroup for which specific targeted agents are now available. However, facilitating patients’ access to molecular testing and personalised treatment is now a major challenge for the oncology community due to discrepancies in accessibility reported across different areas.

Multidisciplinarity is another key issue in the management of gastrointestinal cancers as inputs from professionals with varied expertise are essential to refine treatment strategies in the molecular era of cancer care. With the launch of the new congress in this disease setting, ESMO has interpreted the need of medical oncologists of being educated in the advances of medical areas parallel to oncology, such as surgery, radiation, interventional radiology and molecular pathology. By bringing together a body of assorted knowledge, I am fully convinced that we are going to shape the optimal future practice for gastrointestinal oncology, benefiting all our patients.

How has the management of colorectal cancer evolved in recent times?

Colorectal cancer still represents an important issue in cancer management in Europe, where it accounts for the second highest number of cancer deaths. Despite being a difficult disease, mortality has declined over the last decade, with an observed trend toward better five-year survival rates. Partially this is due to a growing treatment armamentarium also in the advanced and metastatic settings where different lines are now available to control the disease for longer periods of time (Ann Oncol. 2023;34(1):10-32).

Also, innovation is coming for the treatment of some defined subtypes. We have some hope on novel RAS inhibitors, not only targeting G12C mutation but that could tackle a higher proportion of patients with advanced disease.

Despite research advances, expected survival may vary greatly across different countries, and prevention can be key to improve prognosis. There is a lot of room for improvement in colorectal cancer screening and early detection: campaigns have been run in many countries, but acceptance of preventive measures is not optimal yet in the general population. Increasing chances of diagnosing malignancies at an early stage may certainly impact on their curability.

In the last years, many positive data were presented for upper gastrointestinal cancer at the ESMO congresses. Are we at a turning point for the management of these malignancies?

The approval by the European Medicines Agency (EMA) of nivolumab for the treatment of patients with advanced oesophageal squamous cell carcinoma based on a study results (Lancet Oncol. 2019 Nov;20(11):1506-1517) has represented a significant step forward that has opened up the door to immunotherapy in upper gastrointestinal cancers.

Today, several compounds are investigated in trials, giving positive results in terms of overall survival. This is rapidly shaping the new way of treating difficult-to-treat diseases like cholangiocarcinoma and pancreatic cancer. This area is drawing researchers’ attention, so many innovative publications are expected to come into the field. Everyone is dreaming that this piece of science will soon modify the expectations of patients with these tumours.

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