The Barcelona Colorectal Cancer Observatory

Transcription

1 The Barcelona Colorectal Cancer Observatory The only relevant test of the validity of a hypothesis is comparison of prediction with experience. Milton Friedman

2 Predictions Growth of adjuvant surgery : liver and lung resection for metastatic colorectal cancer Better definition of risk factors for relapse and benefit molecular mechanisms and signatures Better neoadjuvant treatments: more sphincter saving surgery Oral therapy will increase bet less than expected before New efforts to understand when to use either anti EGFR drugs or antiangiogenic drugs on a honest and rational basis Whatever the diagnosis may be, there is always hope in the head of a patient

3 The Barcelona Colorectal Cancer Observatory: Innovation and care in the next 12 months Saturday 30th June 2012, Panellists: Graeme Poston, UK Chris Verslype, BE Roberto Labianca, IT Andres Cervantes, ES Milan Djordjevic, RS Chair: Mario Dicato, LU Moderator: Jola Gore-Booth, UK - Alberto Costa, IT

4 The Barcelona Colorectal Cancer Observatory: Innovation and care in the next 12 months Graeme Poston Aintree University Hospital Liverpool, United Kingdom View of a Surgical Oncologist

5 Liver metastases: increasing use of debulking strategies (resection + ablation) following the successful outcomes of the CLOCC and ARF2003 trails Oesophageal cancer: increasing use of neoadjuvant chemoradiotherapy in resectable disease

6 Liver tumours: increasing use of targeted regional therapies Rectal cancer: better definitions and use of appropriate neoadjuvant therapies

7 The Barcelona Colorectal Cancer Observatory: Innovation and care in the next 12 months Chris Verslype University Hospital Leuven Leuven, Belgium View of a Clinical Oncologist

8 Adjuvant therapy Towards shorter duration of adjuvant therapy (3 months) Beyond FOLFOX -Diet - Physical exercise

9 Adjuvant therapy (2) More recurrence scores will be developed, but their exact utility (predictive for therapy benefit) will remain obscure More attention to: interactions (e.g. adjuvant treatment, p53 status, gender) prospective clinical trials with companion diagnostics

10 The Barcelona Colorectal Cancer Observatory: Innovation and care in the next 12 months Roberto Labianca Ospedali Riuniti Bergamo, Italy View of a Medical Oncologist

11 Metastatic disease in the next 12 months Oral therapy (e.g. XELOX instead of FOLFOX) will increase, but less than expected before The multidisciplinary approach will increase in many (not all!) clinical institutions A flexible, patient-based strategy (chemo-free intervals, depotentiationof therapy, maintenance treatment vs observation ) will be the rule in clinical practice The cost of drugs will be an increasing concern Triplet chemotherapy instead of doublets with biologicalswill be an increasing choice The constraints for independent clinical research will increase

12 Metastatic disease in the next 12 months The maintenance treatment will be applied to an increasing number of patients The long-term inhibition of angiogenesis (through Bevacizumabbeyond progression or Afliberceptor Regorafenib) will become an important option in clinical practice New molecular biomarkers will be possibly identified for anti- EGFR drugs, but not for anti-angiogenetic molecules

13 The Barcelona Colorectal Cancer Observatory: Innovation and care in the next 12 months Andrés Cervantes Institute of Health Research INCLIVA University of Valencia, Spain View of a Medical Oncologist

14 Molecular targeted therapies have an established role in the management of metastatic colorectal cancer So far the only established molecular targeted agents effective in metastatic CRC are monoclonal antibodies, either neutralizing VEGFA (Bevacizumab) or blocking EGFR (Cetuximab and Panitumumab) These drugs are usually combined with standard chemotherapy in the continuum of care of metastatic colorectal cancer

15 Two new potentially active agents are going to be incorporated very soon for the medical treatment of CRC: - Aflibercept is a new antiangiogenic agent that have shown improvement in survival in a second line trial in combination with Chemotherapy - Regorafenib is an oral multikinase inhibitor targeting multiple cancer pathways, that prolongs survival in chemorefractory patients

16 We still need to define the best selection criteria for a true personalised approach for the use of these drugs KRAS mutations are validated as predictive biomarkers for Anti-EGFR drugs No predictive biomarkers yet for clinical practice for antiangiogenic drugs

17 The Barcelona Colorectal Cancer Observatory: Innovation and care in the next 12 months Milan Djordjevic Europacolon Belgrade, Serbia View of an Advocate Representative

18 More than 10 years ago I was finding all kind of excuses for frequent visits to the bathroom I lost about 20 kg I felt sleepy all the time I was trying to avoid colonoscopy because For more than a year I was Mr. Excuse

19 More than 10 years ago Finally I went to see a gastroenterologist Was rushed to a surgery a week later To be honest they never did tell me But anyway, I knew PH analysis confirmed adenocarcinoma Milan to find the details And then second and third surgery And finally when I thought it was over, chemotherapy

20 NOW I am like any other person my age I go for regular colonoscopies and for regular check-ups Together with EuropaColon we are starting Young Voices United against CRC To raise awareness in young adults To help those affected by CRC To create empowered community

21 Predictions Formal screening process in more countries More research on unknown mutations that develop to CRC in young adults Better usage of oral therapy Better understanding of anti EGFR and antiangiogenic therapy More hope for patients