Non-Surgical Treatment for Rectal Cancer: Advances in Chemoradiation and Molecular Profiling

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• Rectal Cancer Treatment Without Surgery
• Identifying Patients for Organ Preservation
• Molecular Profiling in Colorectal Cancer
• Data Sharing in Clinical Trials
• Future of Targeted Therapies
• Full Transcript

Rectal Cancer Treatment Without Surgery

Dr. Hans-Joachim Schmoll, MD, discusses a paradigm shift in managing rectal cancer. A major breakthrough is the potential to treat some patients without surgical resection of the primary tumor. This approach is particularly vital for patients with low rectal tumors. Surgery in this location carries a high risk of losing anorectal sphincter function.

Chemotherapy combined with radiation therapy can be so effective that it eradicates the cancer. This organ preservation strategy aims to reduce the amount of treatment a patient receives. The ultimate goal is to improve a patient's quality of life while still achieving a cure.

Identifying Patients for Organ Preservation

Not every patient with rectal cancer is a candidate for avoiding surgery. Dr. Hans-Joachim Schmoll, MD, emphasizes that patient selection is based on a robust response to initial chemoradiation. Patients must have a biopsy-proven "complete response" to be considered for a "wait and see" follow-up protocol.

This careful monitoring strategy allows doctors to observe the local tumor site. If the cancer has been eradicated, the patient avoids a major operation. Dr. Anton Titov, MD, and Dr. Hans-Joachim Schmoll, MD, agree this method adapts treatment to the individual's needs.

Molecular Profiling in Colorectal Cancer

A comprehensive molecular profile of the tumor is now a non-negotiable step. Dr. Hans-Joachim Schmoll, MD, states that all clinical trials must use molecular characterization. This profiling creates a common language for comparing results across different studies and medical centers.

Understanding the tumor's genetic makeup is key to finding new, effective chemotherapy combinations. It helps clinicians understand why certain treatments work for some patients but not others. This personalized approach is fundamental to the future of colorectal cancer therapy.

Data Sharing in Clinical Trials

Centralized data access is extremely important for advancing colorectal cancer research. Dr. Schmoll points out that hundreds of thousands of patients are in clinical trials. Sharing this data is absolutely necessary to accelerate progress and improve patient outcomes.

However, significant challenges remain. Financial constraints and cooperation problems between medical centers can hinder this vital data sharing. Overcoming these obstacles is a critical priority for the oncology community.

Future of Targeted Therapies

The clinical development of new targeted medications is a third major direction. Dr. Hans-Joachim Schmoll, MD, explains that focus must be on the efficacy of available targeted treatments. Researchers need to know which medications help specific molecular subgroups of patients.

Testing these targeted therapies in earlier lines of treatment is crucial. This system will provide rapid information on a medication's activity within a specific patient subgroup. Dr. Anton Titov, MD, highlights that this targeted approach is what is needed to improve colon cancer treatment outcomes further.

Full Transcript

Dr. Anton Titov, MD: What will be the major breakthroughs in colorectal cancer treatment in the near future? One of them is treatment of rectal cancer without surgery. Chemotherapy alone can eradicate cancer in some patients with rectal cancer. Why must a comprehensive molecular profile of the tumor be tested in every patient?

Colorectal cancer treatment, and in particular metastatic colon cancer treatment, has made huge progress in the last decade. Dr. Anton Titov, MD. What are the most important advances in the next 5 to 10 years that will make the most impact on colorectal cancer treatment in the future?

Dr. Hans-Joachim Schmoll, MD: One interesting development is in rectal cancer treatment. I recently spoke at a meeting of general practitioners about it. It is about treatment of rectal cancer without surgical resection of the primary tumor in the rectum. This is an important consideration for patients with rectal cancer. Some patients might be at high risk for losing anorectal function after surgery, especially in patients with a low location of rectal cancer.

There are patients with a good response to chemotherapy and radiation therapy. They have biopsy-proven "complete response" of the rectal cancer tumor to treatment. Such patients with rectal cancer should not have surgery to remove the primary tumor. They should have a "wait and see" follow-up after chemotherapy and radiotherapy.

Dr. Anton Titov, MD: To see what happens with this local tumor.

Dr. Hans-Joachim Schmoll, MD: Chemotherapy and radiotherapy alone can eradicate the rectal cancer tumor. It is a new method for rectal cancer treatment to reduce the amount of chemotherapy and to reduce the number of patients who have resection of the rectum. Sometimes they risk the loss of anorectal sphincter function. This is an important step to adapt the surgical and radiation steps to the patient where it is really necessary. We reduce the amount of treatment to improve the quality of life of the patient with colorectal cancer.

Our goal is to prolong the life for colon cancer patients and to improve the outcome with optimal treatment of colon cancer. We need more effective chemotherapy combinations. We do not totally understand how to find new treatment medications, but a new molecular classification of colorectal cancer is important for this goal.

All clinical trials for colorectal cancer must use molecular characterization of the tumor so we speak the same language when we compare results. This is extremely important to make a centralized access and comparison of all data from clinical trials. We have hundreds of thousands of patients with colorectal cancer in clinical trials now. Data sharing is absolutely necessary. It is happening now, but there are financial problems and cooperation problems between medical centers.

The third important direction in colon cancer therapy is clinical development of the new targeted medications. We have to focus on clinical information of efficacy of available targeted treatments. We have to know which medications help specific molecular subgroups of colon cancer patients. We have to find efficacy of various targeted chemotherapy medications in early treatment of colon cancer patients.

Dr. Anton Titov, MD: This system will give us rapid information that these medications are active in this subgroup of colon cancer patients. This is what we need. Thank you very much! Professor Schmoll, I very much appreciate your time and sharing your expertise with our viewers around the world. I hope that our conversation will be very useful for patients with colorectal cancer and all patients who are interested. Thank you very much! We will revert to you in the future to learn more about advances in colon cancer and rectal cancer treatment.

Dr. Hans-Joachim Schmoll, MD: Thank you! It was my pleasure to speak with you.