written by Dr. Tom Marsilje, Andrea (Andi) Dwyer, Nancy Roach and Anjee Davis
Last December, Fight Colorectal Cancer (Fight CRC) and the Cancer Research Institute (CRI) brought together many of the world’s leading experts on CRC and immuno-oncology. (Read more about this meeting.)
The meeting goal: To discuss the unique issues impeding successful treatment of CRC and develop a blueprint for what is needed to advance immunotherapies for all forms of CRC. (Read more about this.)
The ultimate goal: drive us closer to a cure.
The Blueprint Begins
The group of experts convened in December has been meeting and working ever since to develop this blueprint which focuses on determining why non-MSI (MSS) CRC is so much less responsive to immunotherapies than MSI-high CRC. And, related to that question, are there therapies or strategies that could be used to make non-MSI CRC “look like” MSI-high CRC and become responsive to anti-PD-1 therapies?
Like any blueprint, this will serve as a plan to tackle key issues.
The Blueprint Presented
We’re pleased to report that Dr. Al Benson is presenting the blueprint for the first time at the prestigious American Association for Cancer Research (AACR) annual meeting in New Orleans on April 19, 2016. Here is a summary of the presentation and key highlights of the blueprint:
Sub-types of CRC and Impact on Immuno-Oncology
The first step in solving a problem is to fully understand the problem. If you are solving an issue of non-MSI CRC, a first question to address is, “What exactly is “non-MSI CRC”? The answer is more complex than originally envisioned.
Within the grouping of non-MSI CRC, we now know that multiple different sub-types exist. Each sub-type has its own unique interactions with the immune system. Knowing these different interactions can now guide which experimental therapy strategy should be prioritized for a particular patient.
Clinical Path Identified
A number of recommendations have been developed to help guide patients to experimental therapy strategies. These strategies are believed to be most appropriate in treating patients’ sub-groups of non-MSI-high CRC to make it look like MSI-high CRC.
The data needed to guide Phase 1 trial choice includes: MSI-testing and “Immunoscore” of tumor samples.
- MSI-testing tells a patient if their tumor is MSI-high or MSS. (Learn more.)
- The Immunoscore shows how a patient’s tumor is interacting with the immune system. (Learn more)
Taken together, this data will determine the sub-type of the patient’s non-MSI-high CRC. This information is vitally important to guide which experimental treatment strategy a patient should pursue.
Thankfully, there are numerous experimental drugs and treatment strategies either in, or close to, clinical trial testing which are believed to potentially address each of the treatment strategies.
The ultimate goal is to test the experimental therapy strategies in focused Phase 1 trials using the most appropriate patients possible. These Phase 1 trials will include extensive biomarker analysis to help explain and describe the patterns of responding vs. non-responding patients.
This data and the overall focused Phase 1 trial results will be essential to design and implement subsequent larger clinical trials. This paradigm will lessen the chances of a patient entering an immunotherapy trial which does not address the fundamental issues which are allowing his or her tumors to escape from the immune system.
The CRC Immunotherpy Workgroup
This first step of the blueprint may be nearly finished, but its work has just begun.
The panel of experts convened in December are becoming a Colorectal Cancer (CRC) Immunotherapy Workgroup. Their next task is ensuring the plans of this blueprint get put into motion and updated as science continuously and quickly evolves.
Just this week, a groundbreaking paper on the interplay of genomics and how CRC interacts with the immune system was published. The science of CRC immuno-oncology continues to advance at a very fast pace!
This is an extremely exciting time in cancer research and we’re very proud to have an active role! Fight CRC and CRI will continue to support this research and get the advocate community involved.
Fight CRC and CRI’s Role
We will stay committed to this critical effort. Our next steps include initiating and convening an active dialogue amongst the experts. Direct research funding will be announced for the priorities identified from the blueprint, starting with the foundational and priority areas.
As advocates for research, we will deliberately seek opportunities for outreach and inform our partners at the National Cancer Institute (NCI), the Department of Defense (DoD) and large philanthropic funders about the blueprint priorities. This is about coordination, synchronizing our efforts and working to ensure resources are efficiently used in pursuit of the specified objectives.
The Advocate’s Role
As patients, caregivers and loves ones – you have a role in this process too. Here’s how you can get involved NOW:
Let your doctors, members of Congress and friends within the colorectal cancer community know about this important work within colorectal cancer and immunotherapy research. We need YOU to talk about what’s happening to improve and extend the lives of CRC patients. Help spread the word! (To engage Congress, sign up as an advocate.)
Make sure you sign up to receive Fight CRC’s emails so you know the latest progress on this research and ways YOU can participate. Check out this blog post by CRI to learn more about immunoscore.
The CRC Immunotherapy Workgroup, Fight CRC and CRI will not rest until the ultimate immuno-oncology goal is achieved: Maximizing the immunotherapy potential to treat all forms of CRC as soon as possible.
The groundbreaking collaboration between Fight Colorectal Cancer and the Cancer Research Institute to jumpstart this research was made possible thanks to a generous donation in memory of Gordon Cole.