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In January, the American Society of Clinical Oncology’s Gastrointestinal Symposium (GI ASCO 2018) concluded after several thousand researchers, clinicians and patient advocates passed through the doors of the Moscone West Building in San Francisco, CA.

This year brought new excitement, ideas and groups together to discuss the future of GI cancer research.

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Major themes of GI ASCO 2018

Two big themes that emerged from this year’s conference included early-onset colorectal cancer and immunotherapy.

Early-Onset Colorectal Cancer

Although 90% of colorectal cancer (CRC) cases occur in people over age 50, the incidence of colorectal cancer in individuals under 55 has been increasing since the mid 80’s.

The rise in early-onset CRC was validated by epidemiological data presented by Dr. Joseph J.Y. Sung from the Chinese University of Hong Kong during GI ASCO, which highlighted that individuals born in the US during the early 90’s have twice the risk of colon cancer and four times the risk of rectal cancer compared to adults born in the early 50’s.

The rise in incidence and the uncertainty as to what could be causing early-onset CRC has prompted researchers to explore the data in more depth and determine what biological and clinical differences exist between young and old CRC patients.

Dr. Kastrinos from Columbia University Medical Center noted that previous genetic analyses have indicated a higher frequency of germline mutations and a greater variability of mutations among early-onset CRC patients. She suggested universal multigene germline testing be considered for all early-onset CRC patients to guide genetic counseling.

While these findings may develop a better understanding of these cases, it’s worthy to note that other research has not found noticeable biological differences between young and old patients.

Howard S. Hochster, M.D., from the Yale School of Medicine, investigated the differences between early-onset CRC between younger and older populations. His team ultimately determined there was no biological difference in gene expression patterns between younger and older patients.

Additionally, researchers at the University of Colorado looked into the clinical and molecular characteristics of younger versus older patients with CRC and found that certain mutations (APC and BRAF) were less common in younger patients, however there were no mutations more prevalent in the younger cohort compared to the older cohort.

Future Research of Early-Onset CRC

Further research into specific cell functions is needed to determine if biological differences exist based on age of disease onset.

Additionally, lifestyle factors such as obesity, tobacco use and the microbiome are areas of exploration for understanding increased CRC risk.

This past year, Fight CRC funded research conducted by Cindy Sears from Johns Hopkins University to better understand the gut microbiome and the role it plays in the development of CRC!

Although there is still a lot of work to be done to understand early-onset colorectal cancer, Fight CRC will continue to stay up to date on the latest research and pass relevant findings on to patients.

Immunotherapy

With immunotherapy being at the forefront of research based on the success it has had with MSI-H patients, and the potential it could have for MSS patients, discussions at GI ASCO 2018 focused on combination therapies and the future of IO research.

Dr. Michael Overman from the University of Texas MD Anderson Cancer Center and Dr. Thierry Andrés from the Saint-Antoine Hospital, in France presented findings from the CheckMate-142 study.

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About CheckMate-142

CheckMate-142 is a phase II study combining nivolumab with other anticancer drugs for patients with MSI-H disease to determine if the combination results in decreased tumor size.

Dr. Andres presented results from the first report of the full cohort of patients treated with combination therapy nivolumab plus ipilimumab, which was the largest single-study of two combination immune checkpoint inhibitors in MSI-H patients.

Findings from CheckMate-142 were encouraging.

At 9 months, progression free survival rates were 76% and 71% at 12 months. Additionally, overall survival rates were 87% and 85% respectively.

Researchers are hopeful this combination therapy could potentially lead to a new standard of care.

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Other Notable Topics

Other notable topics out of GI ASCO this year included exercise-based studies for CRC patients.

Dr. Van Blarigan, the lead researcher on a study investigating the effects of text messages to increase physical activity after colorectal cancer, found that this technology-based intervention was both feasible and acceptable.

Dr. Van Blarigan even took the time to share these findings with Fight CRC research advocates during GI ASCO.  Not only did she discuss her work and future steps, but these conversations led to understanding survivorship as a whole and the necessary role it plays throughout the cancer continuum.

Research led by Dr. Scott Kopetz and the S1406 team was also highly discussed.

Back in 2017, Kopetz presented his SWOG study that showed promise in metastatic CRC patients with BRAF mutations when using the BRAF inhibitor vemurafenib combined with the standard chemotherapy (irinotecan or cetuximab).

This year, those recommendations were added into the National Comprehensive Cancer Network (NCCN) clinical practice guidelines, providing a standard of care for patients with this specific mutation.

This is a major success not only because it offers patients with BRAF mutations a line of treatment that hadn’t existed prior, but it shows the power of research and opens the door for future advancements in cancer research.

Get More Updates

To get more information about the research presented at the 2018 GI ASCO, check out the GI ASCO 2018 webinar recap where Dr. Dusty Deming explained what came out of the conference. AND, check out our blog where we listed the top abstracts for which we recommended paying close attention prior to GI ASCO!

FUNDING DISCLOSURE

Disclosure: Fight Colorectal Cancer has received funding from Genentech (the producers of ZELBORAF), Lilly (the producers of ERBITUX) and Bristol Myers Squibb (producers of Opdivo and YERVOY® ) in the form of unrestricted educational grants. We maintain ultimate authority over website content and the content written in this article. Fight Colorectal Cancer never recommends or endorses any specific physicians, products or treatments for any condition.

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