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Harnessing the power of precision medicine for the treatment of colorectal cancer

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This activity is funded by an independent medical education grant from the Healthcare Business of Merck KGaA, Darmstadt, Germany.

This medical education activity is jointly provided by USF Health and touchIME.

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    Faculty & Disclosures
    Dr Juan Manuel O’Connor

    Alexander Fleming Institute, Buenos Aires, Argentina

    Dr Juan Manuel O’Connor is the head of the Department of Gastrointestinal Tumors at the Instituto Alexander Fleming in Buenos Aires, Argentina, and assistant professor of clinical pharmacology at the School of Medicine of the Instituto Universitario CEMIC, Buenos Aires. read more

    He is a founding member of the ARGENTUM Working Group on neuroendocrine tumours, created in 2005, a member of the Argentinian Intergroup of Gastrointestinal Tumors (IATTGI), and of the recently created Latin American Society for Gastrointestinal Tumors. Dr O’Connor has been a member of the advisory board for the European Society of Neuroendocrine Tumors since 2008, and an active member of the American Society of Clinical Oncology since 2011.

    Dr O’Connor has authored over 50 papers and book chapters on gastrointestinal tumours, and has received several international awards for his work in the area of ​​neuroendocrine tumours. He has participated in more than 200 national and international events as a speaker and was part of the Scientific Committee for the European Society of Medical Oncology World Congress on Gastrointestinal Cancer in 2021 and 2022. Dr O’Connor also served as a consultant to the National Cancer Institute in Argentina and was involved in the development of the clinical practice guidelines in Argentina on metastatic colorectal cancer (2014) and recommendations for CRC screening (2022), as a member of the Argentinian Association of Clinical Oncology.

    Dr Juan Manuel O’Connor discloses: Advisory board or panel fees from BMS, Merck, MSD and Pfizer. Consultancy fees from BMS, Merck and Pfizer. Speaker’s bureau fees from BMS and Pfizer.
    Prof. Dr. Francesco Sclafani

    Institut Jules Bordet, Brussels, Belgium

    Prof. Dr. Francesco Sclafani is a consultant medical oncologist, working as Head of Clinic in the Department of Gastrointestinal Oncology at the Institut Jules Bordet in Brussels, Belgium, and associate professor (Maître de Conférence) at the Université Libre de Bruxelles, Belgium. read more

    Prof. Dr. Sclafani completed his specialist medical oncology training at the University of Milan, Italy, before moving to St Vincent’s University Hospital in Dublin, Ireland, then to The Royal Marsden NHS Foundation Trust in London, UK. He was awarded an MD(Res) degree at the Institute of Cancer Research, University of London, UK.

    Prof. Dr. Sclafani is an active member of international cooperative groups such as the European Organisation for Research and Treatment of Cancer (EORTC) Gastrointestinal Tumour Study Group and the International Rare Cancer Initiative Anal Cancer Working Subgroup. He is a member of the European Commission Initiative on Colorectal Cancer working group, Secretary of the EORTC Gastrointestinal Cancer Tract Group, and co-chair of the European Cancer Organisation Essential Requirements for Quality Cancer Care initiative for pancreatic cancer. He is an investigator on a number of phase I–IV clinical trials in gastrointestinal cancers and has published over 110 peer-reviewed articles and book chapters on the subject.

    Prof. Dr. Francesco Sclafani discloses: Advisory board or panel fees from Bayer, BMS and Nordic Pharma (all relationships terminated). Grants/research support from Bayer and Roche. Speakers’ bureau fees from Amgen, Merck, Roche and Servier (all relationships terminated).
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    touchONCOLOGY touchONCOLOGY
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    Poll

    Which of these emerging CRC treatments do you think is most promising for patients?

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    Immune checkpoint inhibitor combination therapy for MSS disease
       
    Immunotherapy + anti-angiogenic combination therapy for MSS disease
       
    Anti-HER2 therapy for HER2-positive disease
       

    Tutorial

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    Poll

    The main challenge with biomarker-targeted therapies for your patients with CRC is:

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    Sufficiently addressing patient concerns
       
    Genomic testing infrastructure
       
    Understanding colorectal cancer molecular pathology
       
    Other factor(s)
       

    Tutorial

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    Poll

    What do you use most often to decide the treatment sequence in your CRC patients?

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    Mutational status re-test using liquid biopsy
       
    Mutational status re-test using tumour biopsy
       
    Clinical condition of the patient
       
    Other factor(s)
       

    Tutorial

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    Poll

    What is your real-world experience of anti-EGFR rechallenge in patients with CRC?

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    Benefits the majority of patients
       
    Benefits up to half of patients
       
    Minimal clinical benefit over other treatments
       
    I do not recommend anti-EGFR rechallenge
       

    Tutorial

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    Poll

    How many MSI-H CRC patients do you recommend for frontline immunotherapy per month?

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    <5
       
    5–10
       
    11–20
       
    >20
       

    Tutorial

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    Poll

    How quickly are biomarker test results received in your clinical practice?

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    Within 24 hours
       
    Within 1 week
       
    After >1 week
       
     
    Identifying patients for biomarker-targeted treatment in CRC
    Current CRC treatment landscape
    Clinical insights on anti-EGFR-rechallenge in the treatment of CRC
    Biomarker-driven treatment sequencing in CRC
    Practical challenges in biomarker-targeted treatment of CRC
    Emerging targeted therapies for patients with CRC
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    Colorectal Cancer, Gastrointestinal Cancers CE/CME accredited

    touchIN CONVERSATION
    A relaxed discussion between two faculty focussed on real world clinical issues. Useful tips below will show how to navigate the activity. Join the conversation. Close

    Harnessing the power of precision medicine for the treatment of colorectal cancer

    Faculty Podcast Featured
    Useful tips
    • Select in the video player controls bar to choose subtitle language. Subtitles available in English, Mandarin, Japanese, Korean, Portuguese, Spanish.
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    Learning Objectives

    After watching this activity, participants should be better able to:

    • Recognize the importance of biomarker testing to inform treatment decisions in CRC
    • Evaluate the latest data for current and emerging therapies for the treatment of CRC
    • Apply strategies to address practical challenges in biomarker-targeted treatment of CRC
    Overview

    In this activity, two experts in gastrointestinal oncology respond to questions from the oncology community on the role of biomarker-targeted therapies in personalizing treatment decisions in CRC. In Module 1, they explore biomarker-led patient identification, current treatment options and considerations for anti-EGFR rechallenge. In Module 2, they discuss the role of biomarkers in treatment sequencing and associated practical challenges, alongside emerging indications of interest.

    This activity is jointly provided by USF Health and touchIME.

    Target Audience

    Oncologists, including gastrointestinal oncologists, and pathologists involved in the management of patients with CRC.

    Disclosures

    USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

    Faculty

    Dr Juan Manuel O’Connor discloses: Advisory board or panel fees from BMS, Merck, MSD and Pfizer. Consultancy fees from BMS, Merck and Pfizer. Speaker’s bureau fees from BMS and Pfizer.

    Prof. Dr. Francesco Sclafani discloses: Advisory board or panel fees from Bayer, BMS and Nordic Pharma (all relationships terminated). Grants/research support from Bayer and Roche. Speakers’ bureau fees from Amgen, Merck, Roche and Servier (all relationships terminated).

    Content Reviewer

    Alicia Canalejo, APRN has no financial interests/relationships or affiliations in relation to this activity.

    Touch Medical Contributor

    Sola Neunie has no financial interests/relationships or affiliations in relation to this activity.

    USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

    Requirements for Successful Completion

    In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

    If you have questions regarding credit please contact cpdsupport@usf.edu.

    Accreditations

    Physicians

    This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

    USF Health designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

    Advanced Practice Providers

    Physician Assistants may claim a maximum of 1.0 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

    The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

    Date of original release: 23 May 2024. Date credits expire: 23 May 2025.

    If you have any questions regarding credit please contact cpdsupport@usf.edu.

    This activity is CE/CME accredited

    To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

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    Topics covered in this activity

    Colorectal Cancer / Gastrointestinal Cancers
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    This activity is funded by:

    An independent medical education grant from the Healthcare Business of
    Merck KGaA, Darmstadt, Germany.
    This activity is jointly provided by USF Health and touchIME.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals.

    Date of original release: 23 May 2024. Date credits expire: 23 May 2025.

    Claim Credit
    touchIN CONVERSATION
    Harnessing the power of precision medicine for the treatment of colorectal cancer
    1.0 CE/CME credit
    Question 1/5
    Which of the following alterations is most commonly seen in patients with CRC that is also an actionable biomarker?

    CRC, colorectal cancer.

    The RAS family is one of the most frequently mutated across all malignancies, including CRC.1 Approximately 40% of colorectal cancer tumours harbour KRAS mutations; 4% NRAS mutations and <1% HRAS mutations.1 NTRK fusions are rare in patients with CRC (<1%); HER2 amplification occurs in ~2–5% of all CRCs; BRAF mutation occurs in ~10–20% of CRCs.2

    Abbreviations

    CRC, colorectal cancer.

    References

    1. Patelli G, et al. ESMO Open. 2021;6:100156.
    2. Puccini A, et al. Cancers (Basel). 2022;14:4828.
    Question 2/5
    In your patients with metastatic CRC, which of the following biomarker test results would prompt you to consider treatment with immunotherapy in the first-line setting?

    CRC, colorectal cancer; dMMR, deficient mismatch repair; MSI-H, microsatellite instability-high.

    dMMR tumours (~4–5% of all metastatic CRCs) are unable to repair certain classes of mutations, resulting in high tumour mutational burden and microsatellite instability.1 The phase III KEYNOTE-177 trial in patients with dMMR/MSI-H metastatic CRC showed clinical benefit of pembrolizumab, an immune checkpoint inhibitor, over investigator choice of chemotherapy ± bevacizumab or cetuximab in the first-line setting, and it is now recommended as standard of care in this patient population.2,3

    Abbreviations

    CRC, colorectal cancer; dMMR, deficient mismatch repair; MSI-H, microsatellite instability-high.

    References

    1. Diaz Jr LA, et al. Lancet Oncol. 2022;23:659–70.
    2. Cervantes A, et al. Ann Oncol. 2023;34:10–32.
    3. Yoshino T, et al. ESMO Open. 2023;8:101558.
    Question 3/5
    Your patient with RAS wild-type metastatic CRC has received oxaliplatin-based chemotherapy + cetuximab for 4 months without disease progression or intolerable toxicity. What maintenance therapy would you consider at this stage to de-escalate treatment intensity whilst optimizing patient outcomes?

    5-FU, fluorouracil; CRC, colorectal cancer; FOLFIRI, leucovorine–5-fluorouracil–irinotecan.

    Maintenance therapy de-escalates treatment intensity to minimize side effects and improve quality of life, without compromising therapeutic efficacy and disease control.1 The ESMO and Pan-Asian adapted ESMO Clinical Practice Guidelines recommend that, after first-line oxaliplatin-based chemotherapy + anti-EGFR, maintenance therapy with a fluoropyrimidine + anti-EGFR could be considered in patients without disease progression.1,2

    Abbreviations

    EGFR, epidermal growth factor receptor; ESMO, European Society for Medical Oncology.

    References

    1. Cervantes A, et al. Ann Oncol. 2023;34:10–32.
    2. Yoshino T, et al. ESMO Open. 2023;8:101558.
    Question 4/5
    Which of the following statements best summarizes the current status of predictive markers to guide anti-EGFR rechallenge decisions in CRC?

    CRC, colorectal cancer; EGFR, epidermal growth factor receptor; OS, overall survival; PFS, progression-free survival.

    Current evidence shows a lack of association between clinical characteristics and outcomes with anti-EGFR retreatment.1–3 Data from the CHRONOS and FIRE-4 trials suggest liquid biopsy ctDNA evaluation of RAS, BRAF and EGFR extracellular domain mutations may be clinically relevant in selecting patients for anti-EGFR rechallenge.3,4 Patients with KRASG13D-mutated metastatic CRC are unlikely to benefit from anti-EGFR therapy.5

    Abbreviations

    CRC, colorectal cancer; ctDNA, circulating tumour DNA; EGFR, epidermal growth factor receptor.

    References

    1. Rossini D, et al. Clin Colorectal Cancer. 2020;19:191–9.
    2. Duarte-Mendes A, et al. Ann Oncol. 2023;43(Suppl. 1):388.
    3. Sartore-Bianchi A, et al. Nat Med. 2022;28:1612–8.
    4. Stintzing S, et al. J Clin Oncol. 2023;41(Suppl. 16):3507.
    5. Chung C, et al. J Oncol Pharm Pract. 2022;28:850–69.
    Question 5/5
    Your 37-year-old male patient is receiving treatment for stage III CRC. He lives in a rural setting and expresses concerns about making the long round trips to hospital for the scheduled monitoring and follow-up. Which of the following might you consider to optimize the management and ease the burden of monitoring for this patient?

    CRC, colorectal cancer.

    Telemedicine appointments became fundamental to ongoing cancer care during the COVID-19 pandemic.1 Beyond the pandemic, telemedicine is time- and cost-effective for health workers and patients,1,2 has high patient satisfaction rates and can improve access to oncology specialists.1 Colorectal cancer survivors participating in a study assessing telemedicine models of survivorship care expressed a future preference for telemedicine (video/telephone) appointments over face-to-face follow-up when only receiving test results or asking questions.1 However, in‐person consultations may be preferred for delivering crucial information, when physical examination is necessary and for patients with cognitive impairments or limited health literacy.3

    References

    1. Gore C, et al. Psychooncology. 2024;33:e6265.
    2. Sellars H, et al. Colorectal Dis. 2020;22:1015–21.
    3. Zon RT, et al. JCO Oncol Pract. 2021;17:546–64.
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    This activity is funded by:

    An independent medical education grant from the Healthcare Business of
    Merck KGaA, Darmstadt, Germany.
    This activity is jointly provided by USF Health and touchIME.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals.

    Date of original release: 23 May 2024. Date credits expire: 23 May 2025.

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