Spotlight on Colorectal Cancer Treatment

A deep dive into novel treatments that offer patients new hope and may, one day, turn colorectal (bowel) cancer into a manageable chronic disease.

The third most common cancer worldwide, colorectal cancer (also known as bowel cancer) is estimated to reach 2.2 million cases by 2030 – a 60 per cent increase from current figures. But, as the disease’s burden continues to grow, so does the global research effort into more effective and safer ways to treat it.

Consequently, we are now witnessing a new high in the number of innovative drugs that promise to improve survival rates and quality of life. Following are some of those that are already available, mainly at specialist centres or through participation in clinical trials.

Checkpoint inhibitors are one of the latest and more promising advancements in cancer immunotherapy.

They boost the immune system’s response against the tumour, by binding to a protein, called PD-1, on the surface of immune cells, which, as a result, start to attack and destroy the cancer.

An example of PD-1 checkpoint inhibitor for the treatment of colorectal cancer is pembrolizumab.

Pembrolizumab is only available in clinical trials. Among those currently under way is a study that aims to compare the efficacy of the new drug with that of standard care, in colorectal cancer patients with certain genetic mutations, called microsatellite instability high (MSI-H) and mismatch repair deficiency (dMMR).

The trial is still recruiting patients. Experts predict that pembrolizumab will be the first checkpoint inhibitor to be approved for the treatment of MSI-H and dMMR colorectal cancer.

Another checkpoint inhibitor showing great promise is nivolumab, according to findings presented in January at the 2107 American Society of Clinical Oncology (ASCO) Gastrointestinal Cancers Symposium, in San Francisco.

These show that treatment of microsatellite colorectal cancer with nivolumab is associated with a progression-free survival (the period of time during and after treatment in which the cancer does not get worse) of 9.6 months and one-year progression-free survival rates of 45.6 per cent.

Commenting on the results, in the Journal Of Clinical Pathways, Michael Overman, of the University of Texas MD Anderson Cancer Center, said they “suggest that nivolumab should be considered a new standard of care for patients with previously treated MSI-H advanced [disease].”

Cancer vaccine are a type of immunotherapy, like checkpoint inhibitors. There are several under study, including AVX701, which is being investigated within a clinical trial, currently recruiting participants, by researchers of Duke University Medical Center, North Carolina.

The team, led by Michael Morse, is testing AVX701 in patients with stage III colorectal cancer. In a previous study, by the same researchers, treatment with AVX701 was associated with a trend for longer survival among patients with the stage IV of the disease.

Exciting developments have been made by various research groups in the treatment of advanced colorectal cancer using monoclonal antibodies.

Also known as biological medicines or targeted therapies, these treatments have a key feature: they can selectively target and kill cancer cells, minimizing damage to healthy tissues and, consequently, the risk of side effects.

A number of monoclonal antibodies for colorectal cancer have already been approved, such as cetuximab and panitumumab.

But several others are in the pipeline, and are available as part of research studies.

For example, the novel agents MGD007 and IMMU-130 are currently being investigated in two separate clinical trials, for use in metastatic colorectal cancer. Both trials are still enrolling participants.

A novel oral medication for colorectal cancer, called TAS-102, is among a small group of just nine new cancer drugs described as particularly noteworthy by the US Food and Drug Administration (FDA) in its Novel Drugs 2015 Summary.

TAS-102 consists of a combination of two different compounds: trifluridine and tipiracil. In August 2016, it has been recommended for use on the NHS by the National Institute of Care and Health Excellence (NICE) as an option for the treatment of people with metastatic colorectal cancer who already had, or cannot have, standard treatment.

The recommendation is based on data from the phase III RECOURSE study, showing that, compared with the best standard of care, TAS-102 increases patient overall survival from 5.2 to 7.2 months, and one-year survival rates from 16.6 to 27.1 per cent.

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According to Richard Kensett, managing director at Alivia UK, we are on the way to achieving unprecedented milestones in the progress towards a better management of colorectal cancer.

“The ongoing work in cancer research and development is clearly opening up compelling new avenues for treating patients more effectively and with fewer side effects,” he says. “This holds promise that, in the near future, it will be possible to control the disease like we do today for many chronic conditions.”

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