Precision medicine is here for colorectal cancer treatment. But current tumor classification is not optimal for selection of correct cancer treatment. Why new molecular tumor classification is important for all colon cancer patients? Leading colorectal cancer oncologist and research expert discusses colon cancer diagnosis and treatment options.
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Personalized medicine, precision medicine, for colorectal cancer treatment. Advances in molecular genetics of cancer rewrite the old anatomic and histological classification of cancer. this is true for colorectal cancer. Dr. Anton Titov, MD. You write in scientific article. “It is becoming clear that colon cancer will be divided into five or six different subtypes. These subtypes will be based on distinct molecular characteristics of the tumor.” “It can be predicted that description of this molecular taxonomy of colorectal cancer will have profound clinical implications.” Dr. Anton Titov, MD. What are the implications of the new molecular classification of colorectal cancer for colorectal cancer treatment? Prof. Dr. Hans-Joachim Schmoll, MD. We look beyond the well-known mutations such as KRAS, NRAS, microsatellite instability or BRAF mutations in colon cancer tumors. First of all, we have the intention to divide colon cancer tumors into molecular categorized groups. Cancer characterization is done by third-generation sequencing technologies and by many molecular methods. Dr. Anton Titov, MD. Distinct molecular subgroups of colon cancer can represent a specific prognosis for tumor patients. For the cancer classification taxonomy, patients with resectable colorectal cancers stages are used. Prof. Dr. Hans-Joachim Schmoll, MD. Taxonomy of The consortium of doctors decides on colon cancer classification. These are mostly patients with colon cancer at stage, stage two and stage three. Only a minority of colon cancer patients used for classifying cancer are stage four colon cancer patients. Dr. Anton Titov, MD. Let’s look at stage two and stage three colorectal cancer patients. For now we have no real method to differentiate between these patients within the same stage of disease. Prof. Dr. Hans-Joachim Schmoll, MD. We do not know how patients within stage 2 colon cancer differ in expected prognosis. We do not know the difference between the patients in response to chemotherapy. The same is true for stage 3 colon cancer. The new taxonomy of colorectal cancer is the most important development. New taxonomy has to include many more patient groups than current classification includes. New colon cancer taxonomy should differentiate between patients who would benefit from treatment and who would not. Dr. Anton Titov, MD. For this patients adjuvant chemotherapy would make a difference? How different patients respond to different chemotherapy medications? We have to investigate prognostic factors. We have to investigate response to treatment. Then we will have more precise colon cancer classification in the next three years. But this new colon cancer classification would mean, for example, that we can say this. This patient of this sex who has this colon cancer tumor in that age. with this location of the tumor in the left part of the lower colon or in rectum or the beginning of the colon and so on. with these clinical signs and with these features in patient’s genetic makeup. this patient may have a very distinct prognosis and needs a very distinct adjuvant prophylactic chemotherapy. This is the aim of this effort for new colon cancer classification. Prof. Dr. Hans-Joachim Schmoll, MD. We have to make colon cancer treatment more personal. It means really personalized treatment. Personalized therapy means we have to know the specific biological features of the tumor itself. Dr. Anton Titov, MD. But it also means we have to know patient’s biological characteristic as well. More personalized therapy also means precise decision on the kind of the treatment after the surgery. probably also about what kind of surgery a given patient has to have. how extensive the surgical operation has to be for this patient. Prof. Dr. Hans-Joachim Schmoll, MD. Question of radiotherapy in rectal cancer. Currently all patients with locally advanced rectal cancer get radiotherapy. These decisions must be more individualized. Dr. Anton Titov, MD. It is a huge potential of this new taxonomy of colorectal cancer. why we need new taxonomy of colon cancer? It is clear that it is not just one or two or three molecular subtypes of tumor in one gene or one location. Or one gene expression pattern even. Expression profiling with 8, 10, 15 or 18 genes is not enough to really make the difference from one colon cancer patient to the other. But I’m sure that further research will be done. it will be more than three stages of colon cancer. Prof. Dr. Hans-Joachim Schmoll, MD. Colon cancer treatment will be more individualized. Dr. Anton Titov, MD. Therapy will be based on the personally expected course of disease for each colon cancer patient. Colorectal cancer staging. How new molecular classification helps to personalize cancer treatment. Gene Expression Classification of Colon Cancer is crucial in era of precision medicine. Molecular Markers Identify Subtypes of colon cancer that can be treated separately. Patients can benefit from new genetic classification of colon cancer and rectal cancer. Personalized medicine (p4) is here today. New colon cancer treatment methods have to be applied to correct selected patients. We have to look beyond the well-known mutations such as KRAS, NRAS, microsatellite instability or BRAF mutations in colon cancer tumors. Colon cancers at stage two and stage three are very different between each other at the same cancer stage. New colon cancer taxonomy should differentiate between patients who would benefit from treatment and who would not. personalized therapy also means precise decision on the kind of the treatment after the surgery. Leading colorectal cancer expert discusses new molecular classification of colorectal cancer.