Stage 2 colorectal cancer. Treatment options. 5

40% of patients with stage 2 (Dukes B) colon cancer do not benefit from chemotherapy. Almost half of patients undergo toxic chemotherapy treatment without benefit. How to select Stage 2 colon cancer patients who will benefit from systemic chemotherapy?

Stage 2 colorectal cancer treatment options. Dr. David J. Kerr, MD. Leading colorectal cancer expert from Oxford discusses Stage 2 colorectal cancer treatment options. Dr. Anton Titov, MD. Stage 2 / Dukes B colorectal cancer is common diagnosis. 40% of patients with stage 2 / Dukes B colon cancer do not benefit from chemotherapy. Treatment options algorithm for decision on best treatment for Stage 2 / Dukes B colorectal cancer. Microsatellite instability (MSI) markers in stage 2 / Dukes B colon cancer help predict prognosis and survival rate. Precision medicine in stage 2 colon cancer and rectal cancer treatment. Stage 2 Colorectal cancer targeted chemotherapy options. Second opinion confirms that stage 2 colorectal cancer diagnosis is correct and complete. Second opinion also confirms that cure of colon cancer is possible in Dukes B / Stage 2. Best treatment for locally invasive stage 2 Dukes B colon cancer. Second opinion helps to choose precision medicine and the best targeted chemotherapy treatment for stage 2 colorectal cancer. Get second opinion on stage 2 Dukes B colorectal cancer and be confident that your treatment is the best. Dr. Anton Titov, MD. Best colorectal cancer treatment center for personalized medicine. Dr. David J. Kerr, MD. Video interview with leading expert in colorectal cancer treatment from Oxford. Stage 2 colorectal cancer treatment options. Colorectal cancer therapy decision based on molecular profiling. Dr. Anton Titov, MD. 25% of colon cancer patients have Stage 2 or Dukes B stage of colorectal cancer at diagnosis. Stage 2 or Dukes B stage means colon cancer or rectal cancer penetrated the bowel wall. But there are no signs of tumor spread in the lymphatic nodes. That is a general definition of stage 2 colorectal cancer. Dr. Anton Titov, MD. What does your experience show? What is the best method to personalize treatment of Stage 2 colorectal cancer? Perhaps you could discuss an overall strategy of treating of Stage 2 or Dukes B stage of colon cancer or rectal cancer. Dr. David Kerr, MD (Colon cancer oncologist, Oxford). We have developed a new algorithm to select Stage 2 / Dukes B colorectal cancer patients who would benefit most from adjuvant chemotherapy. We did large clinical trial called QUASAR on Stage 2 / Dukes B colorectal cancer patients. Dr. David J. Kerr, MD. It showed survival advantage for giving adjuvant chemotherapy to Stage 2 / Dukes B colorectal cancer patients. Absolute benefits are very small, 3% to 4%. But they are statistically real. Dr. David Kerr, MD (Colon cancer oncologist, Oxford). These results mean that we are over-treating a large number of Stage 2 / Dukes B patients to benefit a small number of colorectal cancer patients. The chemotherapy algorithm that we use is this. Sometimes colorectal cancer stage 2 is T4N0, we would still give adjuvant chemotherapy. Sometimes colorectal cancer is T3 stage, and molecular markers show microsatellite instability (MSI). Then the patient has a very good prognosis. We will not give adjuvant chemotherapy to those colorectal cancer patients. But for 70% of colorectal cancer patients have T3N0 colorectal cancer. We use molecular tumor profile markers. We use Genomic Health tumor profile panel or other genetic tests. They can help to sort this large group of colorectal cancer patients. Some patients are at high risk of cancer recurrence. Dr. David J. Kerr, MD. Some colon cancer patients are at low risk of cancer recurrence. Then we can work with colorectal cancer patients individually. We can explain the risks of chemotherapy. Dr. David J. Kerr, MD. We can decide together whether to give these stage T3N0 colorectal cancer patients adjuvant chemotherapy. Dr. Anton Titov, MD. Molecular profile testing of colorectal tumor helps to make adjuvant chemotherapy data-driven. It is better than mechanistic decisions. Stage 2 / Dukes B colon cancer may require adjuvant chemotherapy. Dr. Anton Titov, MD. Molecular profiling allows to separate patients with Stage 2 Dukes B colon cancer into distinct groups for personalized adjuvant chemotherapy decisions. Dr. David Kerr, MD (Colon cancer oncologist, Oxford). The evidence for our approach to colorectal cancer Stage 2 patients is very strong. We have done clinical trials in several thousand colon cancer patients. Therefore, I can say this with some degree of confidence. These colon cancer or rectal cancer treatment decisions based on molecular profile are published in good journals. There is strong science that explains why these results is very good. Therefore, I think it’s an important decision making for colorectal cancer treatment. Dr. Anton Titov, MD. Thank you very much! This is very important. Because many patients are diagnosed with stage 2 / Dikes B colorectal cancer. Dr. David J. Kerr, MD. Also it’s important to personalize chemotherapy in colorectal cancer. We should avoid chemotherapy in patients who are likely to have high toxicity. We should also not excessively treat patients who would not benefit from colon cancer chemotherapy.  Dr. David Kerr, MD. I agree Stage 2 / Dukes B colorectal cancer is common diagnosis. 40% of patients with stage 2 colon cancer do NOT benefit from chemotherapy. Choose therapy wisely