Shining a Light on Colorectal Cancer Awareness Month

Shining a Light on Colorectal Cancer Awareness Month

March is Colorectal Cancer Awareness Month, a crucial time to emphasize the importance of prevention and early detection of this highly preventable disease. Despite the availability of effective screening methods, colorectal cancer (CRC) remains a significant health concern.

The Power of Early Screening

One of the most compelling aspects of CRC is its preventability. Early screening allows for the detection and removal of precancerous polyps before they develop into cancer. The American Cancer Society recommends regular screening starting at age 45, with a colonoscopy every 10 years for those at average risk. While colonoscopy is a cornerstone of screening, it's not the only tool. Recognizing other clinical symptoms is also vital. These symptoms include:

• Changes in bowel habits
• Blood in the stool
• Abdominal or rectal pain
• Iron deficiency anemia

Understanding the Risk Factors

Several factors can increase an individual's risk of developing CRC:

• Personal or family history of colorectal cancer or polyps
• Inherited conditions like familial adenomatous polyposis or Lynch syndrome
• History of inflammatory bowel disease
• Previous radiation exposure to the abdomen or pelvic region

The Role of Laboratory Testing in Diagnosis and Monitoring

Laboratory tests play a crucial role in diagnosing and monitoring CRC. Key biomarkers include:

• Carcinoembryonic Antigen (CEA): A serum marker that can be elevated in CRC, although it's not specific and may also be elevated in benign conditions. It's more useful for monitoring disease progression than early detection.
• CA 19-9: Often elevated in metastatic CRC (mCRC) and used for monitoring treatment response.
• Lactate Dehydrogenase (LDH): Elevated levels can indicate a poorer prognosis, particularly in metastatic disease.

Biomarkers for Targeted Therapies

In the era of personalized medicine, biomarkers are essential for identifying patients who may benefit from targeted therapies. Key biomarkers include:

• RAS Mutations (KRAS and NRAS): Crucial for mCRC. Patients without these mutations may be candidates for EGFR-targeted therapies like Erbitux® or Vectibix®.
  • KRAS mutations are found in approximately 40% of CRC cases.
  • NRAS mutations are less common, occurring in about 5% of cases.
• EGFR (Epidermal Growth Factor Receptor): Reported in 60-80% of CRC patients, particularly those with metastatic disease.
• BRAF Mutations: Present in 5-10% of CRC cases.
• MSI-H/dMMR (Microsatellite Instability-High/deficient Mismatch Repair): Observed in 15% of cases. Patients with MSI-H tumors tend to have better survival outcomes.
• NTRK (Neurotrophin Tyrosine Receptor Kinases) Gene Fusions: These fusions can drive tumor growth and are targets for specific therapies.

The Evolving Landscape of CRC Therapies

In addition to traditional chemotherapy and surgery, significant advancements have been made in targeted therapies and immunotherapies for CRC. These treatments are often guided by the biomarker profiles of individual tumors.

Currently Available Therapies:

• Targeted Therapies:
  • EGFR Inhibitors (Cetuximab, Panitumumab): Used in patients with mCRC who have wild-type RAS genes.
  • VEGF Inhibitors (Bevacizumab, Ramucirumab, Ziv-aflibercept, Fruquintinib): These drugs target blood vessel growth, which is essential for tumor development.
  • BRAF Inhibitors (Encorafenib): Used in combination with EGFR inhibitors for patients with BRAF V600E mutations.
  • HER2 Inhibitors (Trastuzumab, Tucatinib): Used in HER2-positive colorectal cancer.
  • NTRK Inhibitors (Larotrectinib, Entrectinib): For CRC with NTRK gene fusions.
  • KRAS G12C Inhibitors (Adagrasib, Sotorasib): Used for patients with KRAS G12C mutations.
• Immunotherapies:
  • Immune Checkpoint Inhibitors (Pembrolizumab, Nivolumab, Ipilimumab): These therapies are particularly effective in patients with MSI-H/dMMR tumors, allowing the immune system to recognize and attack cancer cells.

Phase III Pharmaceutical Therapies:

The field of CRC treatment is continually evolving, with numerous phase III clinical trials investigating promising new therapies. These trials are exploring:

• New combinations of targeted therapies and immunotherapies.
• Novel immunotherapeutic approaches, such as cancer vaccines and CAR T-cell therapy.
• Drugs targeting other key signaling pathways involved in CRC development and progression.
• Investigational agents that target other KRAS mutations beyond G12C.

It's important to note that the availability and suitability of these therapies depend on individual patient characteristics and the stage of the disease.

Partnering for Success: Diagnostics and Targeted Treatments

The synergy between diagnostic testing and patient eligibility for targeted therapies and HCP targeting is crucial. An example of this is the collaboration between Guardant Health and Amgen to develop a companion diagnostic test for AMG 510 in KRAS G12C-mutated non-small cell lung cancer. This model can also be used in CRC.

Call to Action

Finding the right patient at the right time with the need for the right treatment and HCP targeting is paramount. Access to real-time clinical insights, combined with other patient data assets, accelerates the opportunity to intervene and improve outcomes.

At Prognos Health, we are committed to providing the data and insights necessary to empower healthcare professionals and pharmaceutical companies in the fight against colorectal cancer. By leveraging our vast data assets, we can help identify patients who may benefit from specific therapies, enabling more effective HCP targeting and ultimately improving patient outcomes.

Let’s work together to raise awareness, promote screening, and advance the fight against colorectal cancer.