colon cancer stage 2 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 tumor 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. what does your experience show on the best approach to personalize the treatment of patients with 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 those 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. 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 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. if colorectal cancer stage 2 is t4n0, we would still give adjuvant chemotherapy. if colorectal cancer is t3 stage, and molecular markers show microsatellite instability (msi), 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. using molecular tumor profile markers, like genomic health tumor profile panel or other genetic tests can help to separate this large group of colorectal cancer patients. some patients are at high risk of cancer recurrence and some colon cancer patients are at low risk of cancer recurrence. then we can work with colorectal cancer patients individually, explain the risks and decide together whether to give these stage t3n0 colorectal cancer patients adjuvant chemotherapy.
dr. anton titov, md: molecular profile testing of colorectal tumor really helps to make adjuvant chemotherapy data-driven. it is better than mechanistic decisions: stage 2 / dukes b colon cancer - therefore, adjuvant chemotherapy. 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 studies in several thousand colon cancer patients. so 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, science that explains 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 it's a lot of patients are diagnosed with stage 2 / dikes b colorectal cancer. 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 overtreat patients who would not benefit from colon cancer chemotherapy. dr. david kerr, md: i agree
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