Significant progress against gastrointestinal (GI) cancers has been made over the last several years and greater changes are now on the horizon thanks to new imaging technology and even newer surgical interventions. Many tumors of the GI tract are still incurable and result in high morbidity and mortality; however, that is not the case with colorectal cancer (CRC). New advances in imaging, the development of molecular biomarkers, and refined prognostic and predictive information have significantly improved outcomes. In addition, new cytotoxic and targeted therapies are improving survival for patients with metastatic CRC.
“The biggest improvements have been in the area of colon cancer. [It is being caught] earlier, and there is better adjuvant therapy. Metastatic disease survival rates have improved from 8 months to 2.5 years,” said Richard Schilsky, MD, chief of Hematology/Oncology in the Department of Medicine at the University of Chicago Comprehensive Cancer Center and the chief medical officer of the American Society of Clinical Oncology (ASCO). “We have really solidified the biology of colon cancer and we know better who is going to get it and we have good screening policies.”
Pancreatic Cancer Still a Challenge
However, he noted, that is not the case with pancreatic cancer, which can be hard to diagnose and is still largely incurable. Dr. Schilsky and his colleagues recently published an editorial entitled, “Progress Against GI Cancer During the American Society of Clinical Oncology’s First 50 Years,” which discussed that, over the past 30 years, the probability of 5-year survival for pancreatic cancer has increased only slightly from 2% to 6%.1 He explained that, although surgical techniques and postoperative care for pancreatic cancer have improved, there is still a large unmet need.
“There have been some advances with adjuvant chemotherapy and introductions of some new drugs in recent years and they have resulted in small incremental improvements. But we are still struggling to understand the biology of the disease,” explained Dr. Schilsky.
Improved Screening/Treatment Techniques
In recent years, significant advances have occurred in staging and combating esophageal cancer. Dr. Schilsky noted surgery was the standard treatment 50 years ago, but now patients benefit from preoperative chemoradiation, which has been shown to extend survival. Imaging has improved staging for esophageal cancer and it is now much more common for patients to receive rapid early assessment of treatment responsiveness.
Incidence and mortality rates as a result of gastric cancer have been steadily decreasing. New studies suggest that anti-vascular endothelial growth factor receptor monoclonal antibody therapies can help some patients with gastric cancer. In addition, adjuvant or perioperative chemotherapy may enhance surgical outcomes in patients with gastric cancer. “There is still a lot of work to be done. We still don’t know all the molecular drivers,” said Dr. Schilsky. “We are in a new era in cancer in general and that is reflected in some of these various GI cancers, but the advances are not universal.”
New therapies coupled with better screening and treatment for chronic hepatitis B and C have significantly improved hepatocellular carcinoma mortality rates. Significant progress has also been made against anal cancer, since it is now known that it can be caused by human papillomavirus (HPV). The risk of developing anal cancer may now be reduced through HPV vaccination.
Minimally Invasive Procedures Lower GI Cancer Morbidity
Dr. Schilsky said less-invasive surgeries are significantly changing the landscape when it comes to GI cancers. New types of minimally invasive procedures are lowering morbidity, and “many surgeries can now be done with minimally invasive techniques and we have more therapy options than have ever existed before,” he added.
Ziv Haskal, MD, professor of radiology at the University of Virginia School of Medicine, Charlottesville, VA, said interventional radiology now is a newly recognized specialty and it is playing a much greater role in the management of GI cancers. Dr. Haskal said interventional radiologists are now working closely with the oncology team to devise treatment plans much earlier in the course of the disease. Currently, new drug therapies are being combined with interventional radiation modalities in the hopes of improving outcomes.
“I expect that, in the next decade, the central role of interventional radiologic therapies applied to liver, lung, renal, and bone tumors will equally grow in GI cancers. This may begin with ablation or radioembolization of oligometastatic esophageal cancer in the liver. GI cancers may be an important area for the use of some of the newer ablation modalities for percutaneous palliation and debulking of GI tract masses,” Dr. Haskal told ChemotherapyAdvisor.com.
- Mayer RJ, Venook AP, Schilsky RL, et al. Progress against GI cancer during the American Society of Clinical Oncology’s first 50 years. J Clin Oncol. 2014;32(15):1521-1530.