Immunotherapy and liquid biopsies for colorectal cancer patients will be changing treatment decisions in the coming years. But, as it is, those who are patients in community and rural settings, do not have access to the same information as those who are at NIH centers. This is particularly true for Stage 1, 2 and even Stage 3 patients who tend to get treatment at a localized center.
Outreach to this group must be either community-based or social media-based. This project is to create a Facebook group for early stage colorectal cancer patients so that they know about clinical trials and new technologies available to them.
Many of the online Facebook communities have a strong presence of stage IV patients, care-partners and family members. But there aren’t any active research-focused groups that focus on the concerns of stage 1, 2 or 3 patients. Fifty percent of those with stage IV disease started as a stage 1, 2 or 3 patients. So, this is an important area of interest as well as a key area of prevention. Helping to prevent progression may be possible in this population and may be more likely with the advent of immunotherapy and liquid biopsies.
Three Arms to the Facebook group.
1. Information about Immunotherapy options for Stage III patients
• Immunotherapy for MSI patients (about 10% of Stage III CRC patients) is available in a number of trials. One of them, the ATOMIC trial was at about 15% enrollment as of last January. There is some compelling research that immunotherapy may be more effective than chemotherapy for this population (which has FDA approval of I/O as a 2nd line treatment in the metastatic setting)
2. Liquid biopsy and related clinical trial options.
• For Stage III will be tested in clinical trial NCT03803553 starting in the fall of 2019. If circulating cancer DNA is found, patients are believed to be at higher risk for recurrence. These patients will have the ability to choose to have more chemotherapy (e.g. 6 months instead of 3 months.
• Stage II patients can enroll in the COBRA trial (expected December 2019 to January 2020) so that the presence of ctDNA can be monitored. If it is found, those patients can choose to have chemotherapy (which is usually only offered for high-risk” Stage II patients).
• About 20% of Stage II patients will progress to metastatic disease and 28% of Stage III will have progression.
• Liquid biopsies for colorectal cancer patients will be changing treatment decisions in the coming years. The presence of circulating tumor DNA is a sign that treatment has not been effective and that progression of disease to a metastatic setting is more likely.
3. To be a clearing house of other clinical trial information to have a “value added” feature that could appeal to a wide range of Stage II and III patients who are looking for vetted current research
• Observational trials and registries e.g. looking at mutations, gut microbiome
• Registries and trials for heredity colorectal cancers e.g. Lynch Syndrome
• Intervention trials -such as changing diet and/or increasing exercise
• Intervention trials for those who are Stage III but are unresectable
• Upcoming interventional trials in the adjuvant setting (this may happen in 2020/2021 for BRAF V600e patients who have one of the most aggressive cancers in the metastatic colorectal cancer)
• Results from trials that may be of use to Stage II and III patients (e.g. survivorship plans, side effects like neuropathy and supportive care)
• Information on how to enroll or search for a clinical trial
Citation Format: Annie Delores Feehan. Preventing PROGRESSION [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A024.