ASCO 2015: Personalized Medicine and Genomics in Colorectal Cancer

Published on

Topics include: Treatments

Dr. Stacey Shiovitz, medical oncologist at Seattle Cancer Care Alliance (SCCA) and Assistant Professor at the University of Washington School of Medicine, specializes in genetics and colorectal cancer. She discusses a new approach to research helping with treatment selections for patients. In addition to looking at the tumor size and growth, doctors are now looking at the DNA within the tumor. The progress has been made in moving away from just looking at the stage of the cancer and focusing more on the genes. Dr. Shiovitz encourages patients to speak with their health care team about specific characteristics of their tumors, because it can assist with treatment eligibility and maximize their potential of acquiring the best treatment options.  

View more programs featuring and

Produced in association with

Transcript

Please remember the opinions expressed on Patient Power are not necessarily the views of Seattle Cancer Care Alliance, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Carol Preston:

Hello everyone and welcome to Patient Power.  I'm Carol Preston, and we are in Chicago at ASCO, the American Society of Clinical Oncology.  This program is brought to you by the Seattle Cancer Care Alliance, and joining us from the alliance is Dr. Stacey Shiovitz, who specializes in colorectal cancer. 

Dr. Shiovitz, can you tell us a little bit more about your specialty and what you're doing? 

Dr. Shiovitz:

Sure.  So my interest is in genetics in colorectal cancer, and so what that means is now we don't just look at the size of the tumor or where the tumor has spread to but actually look at the DNA, looking at changes in germline mutations, meaning the cells that we carry throughout our body, and also looking at the DNA of the tumor itself and seeing if there [are] differences there that might help us understand how to treat patients.  

Carol Preston:

And what have you learned? 

Dr. Shiovitz:

So I think it's a really exciting field because previously we would treat by stage.  We would say if you have stage III colon cancer you should have six months of a certain kind of chemotherapy, and that's all we think about it.  But now we know that we should actually be thinking a little bit deeper and getting more information about the tumors. 

So, for example, we know that there [are] certain mutations called the RAS genes, KRAS and NRAS, that help us understand whether certain patients that have stage IV, or metastatic colorectal cancer, should have different therapies than people who don't have those mutations. 

Carol Preston:

How are the PD-1 inhibitors doing with colorectal cancer?  

Dr. Shiovitz:

So first we thought that they didn't really work at all, and now we're just finding as of this meeting that actually there is some benefit potentially for PD-1 inhibitors in colorectal cancer.  So there are some subtypes of colorectal cancer called microsatellite instability-high patients, and what that means is that there [are] changes in the tumor DNA that are different than changes in our regular DNA. 

And when we have those changes those patients seem to respond better to the PD-1 inhibitors.  So that just teaches us that we really need to be looking a little bit more carefully at different patients' features of their tumor to better treat patients rather than just treat us all the same. 

Carol Preston:

What percentage of patients are responding? 

Dr. Shiovitz:

So in that particular trial they were just looking at patients that had something called Lynch syndrome, or a germline change that led to this microsatellite instability, and the data that was shown at the conference showed a very good response, where people that did not have this microsatellite instability basically did not respond to the drugs, whereas patients that did almost all of them had some level of response.  And so it's very exciting for colorectal cancer that we can use these new drugs in new ways.  

Carol Preston:

ASCO is in the home stretch…

Dr. Shiovitz:

Yeah. 

Carol Preston:

…in terms of what you have picked up, what you've presented, what your colleagues have presented.  What is—what is spinning in your head?  

Dr. Shiovitz:

Well, right now I am looking into a different subtype, not this microsatellite instability Lynch syndrome, but looking at patients that we're calling double somatic or patients that have different mutations in their tumor genes that make them have maybe a different phenotype or a different clinical picture than Lynch syndrome.  So I think what we're just learning is that we need to subtype more and more. And as we share between different research groups, we learn these are different areas that we could be looking at and then applying them in new ways. 

So I'm just excited about the amount of research in this area and actually incorporating genetics and incorporating biomarkers into our trials. 

Carol Preston:

Thank you very much…

Dr. Shiovitz:

Thank you. 

Carol Preston:

…Dr. Stacey Shiovitz of the Seattle Cancer Care Alliance for sharing the information and the hopeful news… 

Dr. Shiovitz:

Yes.  

Carol Preston:

…about colorectal cancer.  

Dr. Shiovitz:

Yes. 

Carol Preston:

I'm Carol Preston reporting from ASCO.  And remember that knowledge can be the best medicine of all.                 

Please remember the opinions expressed on Patient Power are not necessarily the views of Seattle Cancer Care Alliance, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Related Programs

Is Colon Cancer on the Rise in Young Adults?

Physician-researcher Dr. William Grady stresses that colon cancer is preventable if detected early and discusses the rise of colon cancer in young adults. Who should get a colonoscopy and when? Dr. Grady explains.

Published:

Will the ADAPT Study Revolutionize Treatment Approaches in Colorectal Cancer?

Can an odd combination of medicines treating some advanced colorectal cancer patients attack cancer at the source or other cancers? Dr. Edward Lin, a lead investigator in the ADAPT trial, explains.

Published:

Microsatellite Instability Testing for Colon Cancer

Learn how a new test could potentially spot colon cancer much sooner by pointing out a molecular signature within the tumor. Dr. William Grady of Seattle Cancer Care Alliance explains.

Published:

Advertisement
Join Our Community Register for Events Read Our Latest Blog
Advertisement

Page last updated on June 25, 2015