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Colorectal cancer, the new strategies to improve treatments

November: it’s de time “The days of research”, the campaign promoted by AIRC Foundation to inform and raise awareness of the cancer emergency and present the new challenges of researchers. The pandemic has once again demonstrated the fundamental role of science and its ability to provide the right answers to protect our health. Strengthened by this awareness, AIRC, with the campaign “This is the time”, it promotes collective mobilization to give a strong acceleration to the work of researchers.

Together with the Airc experts, we took stock of the colorectal cancer, unfortunately today still the second cause of cancer death. It should be noted that this is a group of very different neoplasms, affecting either the actual colon (70% of cases) or the rectum (30%). Prevention through screening and targeted therapies to tackle the disease even at an advanced stage have made the difference in the treatment of this neoplasm: cases have decreased by about 20% compared to 2013 and 5-year survival from diagnosis has increased from 52% of the nineties to 65% today, both in men and women.

Colorectal cancer prevention: screening

One of the early diagnosis tools that medicine has in hand is it screening: free in Italy from 50 to 69 years, uses the simple examination of the search for occult blood in the stool: if it is positive, continue with a colonoscopy which allows to identify both early stage tumors and – very important – precancerous lesions (known as polyps), which can then be removed, thus completely avoiding the development of cancer. This explains the decrease in cases: the people who joined the screening have literally “beaten” the cancer.

In 2020 it is estimated to have been 43,700 new diagnoses (they were 54,600 in 2013), 23,400 in men and 20,300 in women. The confirmation of the effectiveness of this approach also comes from the data of 5-year survival from diagnosis which today is about 65%: The more people are screened, the more early diagnoses are made and the greater the chances of cure and recovery. But not only that: a greater knowledge of what is the biology of the tumor has made it possible to develop new molecularly targeted therapies and this has contributed to the increase in survival even in cases in which the disease is at an advanced stage.

Therapies to cure colorectal cancer

In 8 out of 10 patients, the first treatment used is surgery, followed by the chemotherapy so-called with the help of, which aims to reduce the risk of relapse. In selected cases, chemotherapy is also used before surgery in association with radiotherapy, to reduce the size of the tumor mass.

Chemotherapy drugs play a fundamental role in the treatment of this tumor and, depending on the case and the stage of the tumor, can be combined with targeted drugs chosen on the basis of the molecular characteristics of the tumor. Among these are the anti-EGFR (directed against the epidermal growth factor) and the anti-VEGF (targeting vascular endothelial growth factor). Finally, theimmunoterapia, which activates the body’s own defenses against cancer, is now used to treat a particular form of disease, characterized by microsatellite instability (5% of all cases) and a high load of tumor DNA mutations.

Colorectal cancer: new research findings

To understand what are the new discoveries in the oncology field, in particular in the fight against colorectal cancer, we took stock with Dr. Filippo Pietrantonio, oncologist of the National Cancer Institute of Milan and AIRC researcher.

What is the next challenge of colorectal cancer research?

“Being able to make the most ofimmunoterapia, the treatment that has led to great results in many cancers, but not in those of the colon. The only exception is constituted by that 5% of cases of carcinomas with microsatellite instability, in which even in the advanced forms survival has improved surprisingly and in many cases it has been possible to eradicate the disease. The challenge is, therefore, to find new strategies to achieve the same results in all other colorectal cancers. The other challenge is to transfer all the knowledge we have acquired on advanced forms to diseases at an early stage, to further increase healing ».

Pegasus is a project promoted by IFOM of Milan and supported as part of the AIRC “5 per thousand” program directed by Professor Alberto Bardelli, to which she also collaborates. What is the goal?

“The surgical removal of colorectal cancer is not always decisive: micrometastases may already be present, capable of causing recurrence, but impossible to identify with radiological examinations. For this reason, the operated patients are given chemotherapy drugs as a precaution, even if not everyone would need them. Pegasus’ goal is to be able to make post-surgical therapy more precise using liquid biopsy. In this way it should be possible to obtain numerous information on the tumor profile, identify the possible presence of tumor DNA circulating in the blood and thus intensify the treatments in patients who have a high risk of relapse. In the others, with a lower risk, chemo can be weakened with benefits for the quality of life ».


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