MD Anderson Cancer Center Madrid and The University of Texas MD Anderson Cancer Center Houston organized, for the first time, a multidisciplinary conference on the latest advances in pancreatic, colon, rectum, stomach, esophagus and liver cancer.
Surgical oncologists, doctors and radiotherapists, gastroenterologists, radiologists and pathologists will analyze complex clinical cases from Houston and Madrid at a congress in which patients will participate, represented by Jola Gore-Booth, president of Europa Colon.
Between 15% and 17% of patients with rectal cancer who undergo chemotherapy and radiotherapy as a first treatment, would not need follow-up radical surgery for to be cured.
A decade ago, most oncological treatments in patients with metastasis associated with the appearance of a primary tumor were carried out with a fundamentally palliative intention. Now, thanks to the arrival of biologic drugs and immunotherapy, in combination with chemotherapy, it is possible to treat many of these metastatic cancer patients with greater effectiveness. Proof of this is the I MD Anderson International Congress on Gastrointestinal Oncology, which will discuss in depth the treatment of localized but also metastatic cancer of the pancreas, colon, rectum, stomach, esophagus and liver.
Directed jointly by Dr. Santiago Gonzalez-Moreno, medical director of MD Anderson Madrid, and Dr. Miguel A. Rodriguez-Bigas, MD Anderson Houston Department of Surgical Oncology, the congress begins today, Wednesday, November 29 and will last until this Friday, December 1. For both organizers, this meeting, which aims to bring the latest advances in research and treatments in gastrointestinal cancer to health professionals, is a very important opportunity for bidirectional collaboration between continents.
Another important aspect highlighted by the organizers is the multidisciplinary nature of the congress. "Each specialty contributes to the treatment of the patient and, therefore, it is very important to discuss with other professionals what the best treatment alternatives are before making a therapeutic decision", points out Dr. Rodriguez-Bigas. Hence, Dr. Gonzalez-Moreno continues, "both the speakers and the organizers of this congress belong to different specialties, such as surgical oncology, medical oncology, radiotherapy oncology, gastroenterology, radiology or anatomical pathology". A circumstance that both doctors have also used to create a "tumor board" at the end of each session in which complex clinical cases, both from Houston and from Madrid, will be discussed from a multidisciplinary point of view.
Likewise, both Dr. Rodriguez-Bigas and Dr. Gonzalez Moreno wanted to highlight the presence at the congress of Jola Gore-Booth, president of Europa Colon, who will talk about what patients of healthcare professionals expect when it comes to the treatment of a tumor. As Dr. Rodriguez-Bigas points out, "many times we prescribe a treatment without stopping to think about what the patient thinks of this therapy" and, therefore, both organizers were very clear about the need for patients to be represented in an event of these characteristics. "Patient care is what guides our work and, therefore, we think it is important to show our interest in the patient's well-being and in their participation throughout the process of their illness," explains Dr. Gonzalez-Moreno.
A different treatment sequence for each subgroup of patients
Given the specificity of a disease such as cancer, many of the talks and debates at the congress are aimed at defining which specific subgroup of patients can benefit from certain treatment sequences. Thus, for example, one of the debates moderated by Dr. Gonzalez-Moreno will try to define which group of patients with gastric cancer could benefit from intraperitoneal chemotherapy, one of the most used techniques in colon cancer, to treat and prevent the spread of a peritoneal tumor. Discussions present in all types of tumors, but which are especially controversial in the treatment of rectal and pancreatic cancer.
Thus, in locally advanced rectal cancer, for example, neoadjuvant therapy (i.e. therapy administered before surgery) is established as a treatment standard, but, Dr. Gonzalez-Moreno explains, "what is not clear is what combination of chemotherapy and radiotherapy should be given to the patient and what dosage. " In addition, once the surgical intervention is carried out, there is also a lot of controversy regarding which adjuvant treatment (i.e. post surgery) is appropriate.
Also, explains Dr. Rodriguez-Bigas, another of the great debates in rectal cancer is that "between 15% and 17% of patients with rectal cancer undergoing neoadjuvant therapy with chemotherapy and radiotherapy get a complete pathological response, and therefore, would not need follow-up surgery". The problem now is how to select this subgroup of patients and, once defined, the debate also arises to what extent it is really safe to keep these patients, who obtain a complete pathological response, without surgery and only under observation.
In pancreatic cancer, although there are no significant advances at the level of pharmacological therapies and chemotherapy remains the standard of treatment in most cases, there are debates open about the sequence of treatments. One, Dr. Gonzalez-Moreno points out, is to demonstrate that, in cases in which the tumor is a candidate for surgery from the outset, a previous treatment with chemotherapy and radiotherapy could provide better results than performing surgery directly. In cases where the tumor cannot be removed because it is on the verge of resectability or because of fear of remaining residual disease, the key role of neoadjuvant chemotherapy has been demonstrated.
"New Trends" talks to present the latest therapeutic novelties
The scientific program of the congress also echoes the latest developments that have occurred in recent years in pharmacological treatments for cancer patients with metastases and / or high risk of recurrence. "Before, we only had chemotherapy to treat these patients and now, in addition to new drugs such as biologics or immunotherapy, we also have new routes of administration such as oral administration," says Dr. Gonzalez-Moreno.
Thanks to these advances, explains the doctor, "certain patients with colon cancer and liver or lung metastases, for example, can now receive a treatment composed of surgery and chemotherapy with a curative intention, something that was unthinkable a few years ago". Some patients to whom, in a few years, Dr. Gonzalez-Moreno is sure that new patients will be able to join. In fact, another of the conferences held by the medical director of MD Anderson Madrid during the conference speaks precisely of the therapeutic options with curative intent that are being investigated in patients with colorectal cancer and peritoneal carcinomatosis (the spread of the tumor through the wall of the abdomen, pelvis or peritoneum), a type of tumor dissemination traditionally untreatable.
In addition, Dr. Rodriguez-Bigas also highlights as important advances in these talks the discovery that "patients with pancreatic cancer and genetic mutations in BRCA1 and BRCA2 (genes whose mutations cause breast or ovarian cancer) respond better to chemotherapeutic agents or that patients with colon and rectal cancer and instability in microsatellites respond better to treatment with immunotherapy".