Dr Ajay Goel Discusses New Methods of Testing for EOCRC, Recurrence

Ajay Goel, PhD, AGAF, explains the significance of 2 new studies that found that early-onset colorectal cancer (EOCRC) and recurrence in CRC could both be predicted using new blood and tissue tests.

Ajay Goel, PhD, AGAF, professor and chair of the Department of Molecular Diagnostics and Experimental Therapeutics at City of Hope, a cancer research and treatment organization, spoke with The American Journal of Managed Care® about how blood biopsies and tissue-based microRNA tests could predict early-onset colorectal cancer (EOCRC) incidence and recurrence in colorectal cancer, respectively, based on new research presented at Digestive Disease Week.


What are the main takeaways of your study that tested the effectiveness in detecting EOCRC using a liquid biopsy?

At the upcoming Digestive Disease Week, we are presenting 4 different studies. The ones we'll talk about, 2 of them relate to colon cancer, especially early-onset colon cancer. That's a type of colon cancer, which is on the rise. So when we talk about colon cancer, typically in the US, the median age for colon cancer, is still 67, 68 years old. [In] that, we are doing better because we're doing more and more screening for people, we are educating people more about colon cancer screening and awareness. So that incidence is somewhat declining, or it is stable.

But the problem is, about somewhere between about 25% to 30% of newly diagnosed colon cancers—depending on which cohort, which nation, which country you look at—they're falling into this new category of colon cancer referred to as early-onset colon cancer, or EOCRC. What that means is that this cancer happens typically in people younger than age 50, or some people even use the number 45. So somewhere around 45 to 50 [years old]. These individuals do not have any family history of colon cancer, they don't have any predisposition for any genetic mutation. So it's not the familial or hereditary type of colon cancer. This is just sporadic, called early-onset colon cancer. So that's just the background. [This is] important because 2 of the studies relate to that.

One of the studies1 we're going to present is about detection of these patients with early-onset colon cancer. Right now in the US, where we have nationalized colon cancer screening guidelines, those guidelines say that everybody, once you turn age 50, you undergo colonoscopy screening. And very recently, in the last 3 or so years, we have revised those guidelines to lower the age to a 45-year threshold. The point is, right now the colon cancer screening begins at 45 to 50 years of age, but what I just told you a few minutes earlier, early-onset colon cancer typically happens in people much younger than age 50, or 45, sometimes [they're in their] 20s and 30s. So we do not have any screening test for these people.

So that's what this first study is about: Developing a blood test for early detection of people with early-onset colon cancer. That's important, because right now, there's absolutely zero tests for early detection of these cancers. So in this meeting, we will be presenting a blood-based test, which allows us to detect early-onset colon cancer using micro RNA–based monitors in patients with early-onset colon cancer. We are very, very excited about it, because although we've developed this test for early-onset colon cancer, what we recognize is actually the same test can also capture late-onset/irregular colon cancer as well. So what that means is now you can use a single blood test and capture both populations, those with early onset of disease and also with late onset of disease.

How can a tissue-based microRNA test be used in predicting recurrence of CRC?

The second study2 is also about early-onset colon cancer, but this is about that those who have early-onset colon cancer, typically, most of these patients will undergo surgical removal of their cancer. But since this is a very aggressive disease, because it happens in younger people, even after surgery, almost half of these patients, almost 50% to 60% of these patients, will eventually develop recurrence or relapse of that cancer again. But right now, when these patients undergo surgery, we have no way of knowing which of these patients will experience tumor recurrence or disease relapse.

So, what we do is we continue to put these people through extensive endoscopy or colonoscopy surveillance, which means we continue to check them by colonoscopy every 3 years, 5 years depending upon the disease severity. Which is not good, because every time you do a colonoscopy, it is invasive, it is expensive, there is a risk of colonic perforation and other problems with the procedures. But right now, we have no other way of monitoring these patients [and determining] which of these patients will have cancer back.

We have developed a micro-RNA–based test, which rather than looking at repeated colonoscopies, we can look at this micro RNA signature in the tissue of the patients after they receive surgery. And we can predict, based on the markers we have, what is the likelihood this patient will have recurrence 5, 10, 30 years later. The markers are so good that we can even predict up to 20 years which patients will likely have recurrence and which will not. So having this knowledge is clinically very important, because if we know that this patient has a small or high likelihood of experiencing recurrence, we can give these patients chemotherapy, adjuvant chemotherapy, which means after taking their cancer out, we can give them more aggressive chemotherapy so that we can mitigate or eliminate the chances of this tumor coming back.

So the second study is about predicting recurrence and how to manages those patients clinically.


1. Mannucci A, Xu C, Shoda K, Garcia JP, Cavestro GM, Goel A. Development of an exosome-based liquid biopsy powered by machine learning for hte detection of early-onset colorectal cancer. Presented at: Digestive Disease Week; May 18-21, 2024; Washington, DC.

2. Xu C, Mannucci A, Balaguer F, et al. An exosome-based liquid biopsy allows the early detection of advanced adenomas and early-stage colorectal cancer. Presented at: Digestive Disease Week; May 18-21, 2024; Washington, DC.

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