Evaluating Clinical Burden of Metastatic Versus Nonmetastatic CRC

Dr Kristen Ciombor explores clinical impacts during the treatment of patients with metastatic or nonmetastatic colorectal cancer.

Kristen Ciombor, MD: The clinical burden for colorectal cancer has unfortunately been increasing lately, particularly in patients who are under age 50. That has become an important problem that we’ve noticed, not only in the trends coming through in research but also in my clinical day-to-day practice. Fortunately, we’re seeing a decrease in incidence of colorectal cancer in patients over age 50, which I think is related mostly to colonoscopic and other screening methods. But we need to start targeting patients under age 50 as well. This led to a decrease in the age that patients are recommended to undergo colonoscopy, from age 50 to 45, based on the USPSTF [United States Preventive Services Taskforce] guidelines.

We’re noticing those different patterns and trying to make some changes as a result, in not only screening but also treatment. We know that the majority of patients diagnosed with colorectal cancer are diagnosed in a nonmetastatic stage, stages I through III. Unfortunately, about 1 of 5 patients can be diagnosed with metastatic disease at the time of diagnosis. Stage-wise, the earlier the disease can be diagnosed, the more likely we are to have a chance to cure it. That’s why that’s important.

In addition to the patients who are diagnosed with metastatic disease de novo, a substantial percentage of patients can develop metastatic disease or have a recurrence after a localized diagnosis. This is why getting the best treatment in the localized setting is important. If you have stage III colon cancer, we generally recommend adjuvant chemotherapy to try to prevent recurrence because you have the best chance at curing this cancer when it’s first diagnosed. In all comers for stage III disease, for instance, the recurrence rate with surgery alone can be 50% or sometimes higher. Chemotherapy can reduce that risk. It often becomes a disease that’s treated with both surgery and chemotherapy. It isn’t only the patients who are originally diagnosed with metastatic disease. It’s also the patients who can develop recurrent disease, which we’re always trying to reduce.

Even with our best treatments, patients can still have poor outcomes, whether they have recurrent disease that isn’t able to be resected or metastatic disease at diagnosis and aren’t able to undergo surgery or metastasectomy. The 5-year overall survival rate for metastatic colorectal cancer is only about 15%. We’re making inroads in that, especially with biomarker testing and targeted therapies, but we still have a long way to go to make that better.

Transcript edited for clarity.

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