Treatment of Colorectal Cancer

June 14, 2021

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June 13, 2021

Yale Cancer Center

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00:00Support for Yale Cancer Answers
00:02comes from AstraZeneca, dedicated
00:05to advancing options and providing
00:07hope for people living with cancer.
00:10More information at astrazeneca-us.com.
00:14Welcome to Yale Cancer Answers with
00:16your host doctor Anees Chagpar.
00:18Yale Cancer Answers features the
00:20latest information on cancer care by
00:22welcoming oncologists and specialists
00:24who are on the forefront of the
00:26battle to fight cancer. This week,
00:29it's a conversation about colorectal
00:30cancer with Doctor Michael Cecchini.
00:32Doctor Cecchini is an assistant
00:34professor of medicine and medical
00:36oncology at the Yale School of
00:38Medicine where Doctor Chagpar is
00:40a professor of surgical oncology.
00:43So Mike, maybe we can start
00:45off by you telling us a little
00:48bit about colorectal cancer.
00:50A little bit about the epidemiology.
00:52Who gets it? How common is it?
00:55How lethal is it?
00:56And then we'll get into some
00:58of the more recent updates with
01:00regards to screening of colorectal cancer.
01:03I am a gastrointestinal
01:05medical oncologist, and I see a variety
01:08of GI cancers, colorectal cancers and it is where
01:10I focus the majority of my research.
01:16It's quite common.
01:17There are about 150,000 cases diagnosed
01:19annually in the United States and
01:22more than 50,000 annual deaths.
01:25And I do think it needs to be stated
01:28that there is also a rise in incidence
01:31in adults less than age of 50.
01:34Although it is like many cancers,
01:36predominantly a cancer of older
01:37individuals, for some unclear reason,
01:39the incidence is actually rising
01:41in adults less than age of 50,
01:45while it is going down overall,
01:47due to effective screening by
01:50colonoscopy for adults over the
01:54age of 50.
02:03Patients with a personal history or
02:06family history of colorectal cancer are at
02:08increased risk for developing the disease.
02:11Personal history for large polyps etc.,
02:14certain polyps with certain characteristics
02:16increase the risk for colorectal cancer,
02:19but it is mostly sporadic,
02:20not familial.
02:21There are conditions like
02:23inflammatory bowel disease,
02:24prior radiation and then in rare
02:27circumstances inherited syndromes such as
02:29Lynch syndrome and something called FAP.
02:32Familial adenomatous polyposis syndrome.
02:34And other polyp syndromes.
02:36So when thinking about
02:38the fact that the majority
02:40of these are sporadic,
02:42are there any risk factors
02:44that people who don't have a family
02:47history should really be cognizant of?
02:50So I'm thinking here about
02:52things like you know,
02:54people often ask about smoking or alcohol,
02:57or smoked meats or other
02:59things that might increase their risk.
03:02So there
03:03isn't this clear association
03:05with some carcinogen,
03:06some cancer predisposing factor,
03:08like there is with lung cancer and smoking,
03:11for example.
03:13I'd say that the data is a bit mixed on
03:17how important certain risk factors are.
03:20Certainly things like obesity,
03:21diabetes and red or processed meats
03:23increase risk and
03:25they may affect the rate to some degree,
03:28but the data again isn't
03:31always consistent.
03:33The smoked meats issue is
03:35more thought to be related to
03:37gastric cancer or certainly seems
03:39to play a bit more of a role.
03:42Race also plays a role.
03:43African Americans have the highest
03:45colorectal cancer rates in the
03:47United States and mortality
03:48is also higher compared to
03:50other ethnic groups.
03:51So do we know why we see some
03:53of these epidemiologic trends?
03:55Why is it that more African
03:57Americans get colorectal cancer?
03:59Why is it that we're now seeing
04:01more colorectal cancer occurring in
04:03adults younger than the age of 50?
04:05What are the factors in
04:07these particular populations
04:08that's increasing their risk?
04:09The short
04:10answer would be we don't know,
04:11and where there's a tremendous
04:14effort in trying to understand some of
04:16the risk factor and some of
04:19the reasons for the increased risk in
04:21the groups that you just articulated.
04:24Interesting and to get back
04:26to the younger age group.
04:27It's not just that the incidence
04:29has been static in that group,
04:31it's increasing and so we do
04:33think that it has some lifestyle factors,
04:35perhaps diet is a factor that is
04:37playing a role here,
04:38but we really don't know,
04:40and there's a tremendous area of
04:44research to try and understand why these incidences
04:46are increasing in the young adults.
04:48But we don't know.
04:50And so as we see more incidence
04:52in younger people, one of the
04:55questions that might come up is,
04:58you know historically,
04:59and I know that the screening guidelines
05:02have recently changed to include
05:04younger people in terms of routine
05:06screening for asymptomatic people.
05:08But when we think about the fact that
05:11over the last several several years,
05:14we're starting to see more
05:16colon cancer in younger people,
05:18how is it that they present because
05:21they wouldn't have presented on a
05:23routine asymptomatic colonoscopy,
05:25presumably because historically the
05:27guidelines had recommended starting
05:29colorectal screening at the age of 50.
05:31So how are we picking up these cancers in
05:34younger people?
05:36Unfortunately, it's the last thing
05:38on many caregivers minds,
05:39medical professionals minds that
05:42somebody symptoms would be related to
05:45colon cancer if they are a younger adult.
05:47But the majority of patients, about
05:503/4 of patients ,will have some
05:52nonspecific change in their bowel habits.
05:58Half will have bleeding.
05:59There's a palpable rectal mass
06:01in about 1/4 of patients,
06:03and iron deficency, or anemia isn't actually
06:05a sensitive as you might think.
06:07It's fewer than 20% of patients,
06:10especially young adults that
06:12would present with iron deficiency anemia.
06:14So unfortunately,
06:15I have numerous patients in my
06:17practice that had some lower GI
06:20bleeding that was attributed to
06:22hemorrhoids and incidence wise.
06:29Individuals should also
06:30listen to their bodies,
06:31and if something's not right,
06:33change in bowel habits,
06:34bleeding,
06:34they should take
06:35those very seriously,
06:36even if they're younger.
06:38Is it the case that,
06:39as we've seen this increasing
06:41incidence in younger people because
06:43they are presenting with symptoms?
06:45Presumably because screening was
06:46not recommended for
06:48people who were younger than age 50?
06:50Is it the case that these
06:51younger people that we were
06:53seeing colorectal cancers in
06:55were actually presenting
06:56with a higher stage,
06:58and what implications does
07:00that have for prognosis?
07:02Yeah, that's completely correct.
07:04Unfortunately, when you have a disease
07:07that is presenting because symptoms
07:09develop instead of asymptomatic screening,
07:11generally this stage is higher,
07:13so these younger adults generally
07:15are diagnosed at a more advanced
07:17stage and sometimes have even
07:20more aggressive biology overall.
07:22So again, the stage is going to be higher.
07:25The younger adult population tends
07:27to do better than the older adult
07:30population for when you're matching them
07:33by stage, because they can probably
07:35withstand treatment better but they
07:38are diagnosed at a more advanced stage
07:40then the patients that are
07:43diagnosed by asymptomatic screening and
07:46so now the American Cancer Society has
07:48come out and said that they recommend
07:52starting screening at the age of 45.
07:55Can you tell us more about
07:57their recommendations?
07:59Absolutely.
08:01The American College of Gastroenterology
08:03initially recommended
08:05dropping the screening age to
08:0745 for adults at average risk,
08:10but the most widely followed
08:12guidelines are actually the US
08:14preventative Task Force guidelines,
08:16which the majority of primary
08:18care physicians follow,
08:20and they did change their
08:22recommendation about a year or two ago
08:26to propose a Grade B recommendation
08:28for adults over the age of 45.
08:31But they still kept the greater
08:34recommendation for adults over the age of 50.
08:36But just yesterday this was
08:38updated and now for all adults,
08:40they've listed a strong recommendation
08:41for adults over the age of 45,
08:43so I think now going forward that's really
08:46going to be the age we start screening
08:49almost all asymptomatic adults.
08:57Colonoscopy is a very powerful screening procedure,
08:58not only because they can diagnose
09:01a cancer that's there and then we
09:03can deal with surgery
09:05or chemo as necessary,
09:07but they also remove
09:09premalignant conditions.
09:09So they are helping prevent
09:12the development of colorectal
09:13cancer even down the road.
09:15And there are
09:18so many screening tests now
09:20are recommended or that at
09:22least individuals could consider.
09:24So colonoscopy is often thought
09:26of as the gold standard,
09:27but some of these other tests
09:29seem to be really quite easy.
09:32Tell us a little bit about the
09:34different tests and the advantages
09:36and disadvantages of each.
09:37What do you recommend for patients
09:40who come to you and say,
09:43I heard about the updated guidelines,
09:45I'm now 45. What test should I have?
09:49I can comment a little bit there.
09:51It's not exactly my area.
09:53Unfortunately,
09:53the majority of patients I see have
09:55already been diagnosed with cancer,
09:57but absolutely colonoscopy is
09:57still the gold standard,
09:59so that would be my kind of
10:01blanket recommendation. For those
10:02that aren't ready to do that,
10:04but are interested in doing some screening,
10:08there are test for fecal occult blood,
10:11so for small amounts of undetectable
10:12blood and
10:14that's an imperfect way to
10:16assess whether or not there's a
10:19cancerous or precancerous condition.
10:20Again, the colonoscopy offers the
10:22power to remove precancerous lesions,
10:23which probably are not doing
10:25much at that point in time,
10:27but maybe missed by a test
10:29we're trying to detect small
10:31amounts of blood in the stool.
10:33There are also tests that actually try
10:36to detect DNA in in the stool, and
10:38that may be a more sensitive way,
10:42but also we're not removing anything
10:44premalignant with that we have
10:46yet to develop a blood based test
10:48that's diagnosing cancer before
10:50it develops, or at an early stage.
10:52So there are companies that
10:54are working on that,
10:55but we have a ways to go,
10:58but most of these patients are seen
11:00by my colleagues in Gastroenterology
11:03for their screening discussions and
11:08they are able to give some more eloquent answers
11:10on that
11:11than I am.
11:13Mike, the other question, and this might
11:15be a tough question as well,
11:17is why the magic number of 45?
11:20I mean, if we're seeing patients with
11:23younger colon cancers, why is it 45?
11:25Why not 40 or 42 or 38?
11:28How do people come up with
11:30these numbers as to at what age
11:33people should start screening?
11:36That's a great question and
11:37somebody asked the same question just last night.
11:45And I feel
11:47that same sentiment as well.
11:51I think that this is a first step and we
11:54may be recommending 40 in a few years,
11:56but we'll have to see how the data and
11:58the number needed to treat the
12:01number of colonoscopies done to really
12:03prevent one colorectal cancer holds up
12:04over time at these younger age groups.
12:07There's also
12:09as you know,
12:10I think different opinions on
12:12the age of of mammography as well.
12:15But again,
12:16getting back to the time it takes
12:19for colorectal cancer to develop in
12:22general somewhere on the order of a decade,
12:26I think by lowering the age to 40
12:28we're really capturing that group.
12:30If we were to lower the age of 40
12:32we're really capturing that group
12:34in the 45 to 50 range versus right
12:37now with this age of 45.
12:39Or probably
12:41we're helping prevent higher
12:42incidence in that 50 to 45 range.
12:45But as we started out the discussion
12:47really less than 50 is still seeing
12:49an increased incidence of colon cancer.
12:51So I think this is a moving target and
12:54we will benefit over time
12:57lowering the age,
12:58and I certainly, unfortunately,
13:00see patients in my practice below the
13:02age of 40 and 30 sometimes.
13:05Certainly it's going to be a
13:08moving target that we will follow,
13:10but for right now we're going to take
13:13a short break for a medical minute.
13:15Please stay tuned to learn
13:17more about the treatment of
13:19colorectal cancer with my guest doctor
13:21Michael Cecchini.
13:23Support for Yale Cancer Answers comes from Astrazeneca,
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13:27cancer as a cause of death.
13:29Learn more at astrazeneca-u.com.
13:32This is a medical minute about lung cancer.
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13:38are related to smoking and quitting even
13:41after decades of use can significantly
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13:46cancer for lung cancer patients.
13:48Clinical trials are currently underway
13:50to test innovative new treatments.
13:52Advances are being made by utilizing
13:55targeted therapies and immunotherapy.
13:57The battle two trial aims to learn
13:59if a drug or combination of drugs
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14:07More information is available
14:10at yalecancercenter.org.
14:11You're listening to Connecticut public radio.
14:15Welcome
14:16back to Yale Cancer Answers.
14:18This is doctor Anees Chagpar
14:20and I'm joined tonight by my
14:22guest doctor Michael Cecchini.
14:24We're talking about the treatment
14:26of colorectal cancer and Mike right
14:28before the break we were talking about
14:30the new updated screening guidelines,
14:33which now are recommending
14:34screening for colorectal cancer
14:36going back to the age of 45.
14:39One last question with regards
14:40to screening, before the break,
14:42you had mentioned that there
14:44are certain racial groups,
14:46for example, African Americans
14:49that tend to be diagnosed at a higher frequency,
14:52tend to have a worse prognosis
14:55than their Caucasian counterparts.
14:56So are the screening guidelines any
14:59different for African Americans
15:01versus Caucasian
15:02patients?
15:03There are slightly different recommendations
15:13Just as of yesterday the
15:15US preventive taskforce has
15:17changed it 45 and above for all
15:18adults and so I think there
15:20were some high risk groups
15:22including African Americans that were
15:23recommended 45 and above previously.
15:25But now it's just everybody 45.
15:28One wonders whether they will,
15:30as we were talking about before the
15:32break and edging even earlier,
15:35whether they would make that now
15:38a new age for higher risk groups.
15:41But I want to switch gears now and
15:43talk a little bit about what happens
15:46to patients after they have been
15:48diagnosed with colorectal cancer.
15:50So somebody goes and they get
15:53their colonoscopy and you know,
15:55we talked about colonoscopy being a
15:57great modality that can actually
15:59find premalignant lesions and remove them.
16:01But let's suppose on colonoscopy
16:03a patient is found to actually
16:06have an invasive cancer.
16:08Tell us a little bit more about
16:10how the treatment really works
16:12in terms of managing patients
16:14with colorectal cancer.
16:16Absolutely so it's a very
16:18multidisciplinary effort,
16:19meaning there's numerous care
16:21providers that are involved in
16:23navigating somebody through a
16:24diagnosis of colorectal cancer.
16:26There's myself as a medical oncologist,
16:29there are our surgical colleagues.
16:31There's our pathologists, radiologists,
16:33our radiation oncologists.
16:35Our nutritionists, social workers,
16:37everybody really involved here,
16:38so the first step to really
16:40know how we're going to treat
16:42somebody's cancer is the stage.
16:44So that's not unique to colorectal
16:46cancer, it is very common in cancer.
16:48The stage will help dictate
16:50what the care is going to be.
16:54Stage 1,2,3 and four is how we stage
16:56the cancer and I could probably spend
16:59hours talking about all of this.
17:01But stage one is basically a small
17:03cancer that's barely invaded
17:04into the wall of the colon.
17:06If we think of the colon as a tube,
17:09it's barely in.
17:10It starts on the inner part of that tube.
17:13It's barely invaded through the wall,
17:17and a tumor like that is just excised by surgery.
17:19They may never even see me as a
17:22medical oncologist because surgery
17:23is curative in the majority of cases.
17:25A stage two cancer has gone a
17:27little bit further into that wall,
17:29but hasn't spread to any lymph nodes.
17:31Those patients will see a medical
17:33oncologist and it
17:35will be discussed whether or not
17:37they get chemotherapy after surgery to
17:39increase their cure rate and eradicate small
17:41amounts of possible residual disease
17:42based on risk factors.
17:44Stage three cancer means it's gone
17:46to the lymph nodes,
17:47so it's behaving a bit
17:50more aggressively so a patient
17:51with an invasive mass, a colonoscopy is done.
17:53A surgery is done,
17:55lymph nodes are removed at
17:56the time of surgery
17:58in addition to the tumor if
18:00there's cancer in the lymph nodes.
18:02So if it's a stage three cancer,
18:04all of those patients are going
18:06to see a medical oncologist.
18:08And almost universally,
18:09as long as they're healthy afterwards,
18:11will get chemotherapy to hopefully increase
18:13their care.
18:15Like with many other cancers,
18:16stage 4 means it's spread more distantly,
18:18so cancer that started in the colon
18:20spread to the liver, the lung,
18:22the lining of the abdomen,
18:24which we call the peritoneum,
18:26would make a cancer stage four.
18:29One of those spots would make
18:31a cancer stage four,
18:32and there still may be a role for surgery.
18:37But chemotherapy is generally.
18:38Generally, where we will start,
18:40we think of it as a systemic disease
18:43throughout the body,
18:44and chemotherapy works throughout the body.
18:46When it's working in those stage
18:48four cancers, though, there's
18:49a lot that we need to know to
18:52personalize the therapy for the cancers.
18:54We do a lot of tests in the lab
18:57and to characterize the cancer,
18:59is it mismatch, repair, deficient or not?
19:01Are there mutations in genes
19:03called RAFS or not?
19:04And they tell us how we tweak the chemo,
19:07or maybe even offer immunotherapy
19:09to the patients, and then again,
19:11we will sometimes consider surgery to
19:14remove distant metastases in select cases,
19:16and that's why it's so important
19:18to have a multi disciplinary team.
19:21So a true team involved in
19:23the care of these patients,
19:25even with stage four disease and all
19:28of these cases are reviewed at our
19:31tumor board with that whole team,
19:33I articulate how best
19:36to approach somebody's care in
19:38terms of these molecular genetics.
19:40The RAF mutations,
19:42the mismatch repair
19:43mutations you mentioned those in terms
19:45of tweaking chemotherapy for stage four,
19:48are those also used in
19:50kind of tailoring therapy
19:52for people with earlier stage disease?
19:55If I could only know a couple
19:57things about the molecular
19:58characteristics of somebody's tumor,
20:00it would be the mismatch repair status,
20:03which is also sometimes called the
20:05microsatellite status or their
20:07RAF status.
20:09So in localized disease,
20:11the mismatch repair status is very important.
20:14The RAF and the RAF status
20:16is not so important,
20:18so we often only send the latter
20:20component for metastatic disease.
20:22But for localized cancer mismatch repair,
20:24deficient, or microsatellite instability
20:26high cancers generally have
20:28a more favorable prognosis,
20:30and sometimes we will take that
20:31information and say you don't even
20:33need chemotherapy after surgery
20:35because of this
20:37finding of mismatch repair deficiency
20:40or microsatellite instability
20:41and it's less likely to come back
20:44and therefore you don't need chemotherapy.
20:46There's a lot of other factors
20:48that come into play there,
20:50so I don't want to say that all mismatch
20:52repair division microsatellite instability
20:54high tumors don't need
20:55chemotherapy after surgery,
20:56but it's generally thought to
20:57be a good prognosis.
20:59And we know from metastatic disease,
21:00those tumors are much more
21:02sensitive to immunotherapy.
21:03Some of the most sensitive cancers
21:05that there are in fact to immunotherapy,
21:07and it's being investigated whether
21:08or not immunotherapy is going to
21:10increase cure rates in that population.
21:12And we have some of those
21:14clinical trials going on.
21:15That brings me to the next question,
21:17which is about clinical trials.
21:19Colorectal cancer has been around
21:21for a long time and is one of
21:24the leading cancers
21:27affecting both men and women,
21:29and so presumably there are some
21:31pretty standard regimens in terms of
21:33chemotherapy that we offer these patients.
21:35So tell us a little bit about when
21:38you offer people a standard regimen,
21:41and when you offer them a
21:43clinical trial?
21:45Clinical trials play a tremendous role in the management
21:48of a disease like colorectal cancer.
21:50And are really how we move the field
21:53forward and we've doubled and tripled the
21:55survival rate especially for metastatic
21:57disease over the last few decades.
22:00And that's because clinical trials
22:01brought new agents and drugs and
22:04treatment approaches into the fold and the
22:06treatments we have for metastatic disease,
22:08we use some of them again
22:10after surgery we use drugs, and
22:12we like our acronyms or abbreviations so we
22:15we have a regimen we call folfox which is 5FU,
22:18and oxaliplatin and a
22:20vitamin called leucovorin.
22:21It's really two chemo drugs together and we have
22:23another chemo regimen called FOLFIRI.
22:28so again two chemo drugs together just a
22:30second one instead of the oxaliplatin,
22:33and that's really the backbone of our care,
22:36and we can usually control a metastatic
22:38colorectal cancer patient for years
22:40with those two regimens together,
22:42but at some point we run out of
22:45mileage with those agents,
22:46resistance develops,
22:47tolerability becomes an issue,
22:49something that necessitates us
22:50moving on from those regimens.
22:52And we really don't have great
22:54agents after that,
22:55so I'm often thinking about clinical trials,
22:57novel clinical trials after those
22:59regimens have stopped working,
23:01but I am often thinking about clinical
23:03trials even initially where those
23:07agents will be added on,
23:09or different treatment approaches
23:11will be added onto those chemo drugs,
23:13so they are good chemo backbones.
23:15We can do better and we are
23:18investigating numerous ways,
23:19adding an immunotherapy, new targeted drugs,
23:21new chemo drugs to those regimens.
23:23But we're also investigating
23:25completely new regimens in the
23:263rd and the 4th line setting.
23:29There are third and fourth line
23:31drugs available for patients
23:32with colorectal cancer,
23:33and there's a drug called task 102.
23:38But the effect of those is marginal
23:41compared to those
23:42other therapies that I mentioned.
23:44It sounds like clinical
23:47trials have two kind of roles.
23:49One is after our standard tried and
23:52true regiment have failed and
23:53And we're looking for the best thing that might
23:58help and move us further afield.
24:00And the other is in investigating novel
24:02therapies and straight out of the box.
24:04Is that right?
24:05Yeah, that's
24:06definitely right.
24:08These treatments like folfox and folfiri
24:10have doubled and tripled the survival rate.
24:12But we can still do better than that.
24:15But they are the standard of care,
24:17and since they are so effective,
24:19we add on to those and we should add
24:21on to those so that patients get the
24:24best treatment available to them.
24:25When we've moved on to our
24:27third and our first fourth line,
24:29treatments is task one or two
24:33and start chemo pills.
24:34There is not a great alternative.
24:36They are not tolerated super
24:38well and their time
24:40with Disease Control is not
24:41not as good as we would like,
24:44so that is a time that we try a
24:46more novel approach generally.
24:49So tell us a little bit more about
24:52your research and some of the
24:55things that you're particularly
24:57excited about in this field.
24:59I guess maybe I'll start by
25:02talking about some of the things
25:04I'm excited about more broadly,
25:06and one area that I think has garnered a lot
25:09of attention lately for colorectal cancer
25:12is something called circulating tumor DNA,
25:15where we can detect minimal
25:17amounts of circulating tumor DNA
25:19in the bloodstream after a surgery.
25:22So, for example, patients with stage two
25:26colorectal cancer that happens to have
25:30a blood test done that
25:32circulating tumor DNA is detected.
25:34Now we know that that patient is probably
25:37going to relapse if we don't do anything
25:41besides observation,
25:42so we can use a tool like that
25:44to decide who's high risk,
25:46who's low risk and that gives
25:47us opportunities to intensify
25:49and deintensify treatment.
25:50So trying to increase cure rates
25:51for those that are high risk but
25:53also knowing when somebody is
25:55going to do well and maybe avoid
25:57circumstances of over treatment.
25:58So that's something as a field
26:00I think we're learning
26:02how to use these tests.
26:03We know they correlate really well with
26:05whether or not the cancer is going to come
26:08back when you're only doing observation,
26:10but we don't know how well it
26:12predicts for benefit from chemo
26:13and most our studies are ongoing.
26:16We have some of those studies
26:18ongoing here at Yale.
26:20I also have
26:23a busy clinical practice and
26:25research program studying more novel
26:26therapies in colorectal cancer.
26:28So we have different types of
26:31trials we develop here at Yale.
26:33We have trials where we call them
26:36industry sponsored trials where we
26:38have worked with a company who's
26:41developed a drug and opened their
26:43trial that they came up with
26:47maybe with some input than us from us,
26:50but we've had a little bit less
26:53involvement, perhaps in a trial like that,
26:56and designing the trial,
26:57and in analyzing the data so those
27:00are industry sponsored
27:02trials that we have here.
27:04But we also have a robust program of
27:07investigator initiated trials here,
27:08and I have a couple open and one
27:11specifically in that third line,
27:13colorectal cancer Group, for example.
27:15This is a trial where we've come
27:17up with the idea,
27:19and maybe we've written a grant or
27:22we've partnered with a drug company to
27:24tell them in a way that we think that
27:27we could look at a new subtype of cancer,
27:30or a new way to look at
27:34their drug to leverage that and
27:36for patients with that disease,
27:38so I have an investigator initiated trial
27:40for colorectal cancer that is received
27:42two different types of chemotherapy,
27:44where we look for a marker called MGMT.
27:47So we basically meet a patient,
27:50if they are potential candidate we will
27:52test their tumor for this marker,
27:54and if they have this marker
27:56which ends up being about 40% of
27:58patients if they have this marker,
28:00we will then offer them enrollment
28:02in a clinical trial.
28:08So we basically identify this subgroup
28:11of colorectal cancer and then we had this
28:13trial that we came up with here at Yale.
28:15And we're also studying the
28:17outcome of patients with this to make
28:19sure that we're actually helping people,
28:21but also studying the science to develop
28:23the next generation of trials which,
28:25in my opinion will be leveraging the immune
28:27system to make it work for the majority
28:30of patients with colorectal cancer
28:31as my colleagues in lung cancer and Melanoma
28:34have been doing for the last decade.
28:37Doctor Michael Cecchini is an assistant
28:39professor of medicine and medical
28:41oncology at the Yale School of Medicine.
28:43If you have questions,
28:45the address is canceranswers@yale.edu
28:46and past editions of the program
28:48are available in audio and written
28:50form at yalecancercenter.org.
28:52We hope you'll join us next week to
28:55learn more about the fight against
28:57cancer here on Connecticut Public Radio.