Screening Guideline Updates and New Treatments in Colon Cancer

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Screening Guideline Updates and New Treatments in Colon Cancer
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David H. Wang, MD, PhD

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References
  1. Ng K et al. JAMA. 2021;325(19):1943-1945. doi:10.1001/jama.2021.4133
  2. Xie YH et al. Signal Transduct Target Ther. 2020;5(1):22. doi:10.1038/s41392-020-0116-z
  3. Muller C et al. Cells. 2021;10(5):1018. doi:10.3390/cells10051018
  4. Clebak KT et al. Am Fam Physician. 2022;105(2):198-200.
  5. May FP et al. Dig Dis Sci. 2017;62(8):1923-1932. doi:10.1007/s10620-017-4607-x
  6. May FP et al. Med Care. 2019;57(10):773-780. doi:10.1097/MLR.0000000000001186
  7. US Department of Veterans Affairs, National Oncology Program Office. National Precision Oncology Program (NPOP). Updated June 24, 2022. Accessed December 14, 2022. http://www.cancer.va.gov/CANCER/NPOP.asp
  8. André T et al; KEYNOTE-177 Investigators. N Engl J Med. 2020;383(23):2207-2218. doi:10.1056/NEJMoa2017699
  9. Naidoo M et al. Cancers (Basel). 2021;13(2):346. doi:10.3390/cancers13020346
  10. Kasi PM et al. BMJ Open. 2021;11(9):e047831. doi:10.1136/bmjopen-2020-047831
  11. Jin S et al. Proc Natl Acad Sci U S A. 2021;118(5):e2017421118. doi:10.1073/pnas.2017421118
Author and Disclosure Information

David H. Wang, MD, PhD
Associate Professor of Internal Medicine
UT Southwestern Medical Center
VA North Texas Health Care System
Dallas, TX

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Colon and Rectal
Cancer
Author(s)
David H. Wang, MD, PhD
Author(s)
David H. Wang, MD, PhD
Author and Disclosure Information

David H. Wang, MD, PhD
Associate Professor of Internal Medicine
UT Southwestern Medical Center
VA North Texas Health Care System
Dallas, TX

Author and Disclosure Information

David H. Wang, MD, PhD
Associate Professor of Internal Medicine
UT Southwestern Medical Center
VA North Texas Health Care System
Dallas, TX

Click to view more from Cancer Data Trends 2023.

Click to view more from Cancer Data Trends 2023.

References
  1. Ng K et al. JAMA. 2021;325(19):1943-1945. doi:10.1001/jama.2021.4133
  2. Xie YH et al. Signal Transduct Target Ther. 2020;5(1):22. doi:10.1038/s41392-020-0116-z
  3. Muller C et al. Cells. 2021;10(5):1018. doi:10.3390/cells10051018
  4. Clebak KT et al. Am Fam Physician. 2022;105(2):198-200.
  5. May FP et al. Dig Dis Sci. 2017;62(8):1923-1932. doi:10.1007/s10620-017-4607-x
  6. May FP et al. Med Care. 2019;57(10):773-780. doi:10.1097/MLR.0000000000001186
  7. US Department of Veterans Affairs, National Oncology Program Office. National Precision Oncology Program (NPOP). Updated June 24, 2022. Accessed December 14, 2022. http://www.cancer.va.gov/CANCER/NPOP.asp
  8. André T et al; KEYNOTE-177 Investigators. N Engl J Med. 2020;383(23):2207-2218. doi:10.1056/NEJMoa2017699
  9. Naidoo M et al. Cancers (Basel). 2021;13(2):346. doi:10.3390/cancers13020346
  10. Kasi PM et al. BMJ Open. 2021;11(9):e047831. doi:10.1136/bmjopen-2020-047831
  11. Jin S et al. Proc Natl Acad Sci U S A. 2021;118(5):e2017421118. doi:10.1073/pnas.2017421118
References
  1. Ng K et al. JAMA. 2021;325(19):1943-1945. doi:10.1001/jama.2021.4133
  2. Xie YH et al. Signal Transduct Target Ther. 2020;5(1):22. doi:10.1038/s41392-020-0116-z
  3. Muller C et al. Cells. 2021;10(5):1018. doi:10.3390/cells10051018
  4. Clebak KT et al. Am Fam Physician. 2022;105(2):198-200.
  5. May FP et al. Dig Dis Sci. 2017;62(8):1923-1932. doi:10.1007/s10620-017-4607-x
  6. May FP et al. Med Care. 2019;57(10):773-780. doi:10.1097/MLR.0000000000001186
  7. US Department of Veterans Affairs, National Oncology Program Office. National Precision Oncology Program (NPOP). Updated June 24, 2022. Accessed December 14, 2022. http://www.cancer.va.gov/CANCER/NPOP.asp
  8. André T et al; KEYNOTE-177 Investigators. N Engl J Med. 2020;383(23):2207-2218. doi:10.1056/NEJMoa2017699
  9. Naidoo M et al. Cancers (Basel). 2021;13(2):346. doi:10.3390/cancers13020346
  10. Kasi PM et al. BMJ Open. 2021;11(9):e047831. doi:10.1136/bmjopen-2020-047831
  11. Jin S et al. Proc Natl Acad Sci U S A. 2021;118(5):e2017421118. doi:10.1073/pnas.2017421118
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Screening Guideline Updates and New Treatments in Colon Cancer
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The screening and treatment landscape for colon cancer is changing rapidly.1,2 The recommended age for screening has been lowered to 45 from 50 years due to the increased incidence of colon cancer in younger people, especially among African American individuals.1,3 New screening recommendations also incorporate fecal immunochemical tests (FIT) and multitarget stool DNA tests, where abnormal results on stool-based screening should lead to timely colonoscopy.1,4 For veterans, colon cancer screening rates tend to vary based on VA health coverage, race, income, and mental health status but are higher than for the general public.5,6


The field of colon cancer treatment, along with the rest of oncology, is moving toward molecularly targeted therapies and immunotherapy. In the VA, NPOP provides tumor NGS that predicts response to molecularly targeted therapies.7 In addition, NGS can identify microsatellite instability (MSI)-high colon cancer. In MSI-high colon cancer, immunotherapy alone provides better PFS than older traditional chemotherapeutic regimens.8 Gene alterations of interest in colon cancer include NRAS, KRAS, BRAF, and HER2, which, along with MSI status and PD-L1 expression levels, guide the choice of therapy offered.2,8 The use of liquid biopsy panels that assess the quantity of circulating tumor DNA (ctDNA) is also being studied in veterans.9,10 Liquid biopsies can be used to assess treatment response, if minimal residual disease is present after surgical resection or if new mutations develop during treatment.9 All in all, screening guidelines are adapting as new data and tests become available, while the field of colon cancer treatment is evolving based on increased access to NGS and appropriate use of molecularly targeted therapy and immunotherapy.

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