Syed Kazmi, MD, an oncologist at The University of Texas Southwestern Medical Center, discusses key treatment considerations for young patients with onset colorectal cancer (CRC).

One patient subgroup that requires further consideration are young patients with onset CRC, according to Kazmi. The types of mutations present in this subgroup may be different than those found in standard onset CRC, Kazmi explains.

Moreover, if a young patient is given a test, such as immunohistochemistry, that detects microsatellite stability (MSS) and immunotherapy is not an option, a polymerase chain reaction (PCR) test should also be given, Kazmi says. If a PCR test has already been conducted, then an immunohistochemistry test should be utilized, Kazmi explains. These tests have a discrepancy of approximately 5% to 10%, Kazmi notes. Additionally, because immunotherapy has demonstrated promising long-term durability in patients with CRC, it is worth taking this extra step to ensure a tumor is MSS, Kazmi concludes.

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Syed Kazmi, MD, an oncologist at The University of Texas Southwestern Medical Center, discusses key treatment considerations for young patients with onset colorectal cancer.

Dr. Kazmi on Key Treatment Considerations for Young-Onset CRC

Syed Kazmi, MD, an oncologist at The University of Texas Southwestern Medical Center, discusses the importance of tailoring treatment to different subtypes of colorectal cancer (CRC).

CRC is no longer considered a homogeneous disease, says Kazmi. Instead, the disease is characterized by alterations in 

, and others, Kazmi explains. Moreover, the various subtypes require tailored treatment approaches, Kazmi adds. 

For example, patients with microsatellite instability–high CRC are treated with immunotherapy in the first- or later-line settings, Kazmi says. Although molecular profiling information should be available for all patients with newly diagnosed stage IV CRC, it is even more critical to understand the molecular subtype of patients who progress on frontline therapy, concludes Kazmi.

Syed Kazmi, MD, discusses the importance of tailoring treatment to different subtypes of colorectal cancer.  



Dr. Kazmi on Tailoring Treatment to Various Subtypes of CRC 

Syed Kazmi, MD, an oncologist at The University of Texas Southwestern Medical Center, discusses emerging biomarkers that could help guide treatment decisions in patients with colorectal cancer (CRC).

Some of the known biomarkers in CRC include 

 mutations, Kazmi says. Although inhibitors are used to target 

 mutations in other tumor types, they are not available in CRC yet, Kazmi notes. Moreover, no RAS-targeted therapies are available for patients with CRC, either.

 are the main biomarker targets for CRC, but others are also under exploration. Ongoing research efforts may be able to tease out more molecular subsets in these patients, Kazmi explains. More subsets would allow for more targeted therapies in each group; however, those data are still pending, Kazmi concludes.

Syed Kazmi, MD, discusses emerging biomarkers that could help guide treatment decisions in patients with colorectal cancer.


Dr. Kazmi on Emerging Biomarkers in CRC

Syed Kazmi, MD, an oncologist at The University of Texas Southwestern Medical Center, discusses choosing among regorafenib (Stivarga) and TAS-102 (Lonsurf) in the treatment of patients with metastatic colorectal cancer (CRC).

If a patient presents with low-burden disease and lung metastasis, but is otherwise healthy and has a good performance status, regorafenib would be a feasible treatment option, Kazmi says. Some data suggest that the tolerability for the agent can be improved by slowly ramping up dosing, according to Kazmi, which is the approach he uses in clinical practice. However, if a patient has significant disease burden compared with performance status, regorafenib could increase those toxicities, Kazmi notes. 

Additionally, TAS-102 is also an effective agent and has a role to play in the treatment of patients with metastatic CRC, Kazmi concludes.

Syed Kazmi, MD, discusses choosing among regorafenib and TAS-102 in the treatment of patients with metastatic colorectal cancer. 

Dr. Kazmi on Choosing Among Regorafenib and TAS-102 in Metastatic CRC

Syed Kazmi, MD, an oncologist at The University of Texas Southwestern Medical Center, discusses differences between left- and right-sided tumors in patients with colorectal cancer.

Clinical differences regarding tumor sidedness have the most important implications in the metastatic first-line setting, according to Kazmi. Previous studies have indicated biologic differences between left- and right-sided tumors that derive from different embryonic origins. Moreover, these tumors also have different molecular profiles, Kazmi adds.

Right-sided tumors can occur in the ascending colon up to the hepatic flexure, while left-sided tumors develop in the descending colon, splenic flexure, and rectum, Kazmi concludes.

Syed Kazmi, MD, discusses differences between left- and right-sided tumors in patients with colorectal cancer.

Syed Kazmi, MD

Articles

Dr. Kazmi on Key Treatment Considerations for Young-Onset CRC

Dr. Kazmi on Tailoring Treatment to Various Subtypes of CRC

Dr. Kazmi on Emerging Biomarkers in CRC

Dr. Kazmi on Choosing Among Regorafenib and TAS-102 in Metastatic CRC

Dr. Kazmi on Differences Between Left- Versus Right-Sided CRC Tumors