Tony Philip, MD, a medical oncologist at Monter Cancer Center of the North Shore, LIJ Cancer Institute, and an assistant professor of medicine at Hofstra-North Shore LIJ School of Medicine and New York Institute of Technology College of Osteopathic Medicine, discusses research efforts underway in colorectal cancer (CRC).

Total neoadjuvant therapy for rectal cancer is working to change the landscape, especially for patients who have distal rectal cancer, as it represents a nonoperative disease management option, according to Philip. Nonoperative treatments could decrease the number of patients who require a permanent colostomy and preserve organ function, Philip says.

Additionally, options are now available for patients who are not eligible for aggressive treatment, Philip adds. Ongoing research efforts in CRC will determine the role of circulating tumor DNA. It is an exciting prospect to have numerous novel treatment approaches, but questions regarding how and when these therapies should be utilized still need to be addressed, Philip concludes.

Videos

Tony Philip, MD, discusses research efforts underway in colorectal cancer.

Dr. Philip Spotlights Ongoing Research Efforts in CRC

Tony Philip, MD, a medical oncologist at Monter Cancer Center of the North Shore, LIJ Cancer Institute, and an assistant professor of medicine at Hofstra-North Shore LIJ School of Medicine and New York Institute of Technology College of Osteopathic Medicine, discusses advances made in the treatment of patients with colorectal cancer (CRC).

Short-course radiotherapy, as examined in the phase 3 RAPIDO trial (NCT01558921), could have benefit to patients with CRC during the COVID-19 pandemic, as it reduces the time spent in a hospital or clinic setting, Philip says. As such, outcomes for response to this treatment can be preserved, Philip notes.

Additionally, findings from the phase 2 OPRA trial (NCT02008656), which helped to evolve the non-operative management of distal colon cancer, suggest that up-front chemoradiotherapy followed by chemotherapy could be a good strategy, Philip explains. This is important, as the method was not considered years ago, Philip concludes.

Tony Philip, MD, discusses advances made in the treatment of patients with colorectal cancer.


Dr. Philip on Non-Operative Treatment Advances in CRC

Tony Philip, MD, a medical oncologist at Monter Cancer Center of the North Shore, LIJ Cancer Institute, and an assistant professor of medicine at Hofstra-North Shore LIJ School of Medicine and New York Institute of Technology College of Osteopathic Medicine, discusses the emerging role of circulating tumor DNA (ctDNA) in colorectal cancer (CRC).

During the 2021 Gastrointestinal Cancers Symposium, data from a Danish cohort study demonstrated that postoperative ctDNA positivity was associated with markedly reduced relapse-free survival compared with carcinoembryonic antigen in patients with stage I to III CRC. Moreover, serial ctDNA analysis detected minimal residual disease up to a median of 8 months ahead of radiologic relapse. As such, ctDNA appears to be a useful tool in predicting disease recurrence, says Philip.

Additional data are needed to validate ctDNA as a predictive biomarker that is ready for primetime use, Philip explains. Clinical trials, such as the BEACON CRC study and the ongoing COBRA study (NCT04068103), may yield informative data regarding the utility of ctDNA in this setting, concludes Philip. 

Tony Philip, MD, discusses the emerging role of circulating tumor DNA in colorectal cancer.  



Dr. Philip on the Emerging Role of ctDNA in CRC

Tony Philip, MD, a medical oncologist at Monter Cancer Center of the North Shore, LIJ Cancer Institute, and an assistant professor of medicine at Hofstra-North Shore LIJ School of Medicine and New York Institute of Technology College of Osteopathic Medicine, discusses the efficacy of trifluridine/tipiracil (TAS-102; Lonsurf) in patients with metastatic colorectal cancer (mCRC) who are ineligible for intensive treatment.

TAS-102 is often utilized as a last resort treatment for patients with mCRC. Although the agent is generally thought to be well tolerated, given its approval for use in the fourth- or fifth-line setting, some may not consider it to be as effective as desired, according to Philip.

TAS-102 presents an option for patients who are ineligible for intensive therapy and could be superior to previous standard treatments for this population, without any added toxicity, Philip says. This option is for patients who aren't able to tolerate multiagent chemotherapy regimens, Philip concludes.

Tony Philip, MD, discusses the efficacy of trifluridine/tipiracil in patients with metastatic colorectal cancer who are ineligible for intensive treatment.

Dr. Philip on the Efficacy of TAS-102 in mCRC

Tony Philip, MD, medical oncologist, Monter Cancer Center of the North Shore-LIJ Cancer Institute, assistant professor of Medicine, Hofstra-North Shore LIJ School of Medicine and NYIT College of Osteopathic Medicine, discusses treatment challenges for patients with soft tissue sarcoma.

General challenges in this field, Philip explains, are that there are not enough sarcoma specialists to treat patients, as well as a limited number of pathologists who are able to diagnose the disease. Additionally, there are various subtypes of sarcoma that are all treated differently. 

Treatment for soft tissue sarcoma has not evolved as quickly as other tumor types, Philip explains. This is likely because there is such a variety of subtypes as well as a small patient population. 

Dr. Philip on Treatment Challenges for Patients With Soft Tissue Sarcoma

Tony Philip, MD, medical oncologist, Monter Cancer Center of the North Shore-LIJ Cancer Institute, assistant professor of Medicine, Hofstra-North Shore LIJ School of Medicine and NYIT College of Osteopathic Medicine, discusses the challenges of treating soft tissue sarcomas.

One of the biggest challenges of soft tissue sarcomas is that there are very few oncologists that have expertise in treating the disease, as well as few pathologists that have expertise in diagnosing it, says Philip.

An accurate diagnosis from a pathologist who understands soft tissue sarcomas is key to effective treatment, he says. There are 40 subtypes of soft tissue sarcoma and they are all treated differently.

The field is evolving, though not as quickly as other cancer types. There is an unmet need for further treatment options for patients, says Philip.

Dr. Tony Philip on Soft Tissue Sarcoma Treatment Challenges

Tony Philip, MD, medical oncologist, Monter Cancer Center of the North Shore-LIJ Cancer Institute, assistant professor of Medicine, Hofstra-North Shore LIJ School of Medicine and NYIT College of Osteopathic Medicine, discusses approved and emerging agents for soft tissue sarcomas.

Trabectedin (Yondelis) received FDA approval for liposacoma and leiomyosarcoma, while the breast cancer agent eribulin (Halaven) is being studied in soft tissue sarcoma.

An agent being investigated in an ongoing phase III trial is olaratumab in combination with doxorubicin in advanced soft tissue sarcoma, which has demonstrated promising early-phase data. Olaratumab is a novel agent that could potentially be one of the first new drugs to add benefit to doxorubicin, which has been a standard treatment for several years.

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