On the occasion of colorectal cancer awareness month, Blue March, Nadia Caussé-Amellal, M.D, International Project Director at the Oncology and Immuno-Oncology Therapeutic Area at Servier, sheds light on this pathology and the treatments available.
What are the particularities of colorectal cancer?
Nadia Causse-Amellal : Colorectal cancer (CRC), which includes colon cancer (78%) and rectal cancer (22%), is a type of cancer that develops in the large intestine from initially benign adenomatous polyps. With more than 1.9 million new cases per year, representing 10% of all cancers, it is the third most frequently diagnosed cancer worldwide. Once diagnosed, the prognosis for this cancer is generally poor: with almost 1 million deaths per year (9.4% of all deaths by cancer), CRC is now the second most common cause of death by cancer. Approximately 25% of patients already have metastases in the liver, lungs, or bones at the time of initial diagnosis, and nearly 50% develop metastases afterwards.1
Servier devotes 50% of its global R&D budget (brand-name activity) to the search for new therapeutic solutions against cancer.
What risk factors have been identified to better prevent this type of cancer?
C.-A.: The risk of developing CRC increases with age. In addition, 65% of cases are diagnosed in high-income countries. This incidence can be explained by the effects of industrialization, urbanization, and the Western lifestyle: high consumption of red meat, a diet high in fat and low in fiber, lack of physical activity, obesity, alcohol and tobacco consumption, etc. Several hereditary risk factors have also been identified, such as familial adenomatous polyposis, a history of inflammatory bowel disease (ulcerative colitis, Crohn’s disease), and Lynch syndrome.
Preventing the occurrence of CRC starts with eliminating the external risk factors, as well as the implementation of national screening programs. Active screening with a colonoscopy every 2 years is indicated for those at high risk. For people aged 50 to 74, fecal occult blood testing every 2 years and a colonoscopy every 10 to 20 years is sufficient. However, since the presence of blood in the stool is not specifically related to CRC, like other symptoms (anemia, fatigue, shortness of breath, abdominal discomfortwith transit abnormalities, etc), early diagnosis is still difficult. Only a colonoscopy with tumor biopsy can diagnose CRC with certainty.
“Providing more dedicated treatments to a large proportion of CRC patients, for whom there is still an unmet medical need.”
What are the different treatments for CRC?
C.-A.: Treatment decisions are based on several indicators: the natural history of the disease (stage, grade, patient condition, etc.); the molecular profile of the tumor, the result of the PET scan for metastases, and the patient’s wishes. Based on this information, several options for localized or systemic treatments are possible.
Local surgery with curative intent allows the removal of the primary tumor and sometimes metastases when they are resectable. This treatment may also include perioperative chemotherapy and/or radiotherapy. If the disease has unresectable metastases, chemotherapy aimed at killing cancer cells and/or limiting their growth may be proposed to the patient, even if the chances of a cure are low.
Targeted therapy (small molecule drugs or monoclonal antibodies), which specifically interferes with cell growth, is another treatment option for invasive CRC. But despite recent advances in the treatment of known CRC subtypes, there is still a high number of patients who do not respond to the corresponding treatments.
Today, the priority is to identify other subtypes using biological targets that can be actionable via a specific treatment. This is precisely what Servier is currently working on: providing more dedicated treatments to a large proportion of CRC patients, for whom there is still an unmet medical need.
In December 2020, Servier announced a strategic collaboration with biotech Celsius Therapeutics focused on the identification and validation of novel colorectal cancer drug targets.
1 GLOBOCAN – 2020 – https://gco.iarc.fr/databases.php