Future Directions in Colorectal Cancer Care

A roundtable discussion, moderated by Shikha Jain, MD, FACP, discussed the treatment sequencing, management, and future directions of advanced colorectal cancer, as well as relevant clinical trial data from the 2024 American Society of Clinical Oncology Annual Meeting. Dr. Jain was joined by Suneel Kamath, MD; Arvind Dasari, MD, MS; and Sakti Chakrabarti, MD.

In the final segment of the roundtable series, the panel concludes with the challenges of implementing cutting-edge research into practice, highlighting strategies for navigating insurance barriers and the promising future of immunotherapy and ctDNA in transforming colorectal cancer care.

View previous segments from this roundtable series.

—

Dr. Jain: I often jest with my non-GI oncology colleagues about the excitement of our trials and practice-changing breakthroughs, yet one of the significant challenges we face after this meeting is implementing these advancements due to insurance hurdles, patient understanding, and hospital logistics. I am curious how you navigate these obstacles and integrate new research findings into your practice seamlessly.

Dr. Chakrabarti: Educating our entire team—nurses, APPs, and pharmacists—about new drugs is crucial, followed by involving patients directly with the data, even sharing relevant papers, as I believe informed patients have better outcomes, though empirical evidence is lacking. Navigating insurance approvals involves persistence, sometimes requiring appeals and letters, even for off-label uses pre-FDA approval, like immunotherapy in MSI-high GI cancers.

Dr. Kamath: Insurance dictates much of our practice, necessitating time-intensive efforts like peer-to-peer calls and appeals, but dedicating this effort is essential when advocating for what is best for our patients.

Dr. Jain: Absolutely, even ChatGPT has assisted me in crafting effective appeal letters, underscoring the importance of persistence in navigating these challenges.

As we conclude, let us explore emerging trends in GI oncology and colorectal cancer. What developments do you find most promising or transformative for the next 1 to 5 years?

Dr. Dasari: Moving beyond metastatic settings, I am intrigued by non-surgical approaches in rectal cancer and the potential of ctDNA and MRD to redefine our guidelines and patient care strategies.

Dr. Kamath: Immunotherapy’s evolving role, especially in MSS CRC with promising agents like the bot/bal regimen, offers newfound hope, suggesting a potential breakthrough in GI tumors.

Dr. Chakrabarti: I am particularly focused on immunotherapy’s impact in the neoadjuvant setting for MSI-high GI cancers, leading efforts through my DREAM-GI database to validate complete remission without traditional treatments, underscoring durable immunotherapy benefits.

Dr. Jain: Personally, I am enthusiastic about immunotherapy advancements and the potential of ctDNA to optimize therapy and reduce overtreatment, addressing a critical need in our increasingly younger patient population.