John L. Marshall, MD, chief, Division of Hematology and Oncology, Medstar Georgetown University Hospital, and director, Otto J. Ruesch Center for the Cure of Gastrointestinal Cancers, discusses Y-90 in metastatic castration resistant colorectal cancer (mCRC).

There are new and exciting therapies for liver-dominant patients who can’t have surgery, says Marshall. There is evidence that liver-directed therapy, injected to treat and control liver metastases, may be effective, whether that is with traditional chemotherapy or Yttrium-90 (Y-90).

In the SIRFLOX study, patients were randomized to receive FOLFOX6 plus bevacizumab (Avastin) versus FOLFOX6 and bevacizumab plus Y-90 at the beginning of treatment. This type of regimen is typically used as a salvage refractory therapy, says Marshall.

The study showed that there was a 12-month liver progression-free survival (PFS) with FOLFOX6 plus bevacizumab versus a 20-month PFS with bevacizumab plus Y-90.

An overall survival analysis still needs to be done to verify these findings.

One challenge is that in this study, patients were included who had extrahepatic disease. This impacted overall PFS, causing no significant difference between the two arms, says Marshall.

Videos

Dr. John L. Marshall on Y-90 in Colorectal Cancer

John L. Marshall, MD, chief, Division of Hematology/Oncology, Georgetown University Hospital, discusses potential obstacles ahead with the Cancer Moonshot Initiative following the results of the 2016 United States presidential election.

Billions of dollars have been spent on cancer research, Marshall explains. While there have been significant improvements in patient survival outcomes, Marshall fears that the oncology community has been misguided by "basic science" because preclinical models are not explaining what is specifically occurring in patients. The developments of targeted therapies has helped researchers to understand molecular profiling in patients. This is also something on patients' radar, he adds.

Additionally, there needs to be a shift of investment and research dollars into more clinical-enriched protocols; currently, there is more measurable tumor markers, biopsies, and samples, Marshall says. Therefore, more research dollars can be shifted to the patient, which is beneficial. The Cancer Moonshot Initiative is driving the field in that direction, he adds.

However, the challenge with the Cancer Moonshot Initiative is that there is not enough funding to accomplish all of these research goals. Following the recent results of the 2016 United States presidential election, which was won by Republican Donald J. Trump, Marshall is concerned that the initiative could become obsolete, or has any chance of surviving, once the president-elect is sworn into office.

Dr. Marshall on Challenges With Cancer Moonshot Initiative

John L. Marshall, MD, chief, Division Of Hematology/Oncology, Georgetown University Hospital Associate Director, clinical research, Lombardi Comprehensive Cancer Center at Georgetown University Hospital, discusses the difference between squamous and adenocarcinoma in esophageal and gastric cancer.

Squamous cell carcinoma and adenocarcinoma have different causes and molecular makeup in esophageal and gastric cancers, yet they are still being treated as one in the same. Marshall emphasizes that once oncologist differentiate between the 2 types of cancer and treat them individually, there will be better results and improvements in survival.

View more from the 2016 World Congress on GI Cancer

Dr. John Marshall on Differentiating Squamous and Adenocarcinoma in GI Cancers

John L. Marshall, MD, professor, Chief, Division of Hematology/Oncology, Georgetown University Hospital, provides updates on the recent advancements in colorectal cancer being presented at the 2014 Gastrointestinal Symposium in San Francisco.

Researchers are continuing to work on trials exploring vaccine, in order to increase their understanding of how immunotherapy can have an impact in colorectal cancer, in addition to all GI cancers. Moreover, novel research is being conducted into molecular profiling on all fronts, Marshall says. The PARSC trial is trying to build a better “mouse trap” around gene profiling in stage II colorectal cancer. Marshall says this will give physicians a better understanding of who needs treatment and who does not, so that patients can be better characterized.

Marshall says the newest science coming out of the symposium is refining molecular profiling, specifically in regard to RAS testing. As researchers learn which pathways and mutations matter, there will be higher response rates and longer survival.

View more from the 2014 GI Cancers Symposium

John L. Marshall, MD, from Georgetown University Hospital, on the recent advancements in colorectal cancer.

John L. Marshall, MD

Articles

Dr. John L. Marshall on Y-90 in Colorectal Cancer

Dr. Marshall on Challenges With Cancer Moonshot Initiative

Dr. John Marshall on Differentiating Squamous and Adenocarcinoma in GI Cancers

Dr. John Marshall Provides Colorectal Cancer Updates