Dr Biachi on the Evolving Role for Surgery in CRC

"The significant improvement in OS that we've [seen over] the past 10 years [in CRC] is not only because of systemic therapy, but because of local therapies, including surgery."

Tiago Biachi, MD, PhD, associate member, Department of Gastrointestinal Oncology, Moffitt Cancer Center; associate professor, University of South Florida, discusses the evolving role for surgery in patients with colorectal cancer (CRC).

The management of CRC is unique among gastrointestinal (GI) tumors, as it relies heavily on a multidisciplinary treatment approach, Biachi begins. Unlike other GI cancers, CRC also presents opportunities for potential cure, even in cases with metastatic disease, he says. This aspect is key in patient discussions, as the disease behaves differently than other GI cancers, requiring close follow-up even after curative treatment, Biachi asserts. He adds that early detection of recurrent lesions enables treatment interventions that can sometimes achieve cure in metastatic cases.

Over the past decade, the significant improvement in median overall survival—from approximately 12 months to more than 30 months—reflects advances in systemic therapies, as well as the evolving role of local interventions, particularly surgery, Biachi continues. In cases where a cure is not feasible, local therapies, such as Y90 ablation or surgical resection, can still provide meaningful benefits, he notes. These treatments offer patients time without chemotherapy, hospital visits, or the constant presence of medical care, ultimately enhancing quality of life (QOL), Biachi details. Moreover, surgical resection of metastatic lesions can greatly improve survival outcomes, he adds.

By extending survival and providing intervals free from continuous treatment, the benefits of local therapies reinforce that CRC is unique among GI tumors, according to Biachi. Their role in improving both survival and QOL emphasizes the need for a multidisciplinary approach to CRC, as well as the importance of ongoing follow-up and individualized care for each patient, Biachi concludes.

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Tiago Biachi, MD, PhD, discusses the evolving role for surgery in colorectal cancer.


Tiago Biachi, MD, PhD, associate member, Department of Gastrointestinal Oncology, Moffitt Cancer Center, discusses the growing treatment landscape for patients with hepatocellular carcinoma (HCC).

® State of the Science Summit™ (SOSS), Biachi and colleagues from Moffitt Cancer Center each gave presentations on topics spanning gastrointestinal cancer care. At the event, Biachi discussed recent updates in the field of HCC, with a specific focus on newly published studies. These studies include the phase 3 COSMIC-312 (NCT03755791), LEAP-002 (NCT03713593), and CELESTIAL (NCT01908426) trials.

In 2008, sorafenib (Nexavar) was FDA approved based on findings from a randomized phase 3 trial comparing the agent with a placebo, Biachi says. For a decade, sorafenib was the only treatment option available for patients with HCC. However, several other treatments have nowgained regulatory approval, he explains. The 2020 

FDA approval of atezolizumab (Tecentriq) plus bevacizumab (Avastin)

 for patients with treatment-naïve unresectable or metastatic HCC was supported by findings from the phase 3 IMbrave150 trial (NCT03434379), which evaluated atezolizumab plus bevacizumab vs sorafenib. Additionally, the 2023 

FDA approval of durvalumab (Imfinzi) plus tremelimumab (Imjudo)

 in patients with unresectable HCC was backed by findings from the phase 3 HIMALAYA study (NCT03298451). However, a direct comparison between these 2 approved regimens is needed, he emphasizes. Researchers have discussed using the cause of liver disease as a surrogate for evaluating responses to different combinations, he adds.

During the SOSS, Biachi delved into 2 studies attempting to combine a TKI with immunotherapy: the aforementioned COSMIC-312 and LEAP-002 studies. COSMIC-312 explored the combination of atezolizumab and cabozantinib vs sorafenib, though this trial did not meet its primary end point of overall survival, he explains. The latter trial, LEAP-002, comparedpembrolizumab (Keytruda) plus lenvatinib (Lenvima) with lenvatinib alone, Biachi says. Notably, these data were surprising because although this combination has been approved for patients with other tumor types, it unfortunately did not benefit those with HCC, Biachi notes.

Moreover, investigators at the SOSS discussed the future of HCC treatment, which is likely to involve various modalities, with ongoing studies exploring combinations of immunotherapies, he concludes.

Tiago Biachi, MD, PhD, discusses the growing treatment landscape for patients with hepatocellular carcinoma.


Tiago Biachi, MD, PhD

Articles

Dr Biachi on the Evolving Role for Surgery in CRC

Dr Biachi on the Growing Treatment Landscape in HCC