Colorectal Cancer Awareness Month is an important period focused on increasing awareness and encouraging prevention, screening and treatment efforts for colorectal cancer (CRC). The fight against this common and deadly form of cancer is witnessing considerable advancements in 2024, with innovative treatment options that are offering new hope and improved outcomes for patients.
The Colorectal Cancer Alliance established National Colorectal Cancer Awareness Month in March 2000. The intention was to challenge the stigma surrounding CRC and focus on the importance of proactive screenings. In recent years, the initiative has garnered considerable attention and helped increase education and research funding and provide better treatment options to fight this disease.
Understanding Colorectal Cancer: Facts and Figures
In the US, CRC has been a formidable health challenge and is the third most commonly diagnosed form of cancer as well as the second leading cause of cancer death among men and women combined. Therefore, there is a need to provide better treatment options and increase public awareness of the possible therapies available for CRC. The early detection of CRC has been known to considerably improve the chances of survival. Screening tests, such as colonoscopies, can help detect precancerous polyps, which can be easily removed before they become cancerous.
Although early screening has proven benefits, the overall percentage of the population underdoing CRC screening is low owing to a lack of awareness or access to healthcare services. Therefore, one of the objectives of Colorectal Cancer Awareness Month 2024 is the importance of regular screening starting at age 45 for individuals at average risk.
The American Cancer Society estimates that in 2024, there will be over 150,000 new cases of CRC diagnosed and nearly 53,000 deaths because of CRC.
Between 2015 and 2019, the incidence rate of CRC in the US was 33 percent higher in men (41.5 per 100,000) than in women (31.2 per 100,000) owing to differences in risk factor prevalence such as excess body weight and processed meat consumption.
In the previous decade, although the incidence rate of CRC in people ages 50 to 64 has stabilized, it has increased by two percent per year in people younger than 50 as well as those aged 50 to 54.
The five-year relative survival rate for CRC increased from 50 percent in the mid-1970s to 65 percent between 2012 and 2018.
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Colorectal Cancer: Advances in Treatment Options
In recent years, there has been considerable progress in understanding the biology of CRC, which has helped develop more effective and personalized treatment options. An overview of some of the most promising developments in CRC treatment is provided below.
Immunotherapy
Immunotherapy has been and continues to be a revolutionary form of treatment in oncology, including for CRC. It enables the human body’s immune system to recognize and destroy cancer cells.
In particular, checkpoint inhibitors that target PD-1/PD-L1 and CTLA-4 pathways have demonstrated promise in treating CRC, particularly in patients with high microsatellite instability (MSI-H) or mismatch repair deficiency (dMMR). Moreover, the advances in understanding the tumor microenvironment as well as the identification of biomarkers have improved the selection of patients who will possibly benefit from immunotherapy.
Targeted Therapies
Targeted therapies have been developed to specifically attack cancer cells demonstrating certain characteristics and reduce side effects and not affect normal cells. For CRC, treatment options that are targeting genetic mutations such as BRAF, KRAS and HER2 have been developed.
Targeted therapies thus offer a customized approach, which is particularly beneficial for patients with metastatic CRC who have these mutations. Furthermore, the introduction of multi-targeted kinase inhibitors and monoclonal antibodies is also being examined as a possible form of therapy.
Combination Therapies
To improve the efficacy and overcome resistance towards cancer treatment, combination therapies are being explored as a treatment option. For example, studies have shown that chemotherapy along with targeted therapies or immunotherapies can lead to an improved outcome for CRC patients.
The combination therapy approach helps attack the cancer from multiple angles, thus improving the chances of treatment. There is also on-going research that aims to identify the most effective combinations and sequences of these therapies.
Radioligand Therapy
This is a form of targeted radiation therapy that is emerging as a potential treatment for advanced CRC. It involves using molecules that specifically target cancer cells and directly deliver radioactive substances to the tumor, thus minimizing damage to the surrounding healthy tissue. Early clinical trials have shown promising results and this therapy could become a valuable addition towards CRC treatment in the future.
Gene Editing and CAR T-Cell Therapy
Genetic engineering technologies, such as CRISPR-Cas9, are providing newer potential avenues for cancer treatment. For example, gene editing can possibly be used to correct cancer-causing mutations or enhance the effectiveness of chimeric antigen receptor (CAR) T-cell therapy. Although this approach is still at the experimental stage for CRC, it represents one of the latest developments taking place in cancer research.
CAR T-cell therapy involves the modification of a patient’s T cells to attack cancer cells. It has demonstrated promise in treating hematologic cancers and is now being explored for solid tumors, including CRC. There are early-stage clinical trials that are investigating the efficacy and safety of CAR T-cell therapy for treating CRC, with a focus on targeting cancer-specific antigens. Although there are challenges such as managing toxicity and improving tumor infiltration, CAR-T therapy can possibly be used for treating advanced CRC.
Microbiome Therapies
There are studies suggesting that the gut microbiome plays a role in the development of CRC and treatment response. Studies related to microbiome therapies, such as the use of probiotics and fecal microbiota transplantation (FMT), help modulate the gut microbiome to enhance the effectiveness of cancer treatments. Although this therapy is at an early stage, it could also offer a novel way to improve outcomes for CRC patients.
New FDA Approvals for CRC Treatment
The US Food and Drug Administration (FDA) has recently approved some new treatments that offer hope to patients suffering from CRC:
- Braftovi (encorafenib) plus cetuximab: Encorafenib in combination with cetuximab is a targeted therapy that has been approved for adults with metastatic CRC with the BRAF V600E genetic mutation. This combination therapy has been shown to considerably improve survival rates compared to the standard treatment options for CRC.
- Keytruda (pembrolizumab): This is an immunotherapy drug for patients suffering from metastatic CRC having MSI-H or dMMR. This treatment uses the patient’s immune system to fight cancer cells and is a promising treatment option for those with these specific genetic markers. It also highlights the shift toward personalized medicine in cancer treatment.
- Tukysa (tucatinib) plus Herceptin (trastuzumab): The FDA has approved this treatment for certain individuals with CRC characterized by overexpression of HER2 proteins in their tumors.
There are many investigational new drugs in Phase II/III clinical trials for CRC. For example, one anticipated drug is ABX-EGF, which is a monoclonal antibody that targets the epidermal growth factor receptor (EGFR). It has shown promise in treating patients with KRAS wild-type metastatic CRC. Similarly, TAS-102, a combination of trifluridine and tipiracil, is currently at the Phase III trial stage.
The CRC treatment landscape is rapidly evolving and a clear shift is being observed towards more personalized and targeted approaches. The integration of genomic profiling into clinical practice has allowed the possibility of more precise treatment selection. This in turn is helpful for patients who are suffering from this challenging disease.
Given the extent of on-going research and development towards CRC treatment, healthcare professionals, patients and the general public need to be informed about them. Thus, Colorectal Cancer Awareness Month is an important platform to disseminate this information; moreover, it encourages the importance of early detection, prevention and the promise of new treatments on the horizon for treating this form of cancer.
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