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ESMO 2025 | What are the treatment options for early onset colorectal cancer?
Gianluca Mauri, MD, PhD, University of Milan, Milan, Italy, comments on the treatment of early onset colorectal cancer (CRC), noting that it does not differ significantly from that of older patients, despite a higher prevalence of microsatellite instability in younger patients. Dr Mauri emphasizes the need to conduct international studies to better understand the biology of the tumor and identify potential targets for therapy. This interview took place at the European Society for Medical Oncology (ESMO) 2025 Congress in Berlin, Germany.
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Transcript
Unfortunately, the treatment for these patients compared to the, let’s say, older ones, it’s still the same. Indeed, we do not have a druggable alteration, specific druggable alteration in early onset CRC. The only things that we have is a higher prevalence of microsatellite instability, which of course is a well-known target of immune therapy. But still, apart from which, I mean it’s not that different, it’s just different because of the terms of prevalence because of a higher prevalence of microsatellite-unstable tumors among the younger, but actually, it’s not a specific therapy for the younger because even the older patients can do it, provided that they are MSI, and let’s say this is still at the very beginning...
Unfortunately, the treatment for these patients compared to the, let’s say, older ones, it’s still the same. Indeed, we do not have a druggable alteration, specific druggable alteration in early onset CRC. The only things that we have is a higher prevalence of microsatellite instability, which of course is a well-known target of immune therapy. But still, apart from which, I mean it’s not that different, it’s just different because of the terms of prevalence because of a higher prevalence of microsatellite-unstable tumors among the younger, but actually, it’s not a specific therapy for the younger because even the older patients can do it, provided that they are MSI, and let’s say this is still at the very beginning. We have to go away from the let’s say preconcept that the younger patient might be let’s say treated more intensively because they are young and they are going to treat better with these treatments, whatever they are. So, we have to rationalize the treatment. We have to try to perform international studies, potentially larger, to define really the biology of this tumor by integrating different omics and to see whether we might see some Achilles’ heel in this tumor to be targeted successfully.
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