ESSO 45 | Moving beyond TNM staging with biomarkers, ctDNA, and AI in colon cancer

Yes, TNR, we know that has several limitations because we are not able to stratify and give the right prognosis to resected colon cancer patients. So we are actually expecting the ninth edition of TNM, which should be able to more precisely select patients and give more precisely the prognoses of our patients after resection. But more than that, I think we are developing several new biomarkers that will INTEGRATE with the new TNN in order to establish the right treatment for our patients. One of these is for sure MSI, so the DMMR status will help us first to choose the right adjuvant strategy together with immunotherapy and chemotherapy following the ATOMIC results. But we know that also immunotherapy is moving to the new adjuvant setting. So this is a status and the biomarkers we need to have beforehand and before resection to implement eventually immunotherapy in the newadjuvant setting. Another thing we discussed a lot, it’s been, of course, ctDNA, so circulating tumor DNA. We know that this is our most powerful prognostic factor. Several studies showed its prognostics value. But when it comes to predictive value and also clinical utility, unfortunately, ct DNA is not ready for prime time in our clinical practice. It’s more reliable in ct, in stage two, but we struggle for stage three colon cancer. So I think that new coming trials and results and new also technology or new ctDNA tools will help us INTEGRATE this with TNM in our clinical practice. And finally, the last remark is going to be, of course, AI. We know that several tools are being implemented and studied both for pathology and for radiology, because we are moving now from pathologic TNM to a clinical TNNM in order to decide whether the patient needs a new adjuvant strategy or adjuant strategy. And so, but we know that ct scan so far, it’s failing most of the time to stage properly the patient. And so while we move forward to the new adjuan setting, I think AI and new tools will help us stage the patient better.