ESMO WCGIC 2023 | What have been the major advances in CRC care in the past 25 years?

Yeah, sure. 25 years in two minutes. Well, I will start from the neoadjuvant setting of rectal cancer because to me that’s the most outstanding advancement that has been done not only in the last 25 years, but say in the whole history of modern oncology, including all types of fields. Reason being that with the neoadjuvant dostarlimab data, essentially you get rid of surgery, chemotherapy and radiation therapy and the surgery is mutilating surgery. So not only you advance the field in terms of efficacy, even if the patients relapses tomorrow, say 36 out of 36 patients going into complete remission even if they recur tomorrow will be a fantastic achievement. So again, I have been shocked from those results and those are rank out of scale. Then we may distinguish, some say paradigm changing type of advancements as opposed to some incremental type of advancements. Among the first one is certainly the neoadjuvant use in the field of colon cancer of checkpoint inhibitors. Also that regards about 15% of patients, whereas in rectal cancer that regards the 2.7% of rectal cases. So again, because frequency is a part of relevance of any phenomenon, that’s an important point. However, I’m just coming out of a debate that has been going on now at the main session where it was discussed the idea of neoadjuvant treatment in colon cancer, where surgery is not that aggressive and sometimes you have the urgent need for surgery. So again, I would not put on the same level the advancement made in the neoadjuvant setting of rectal cancer with those made in the neoadjuvant setting of colon cancer. The next point I’m going to make in my review that is certainly a paradigm changing is the advancements that the liquid biopsy technology has allowed. I mean that is going certainly to change the whole the whole business of adjuvant treatment, no question. And I actually felt bad when at the session the opponent to the to the talk by Jeanne Tie that was the proponent for this new technology becoming standard for the treatment. I felt bad that there was an opponent to that because maybe I’m too enthusiastic about the new things. But again, the prognostic power and the predictive power of this technology is so huge, so strong that no matter whether it is imperfect, it should be adopted. So that’s my position as well. Okay. In terms of incremental gains, it’s a whole story of these 25 years. 25 years ago, the median survival was in the range of 16, 17 months. Now we have doubled that. Not only that, the five year survival rate is in the range of 20 to 30% of the paradigm study. The strategic trials. One of the latest trials reported at major meetings, have these figures for long term survival. So again, to conclude, I would say that these small incremental gains one after the other have accounted for a complete change in how we present the information to the patient because that’s not so long or so desperate, it leaves and hope so that now patient empowerment is much more done by doctors and shared decision making is actually implemented.