Personalized medicine is having a transformative impact in the treatment of gastrointestinal (GI) cancers, with advances in next-generation sequencing enabling more targeted therapies and improving both treatment and patient care, explained Tiago Biachi, MD, PhD, colorectal oncologist and gastrointestinal cancer specialist at Moffitt Cancer Center.
He also highlighted the importance of lifestyle factors, such as obesity and lack of exercise, in the prevention and recurrence of gastrointestinal cancer and highlighted the essential role of interdisciplinary teams in the management gastrointestinal cancers.
This transcript has been lightly edited for clarity.
Transcription
How has the role of personalized medicine evolved in the treatment of gastrointestinal cancers?
In fact, I would say that precision oncology has revolutionized the treatment of patients with gastrointestinal cancer. I remember not too long ago we were treating many patients the same way, and now, I would say, mainly thanks to advances in next generation sequencing, we are able to treat patients with more targeted therapies – and I would say, not only the treatment itself, but also the approach to diagnosis and how to follow these patients after surgery.
I gave a talk at a conference on circulating tumor DNA, which is a very new technology. Now we have access to it in the clinic and then we discussed all the possible scenarios in which we can use the technology, even for colorectal cancer screening, for example, to detect minimal residual disease after surgery, or to detect mutations in a specific domain. tumor to treat this patient with therapy. So we are moving quickly in this direction to provide the right treatment to the right patient at the right time, which is important.
What role do you think lifestyle and diet play in the prevention and management of gastrointestinal diseases, and how can healthcare providers better educate patients about it?
In fact, lifestyle is crucial in gastrointestinal cancers, probably more important than in any other solid tumor. For example, we know that for most of our gastrointestinal cancers, obesity and lack of exercise are risk factors for colorectal cancer. It’s very well established. We have data, for example, on colorectal cancer patients (who were) treated, (and) when we followed these patients, we had data showing that overweight or obese patients have a risk of recurrence higher than normal weight patients. .
And we know that, for example, in patients with liver cancer, one of the most common causes of liver cancer now is fatty liver disease, (which is) of course lifestyle related. So there’s a huge room for improvement, I would say, mainly on the prevention side, because, as we know, obesity is a pandemic. But also, not only for prevention, but also for patients already treated, we know that this is also important.
How do you see the role of interdisciplinary teams evolving in the treatment and management of gastrointestinal conditions?
This is probably why I fell in love with gastrointestinal cancers in the past. It’s a kind of specialty where we have to work as a team here. So, for example, tumor boards are crucial to the care of these patients, because that’s the time where we can sit down and talk with the surgeons, the interventional radiologists, everyone involved in taking in charge of this patient, to discuss the best treatment for him. .
And to be honest with you, all the care these patients need. I think it’s too much for one provider to handle. So, for example, patients now of course have more access to information. So they have a lot of questions about diet, what types of exercises they can do, and pain management. So we have to work as a team. It is impossible for a single provider to take care of all aspects related not only to the cancer but also to the well-being of that patient. So it’s crucial (for us) to work as a team here.