Precision medicine produces high levels of GI cancer

Recent advances in immunotherapy have transformed cancer care and come in a time of very meticulous treatment. But to make the best use of these amazing treatments, oncologists need to be able to identify specific biomarkers and oncologic drivers associated with the diagnosis of individual patient cancer. This is especially true for oncologists who specialize in the care of gastrointestinal (GI) cancers.

In this issue of ONCOLOGY®, we spoke with John L. Marshall, MD, director of the Ruesch Center for the treatment of gastrointestinal cancers at the Georgetown Lombardi Acute Cancer Center as well as 6th Annual School of Gastrointestinal Oncology® (SOGO®), maintained by Physician Education Facility, LLC (PER®), on molecular profile enhancement in GI cancer.

“It’s so important for us as oncologists to make sure we do good molecular tests,” says Marshall. “You have to do it right from the start of metastatic disease. A broad molecular profile quickly becomes a standard of care for you [are able to] familiarize yourself with the chess pieces on the chessboard. They are uncommon and unless you look under every rock, you will never find it.

“I wonder [the future] this is all about precision therapy and biomarker – directed treatments, ”adds Marshall, noting that future cancer physicians may specialize in mutations and biomarkers rather than tumor types. “There is one member of my department who thinks we should be RAS-ologists or [microsatellite instability] MSI-ologists instead of GI or breast oncologist or hematologist. I’m not sure we’re there yet. But you can feel like we’re making it that way. “

Also in this journal, we published an initial report examining the factors associated with refusal of treatment and its impact on the survival of patients with small cell lung cancer. The report highlights that more patients than ever before are refusing treatment and discusses suggestions for better messages to both health providers and policy makers.

We also include a case report of a 65-year-old patient with spinal and clinical cuandary examination examining the role of postmastectomy radiotherapy in local advanced breast cancer. Read on to find out the best treatment for these two challenging cases.

Within these pages, you will also read a review of the clinical data supporting the use of PARP inhibitors as a therapeutic option for patients with advanced prostate cancer. The recent licensing of both rucaparib (Rubraca) and olaparib (Lynparza) offers new hope for this subset of patients who have historically seen adverse outcomes.

I hope your journal is useful in caring for your patients through the most probable moments of their lives. As always, thank you for reading.