Prof. Hans-Joachim Schmoll, MD: Colorectal Cancer Highlights from EMCC 2011

Prof. Hans-Joachim Schmoll, MD, PhD discusses the highlights in colorectal cancer research and treatments at the 2011 European Multidisciplinary Cancer Conference in Stockholm.

The Group Room at the 2011 European Multidisciplinary Cancer Conference was made possible, in part, by:

 

VIDEO TRANSCRIPT
Selma Schimmel, Founder & CEO, Vital Options International:

This is Selma Schimmel at the Multidisciplinary Cancer Congress 2011 in Stockholm. Professor Doctor Hans-Joachim Schmoll, thank you for taking time to join us during this multidisciplinary meeting here in Stockholm. And you are certainly one of Europe’s leading physicians in the area of GI Oncology, and I’m hoping you can talk to us a little bit about what we’re learning at this meeting in regards to the GI cancers, and in particular about colorectal cancers.

Prof. Hans-Joachim Schmoll, MD, PhD, Head Dept. Oncology/Hematology, Martin Luther Univ. Halle-Wittenberg, Germany:

Thank you, it’s my pleasure to being here. This is a meeting which is not showing in GI cancer, brand new results of very big trails but a lot of consolidation in between results and some new results from trials which have been recently finished, as well as a lot of pre-clinical data mix and biology. But the most interesting probably new data from the colon cancer area, colorectal cancer, and advanced stages today was in a nice report from the Spanish trail on advanced colorectal cancer where maintenance treatment after induction chemotherapy was investigated was the antigenic agent, bevacizumab would be sufficient instead of continuing chemotherapy. And the look on the camera’s expression and the potential differences and they found out that indeed KRAS mutated tumors of patients with KRAS mutations in the tumor had a worse outcome under this chemotherapy. It was Celox plus bevacizumab than those with zalutumumab. There have been some ripouts before, contradictory results and this was now a very nice study with many patients favoring the prognostic value of KRAS erlotinib for the mutant. So this is a piece of information which is more relevant for the future, in particular the investigated also silk-letting tumor cells which is another biological parameter for prognosis and the treatment of advanced colorectal cancer.

Selma Schimmel:

Let me ask you a question because there has definitely been a shift in the way we’re treating this cancer from the days where we were very limited to purely chemotherapy. Could you maybe take us through a little bit of the evolution from where we were to where we are, and what is the state of genomics, and the biology and the molecular characteristics that we understand now about colon cancer?

Prof. Hans-Joachim Schmoll:

Years ago, many years ago, there was only one drug available which was given all patients, independent of biological or molecular subtype that was not known. And even with addition of different chemotherapeutic agents all patients have got the same. So now we know that at least one parameter, which is the KRAS expression of viable mutation in the tumor makes a difference for those patients who are going to get the EGF receptor antibodies it took some time to get the tumor.

In addition to this molecular marker there are many other molecular markers which can be identified, which is separating different biology of the tumors. But still we do not really know how to use them. Some of them are contradictory as us but in the next two, three, four, five years we will have many more subgroups in colorectal cancer, which is a b-rough mutations subgroup and so on and so on. Currently, and shown today again it was clearly shown from the Spanish group that silk-letting tumor cells together with the mutation of this gene RAS is an excellent indicator to put patients into different prognostic categories. It means based on the clinic but based on the RAS mutation and the circulating tumor cells in the blood before beginning the treatment, can identify the patient very, very precisely and the group has a much better outcome or less outcome or intermediate outcome. So this is the first time we have a biological score to guide to treatment decision. It is still too early to make this routine but it’s now showing that we are on the trek using these biological and molecular options to make patient definition to make better and more precisely and adequate treatment.

Selma Schimmel:

Personalized medicine.

Prof. Hans-Joachim Schmoll:

Yes.

Selma Schimmel:

Does that mean you are now combining the classic chemotherapy with these new biologic agents?

Prof. Hans-Joachim Schmoll:

That we have done before as well but we have to treat most patients without selecting them. Now we could probably better define which patient has more and who has less benefit than just only toxicity of this combination.

Selma Schimmel:

How do you test – let’s say for one of these mutations, like the KRAS?

Prof. Hans-Joachim Schmoll:

This is done by pathology in the tumor tissue which has been taken out during the biopsy. This is a standardized method which most experienced pathologists in the world now can do reliably. Circulating tumor cells for example can be done also by a commercial available test which is doing well and reliable. So more and more of these genetic analyzes and biological additional tools can be done in the clinical team. However they are more expensive they are not effectively validated, so it takes time to put that in a clinical reality.

Selma Schimmel:

How many mutations have been identified to date for colorectal cancers?

Prof. Hans-Joachim Schmoll:

Those of clinical relevance we suspect a prognosis of potentially to select treatment is about five today. But we know there are many, many more, and probably many more highly relevant and in addition we look – we means all the clinical researchers, and pre-clinical laboratories and companies look – on geno-range window which probably more precisely and easily can combine all this factors in a single geno range and tell you are a very high risk you should deserve that treatment. So colon cancer is under way but it takes probably five, eight years to have arrived, which is on the stage which is for the patient beneficially.

Selma Schimmel:

So what is the gold standard today if the patient is…every patient in Europe now being tested for some kind of mutation before treatment is initiated?

Prof. Hans-Joachim Schmoll:

Oh, yes because the administration label for the EGFR inhibitors like cetuximab requires this testing before. But they’re only for KRAS. For the other mutations it’s still experimental or done in a clinical research setting, and not in our team.

Selma Schimmel:

And if I recall last time we talked it was like Foley Fox or…was that not the standard of care?

Prof. Hans-Joachim Schmoll:

Now it’s much more differentiated what is best first line treatment for a patient, and there was a European consensus which we have just finalized the first consensus describing what is the best treatment for a given patient in a given situation. And there all the options listed, and also recommendations are given what is better for that situation and worse. So the first time you have a uniform definition what should be or could be the best for a patient in this personal clinical situation.

Selma Schimmel:

May I ask you what you’re doing in your lab? What’re you doing research wise?

Prof. Hans-Joachim Schmoll:

We look on the combination of new drugs and look what is the best working in the different tumor types but with different gland, different biology of colorectal cancer cell lines to go then for the clinic, which is combinations. At moment but we also look on other biological regulators of the disease.

Selma Schimmel:

And I also imagine that the clinical trials arena is really global in this area, in the United States and Europe that these… and Asia, these are global clinical trials.

Prof. Hans-Joachim Schmoll:

Most of this trials very global. For example I just finished as chairman of the trial the international rectal cancer trial, looking for the better treatment, more cure. This is a thousand one hundred patients in several parts of the world from Australia to many parts of Europe and all of these trials are now very international and another time I have finished together with a company was going from Vietnam to Canada. So all of these trials need international cooperation to collect the patients in a short time because so many drugs, so many new options are there, and the need to be evaluated and we need all patients to do this. And the patients mostly have benefit because they are part of a new treatment option which could help them.

Selma Schimmel:

Thank you Professor Hans-Joachim Schmoll, who comes to us from Germany.

Prof. Hans-Joachim Schmoll:

Thank you.

END OF VIDEO

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