Prof. dr. Marc Peeters, prior you’ve worked in the Department of Hepatogastroenterology, Digestive Oncology Unit, University Hospital Ghent, Belgium. In Medscape.com we saw a review article, written by yourself, J. Balfour and D. Arnold, “Panitumumab - A Fully Human Anti-EGFR Monoclonal Antibody for Treatment of Metastatic Colorectal Cancer”, published in Alimentary Pharmacology & Therapeutics in 2008.
What changed in the treatment of metastatic colorectal cancer since 2008 until now?
The most important points are, first of all, that we have more treatment options; second, that we have a multidisciplinary approach even in the metastatic setting; and third, that our decision is driven by information on the biomarker status of the patients; and the last point, very recently, that probably the disease location of the primary tumor is important to make our decision on which treatment we will give in the first line to these patients.
RAS genes were the first specific genetic alterations identified in human cancer about 3 decades ago. Why are these RAS genes so important today?
If you look at the mode of action of the anti-EGFR antibodies, RAS is playing an important role in the cascade downstream, and now we know that having a mutation in that RAS gene has a negative prediction of outcome when you treat your patients with anti-EGFR.
In other words, if you have a tumor with a RAS mutation, you are not a candidate to be treated with anti-EGFR therapy, because we know that there is no efficacy and it might be toxic to give this type of treatment.
So, the key message is: before starting a treatment in patients with metastatic colon cancer, please determine the RAS state before embarking to a treatment.
We agree with the statement „Surgery, radiotherapy and chemotherapy have been untill now the main therapeutic strategies for disease control and improvement of the overall survival”. We read this in the article “Multisciplinary management of patients with liver metastasis from colorectal cancer”. Which are the newest therapies and how do the patients respond to it?
So, like you said, the most important is the multidisciplinary approach, the integration of not only the chemotherapy, but also targeted therapy, where we have different options, also the fact that especially in liver only disease we have organ-directed therapy - for example, radioembolization, and, the last point, with the new data, on a very small number of patients with MSI high (MSI-H) tumors, in which immunotherapy might have an impact on the outcome of these patients. So, integration of all these options could have an impact on the prognosis of the patients.
What’s your opinion about the medical research field in Romania?
That’s a difficult question. I think that, based on what I have seen and on the interactions with the physicians, they know what is happening in the field and I think it is important to open especially the interactions between other countries, more to the Western side of Europe, and to try to have some collaborations set up, but I’m impressed about the knowledge in the field of colorectal cancer of the treating physicians, and also on the research side.