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Managing colorectal cancer patients in the COVID-19 era: international discussion on the role of precision medicine in triaging patients
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Managing colorectal cancer patients in the COVID-19 era: international discussion on the role of precision medicine in triaging patients
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2023-07-28T00:00:00.0000000
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Language: EN.
Segment:1 Managing colorectal cancer patients in the COVID-19 era: international discussion on the role of precision medicine in triaging patients.
[MUSIC PLAYING]
MATÍAS CHACÓN: Dear friends and colleagues, it's a pleasure to get together today on our-- shared opinion in our respective and recent publication in GI oncology triage in COVID time. Let's start with a short introduction with you, Benjamin, and then from our side at the Fleming Institute
BENJAMIN WEINBERG: Sure. My name is Dr. Benjamin Weinberg. I'm an assistant professor of medicine at Georgetown University in Washington, DC in the United States. I'm a gastrointestinal medical oncologist, and I specialize in the treatment of patients with colon and pancreatic cancer.
JUAN MANUEL O'CONNOR: Hello, I'm Dr. Juan Manuel O'Connor from Fleming Institute in Buenos Aires, Argentina. I'm a medical oncologist, head of department of GI oncology in our center. [MUSIC PLAYING]
Segment:2 What has been the impact of the COVID-19 crisis on cancer patient management in Latin America?.
BENJAMIN WEINBERG: And I wanted to thank you both for the invitation and introduction to have this international discussion, a bridge between Latin America and the United States. It's thrilling to have this opportunity. It was also very interesting to find that both of our papers about our experience in the COVID era included a mention of Immunoscore, which I think we're going to get to in a little bit. But first, I just wanted to ask, how has the COVID crisis impacted your care for cancer patients in Argentina?
JUAN MANUEL O'CONNOR: Yes, indeed
JUAN MANUEL O'CONNOR: very interesting we publish in the same journal as your point of view was aligned with the-- it made sense with yours. The COVID situation in our region, LATAM---- it's a big concern right now because we have the largest number of cases currently being the main focus of the pandemic. And also, in our country, the number of infected people is increasing. And the last official reports show more than 6,000 new cases and roughly 150 deaths per day.
JUAN MANUEL O'CONNOR: So probably we are in the top of the curve, but we don't know exactly. Fortunately, the health system has not been saturated in our country. And the mortality rate remains low in our country. Some societies involved in the treatment of patients in our country developed some guidelines and recommendation for the management of our patients. At our cancer center, for example, we are reassuring people.
JUAN MANUEL O'CONNOR: We are screening everybody at the coming with at least a minimal triage. Only faculty and staff are wearing masks at all time. And we are also developing some local recommendations and platform for telemedicine. But I think that, in general, our strategy is to continue to provide the best possible cancer care in patients who, despite the pandemic, need to be taken care.
Segment:3 How is immune response assessment a valuable tool in the triage of colorectal cancer patients during the COVID-19 epidemic?.
JUAN MANUEL O'CONNOR: [MUSIC PLAYING] Our approach are pretty well complementary indeed. Your group wrote the white paper with biomarker of precision medicine helpful in COVID era. And we look into a range of COVID oncology guidance. Ben, could you give us an overview of your experience with the immune response assessment tool that you have write in your publication and then your talk?
JUAN MANUEL O'CONNOR: How did it come to you to include in your white paper recommendations?
BENJAMIN WEINBERG: Sure, that's a great question. So going back to what you were saying a second ago, I think what's paramount is that we don't lose sight of cancer care just because we're in a pandemic. And that cancer care is really not a luxury. It's really something that is a standard practice. And giving things like adjuvant chemotherapy after colon cancer surgery, we know, can save lives. And we don't want to compromise a short term risk of exposing patients during the COVID era and then losing out on the long term benefit of more patients being cured from their cancer.
BENJAMIN WEINBERG: So can we come up with better strategies to help mitigate both the short term and long term risk to find a balance? And there's a couple of technologies that are being used more and more to help risk stratified patients, especially after colorectal surgery, to really know who could really benefit from adjuvant chemotherapy and who may not. And those are technologies like circulating tumor DNA, but also technologies like Immunoscore being able to understand the T cell subsets and densities in receptive colon cancer tissues and then using their algorithm to help generate an Immunoscore, which has been shown to be very predictive of benefit from chemotherapy and also very prognostic and really should probably be included in our routine staging design as it has been in other countries.
BENJAMIN WEINBERG: So our experience goes back the last couple years already using Immunoscore mostly for patients with stage II cancers where, based on traditional clinical pathological characteristics, we're sort of on the fence about, one, recommending chemotherapy, and two, if we are going to recommend chemotherapy, how intense a chemotherapy regimen to recommend, whether we're recommending sort of single-agent fluoropyrimidine or double it with oxaliplatin.
BENJAMIN WEINBERG: So I found it's been helpful, and especially in patients who, for instance, are T4N0, thought to be a high risk because of their T4 disease, but with no other traditional high risk features-- lymphovascular invasion, obstruction perforation, et cetera. And I found it's been helpful in actually using Immunoscore to show patients that their risk really becomes close to a stage I if they have a high Immunoscore in obviating the need for systemic chemotherapy.
BENJAMIN WEINBERG: For stage III patients, it's a little different. There seems to be a suggestion that a higher Immunoscore actually means maybe we should be exposing these patients to longer durations of chemotherapy, six versus three months, whereas with the results of the idea collaboration, we're now seldom actually giving six months of therapy for stage III patients. But those are the avenues where I found Immunoscore to be helpful.
Segment:4 What are your experiences using precision medicine tools?.
BENJAMIN WEINBERG: [MUSIC PLAYING] But what about in your region? How do you approach these patients using different risk stratification? And how do medical oncologists believe in the early phases of management, prevention, metastasis using these types of precision medicine tools? And do you work with your surgeons and your oncologists together in sort of a multidisciplinary setting, or are these more isolated decisions that you all make?
JUAN MANUEL O'CONNOR: Yes, Ben, OK, let me say we're very interested in using immunoscoring in early stage colorectal cancer because allow us better stratification for our patient. You know that the cooperation between surgeons and medical oncology, it's also important, because both disciplines attend the multidisciplinary teams and the input for the MDT and more information and more accurate information, the state of the tumor, and patient risk group of high impact in appropriate and documented the decision making for our patient.
JUAN MANUEL O'CONNOR: Oncology care, as you know very well, has become pretty much a team science. And we believe that MDT discussion and using this type of precision medicine tools, we are improving care and quality of life. So to sustain your point, Ben, in fact, we are also happy to know and to see the international clinical management guidelines include now the Immunoscore in their recommendation for localized colon cancer that recently published the ESMO guidelines with the new and very important information based on some precision medicine tool.
JUAN MANUEL O'CONNOR: [MUSIC PLAYING]
Segment:5 How do you get access to the Immunoscore test?.
BENJAMIN WEINBERG: Right. So our approach is very integrated with our pathology department. And so most of the patients that are referred to us in the the locally advanced non metastatic setting are internally referred from our hospital. And so the pathologist have the tissue ready to go. And so we basically thought the Immunoscore form. And it's fairly straightforward. And get it to our pathology department.
BENJAMIN WEINBERG: And then they work with HalioDX to get the specimens sent in our shop. It's to Richmond Virginia, which is not too far from our location. And how have you been able to order the tests? Is this something that you've used? And what's your experience with the turnaround time?
JUAN MANUEL O'CONNOR: Yeah, in our experience, from our perspective, we observed that the turnaround time for the test, it's appropriate for the timing to add to one chemotherapy prescription. So physicians probably can receive the result of the test in a well managed time frame, so that MDT could take the right decision based on the well documented and accurate result of the patient.
JUAN MANUEL O'CONNOR: A personal decision making is what do we aim in the scientific and medical community. So I think that we are very happy with the turnaround time for our patient when we decided to perform the test.
MATÍAS CHACÓN: Thank you very much, Juan and Benjamin. For us, it's really a pleasure to have you and to discuss between the continents and to the whole world. This is also a very nice opportunity to show to the world at the medical oncology here in Argentina. It's really a very excellent multidisciplinary and transdisciplinary team. So we hope that we can share with you your knowledge, and let's start with this point, and really this sum of precision medicine could improve our patient outcome.
MATÍAS CHACÓN: So really, we appreciate a lot. Thank you very much. [MUSIC PLAYING]
Segment:1 Managing colorectal cancer patients in the COVID-19 era: international discussion on the role of precision medicine in triaging patients.
[MUSIC PLAYING]
MATÍAS CHACÓN: Dear friends and colleagues, it's a pleasure to get together today on our-- shared opinion in our respective and recent publication in GI oncology triage in COVID time. Let's start with a short introduction with you, Benjamin, and then from our side at the Fleming Institute
BENJAMIN WEINBERG: Sure. My name is Dr. Benjamin Weinberg. I'm an assistant professor of medicine at Georgetown University in Washington, DC in the United States. I'm a gastrointestinal medical oncologist, and I specialize in the treatment of patients with colon and pancreatic cancer.
JUAN MANUEL O'CONNOR: Hello, I'm Dr. Juan Manuel O'Connor from Fleming Institute in Buenos Aires, Argentina. I'm a medical oncologist, head of department of GI oncology in our center. [MUSIC PLAYING]
Segment:2 What has been the impact of the COVID-19 crisis on cancer patient management in Latin America?.
BENJAMIN WEINBERG: And I wanted to thank you both for the invitation and introduction to have this international discussion, a bridge between Latin America and the United States. It's thrilling to have this opportunity. It was also very interesting to find that both of our papers about our experience in the COVID era included a mention of Immunoscore, which I think we're going to get to in a little bit. But first, I just wanted to ask, how has the COVID crisis impacted your care for cancer patients in Argentina?
JUAN MANUEL O'CONNOR: Yes, indeed
JUAN MANUEL O'CONNOR: very interesting we publish in the same journal as your point of view was aligned with the-- it made sense with yours. The COVID situation in our region, LATAM---- it's a big concern right now because we have the largest number of cases currently being the main focus of the pandemic. And also, in our country, the number of infected people is increasing. And the last official reports show more than 6,000 new cases and roughly 150 deaths per day.
JUAN MANUEL O'CONNOR: So probably we are in the top of the curve, but we don't know exactly. Fortunately, the health system has not been saturated in our country. And the mortality rate remains low in our country. Some societies involved in the treatment of patients in our country developed some guidelines and recommendation for the management of our patients. At our cancer center, for example, we are reassuring people.
JUAN MANUEL O'CONNOR: We are screening everybody at the coming with at least a minimal triage. Only faculty and staff are wearing masks at all time. And we are also developing some local recommendations and platform for telemedicine. But I think that, in general, our strategy is to continue to provide the best possible cancer care in patients who, despite the pandemic, need to be taken care.
Segment:3 How is immune response assessment a valuable tool in the triage of colorectal cancer patients during the COVID-19 epidemic?.
JUAN MANUEL O'CONNOR: [MUSIC PLAYING] Our approach are pretty well complementary indeed. Your group wrote the white paper with biomarker of precision medicine helpful in COVID era. And we look into a range of COVID oncology guidance. Ben, could you give us an overview of your experience with the immune response assessment tool that you have write in your publication and then your talk?
JUAN MANUEL O'CONNOR: How did it come to you to include in your white paper recommendations?
BENJAMIN WEINBERG: Sure, that's a great question. So going back to what you were saying a second ago, I think what's paramount is that we don't lose sight of cancer care just because we're in a pandemic. And that cancer care is really not a luxury. It's really something that is a standard practice. And giving things like adjuvant chemotherapy after colon cancer surgery, we know, can save lives. And we don't want to compromise a short term risk of exposing patients during the COVID era and then losing out on the long term benefit of more patients being cured from their cancer.
BENJAMIN WEINBERG: So can we come up with better strategies to help mitigate both the short term and long term risk to find a balance? And there's a couple of technologies that are being used more and more to help risk stratified patients, especially after colorectal surgery, to really know who could really benefit from adjuvant chemotherapy and who may not. And those are technologies like circulating tumor DNA, but also technologies like Immunoscore being able to understand the T cell subsets and densities in receptive colon cancer tissues and then using their algorithm to help generate an Immunoscore, which has been shown to be very predictive of benefit from chemotherapy and also very prognostic and really should probably be included in our routine staging design as it has been in other countries.
BENJAMIN WEINBERG: So our experience goes back the last couple years already using Immunoscore mostly for patients with stage II cancers where, based on traditional clinical pathological characteristics, we're sort of on the fence about, one, recommending chemotherapy, and two, if we are going to recommend chemotherapy, how intense a chemotherapy regimen to recommend, whether we're recommending sort of single-agent fluoropyrimidine or double it with oxaliplatin.
BENJAMIN WEINBERG: So I found it's been helpful, and especially in patients who, for instance, are T4N0, thought to be a high risk because of their T4 disease, but with no other traditional high risk features-- lymphovascular invasion, obstruction perforation, et cetera. And I found it's been helpful in actually using Immunoscore to show patients that their risk really becomes close to a stage I if they have a high Immunoscore in obviating the need for systemic chemotherapy.
BENJAMIN WEINBERG: For stage III patients, it's a little different. There seems to be a suggestion that a higher Immunoscore actually means maybe we should be exposing these patients to longer durations of chemotherapy, six versus three months, whereas with the results of the idea collaboration, we're now seldom actually giving six months of therapy for stage III patients. But those are the avenues where I found Immunoscore to be helpful.
Segment:4 What are your experiences using precision medicine tools?.
BENJAMIN WEINBERG: [MUSIC PLAYING] But what about in your region? How do you approach these patients using different risk stratification? And how do medical oncologists believe in the early phases of management, prevention, metastasis using these types of precision medicine tools? And do you work with your surgeons and your oncologists together in sort of a multidisciplinary setting, or are these more isolated decisions that you all make?
JUAN MANUEL O'CONNOR: Yes, Ben, OK, let me say we're very interested in using immunoscoring in early stage colorectal cancer because allow us better stratification for our patient. You know that the cooperation between surgeons and medical oncology, it's also important, because both disciplines attend the multidisciplinary teams and the input for the MDT and more information and more accurate information, the state of the tumor, and patient risk group of high impact in appropriate and documented the decision making for our patient.
JUAN MANUEL O'CONNOR: Oncology care, as you know very well, has become pretty much a team science. And we believe that MDT discussion and using this type of precision medicine tools, we are improving care and quality of life. So to sustain your point, Ben, in fact, we are also happy to know and to see the international clinical management guidelines include now the Immunoscore in their recommendation for localized colon cancer that recently published the ESMO guidelines with the new and very important information based on some precision medicine tool.
JUAN MANUEL O'CONNOR: [MUSIC PLAYING]
Segment:5 How do you get access to the Immunoscore test?.
BENJAMIN WEINBERG: Right. So our approach is very integrated with our pathology department. And so most of the patients that are referred to us in the the locally advanced non metastatic setting are internally referred from our hospital. And so the pathologist have the tissue ready to go. And so we basically thought the Immunoscore form. And it's fairly straightforward. And get it to our pathology department.
BENJAMIN WEINBERG: And then they work with HalioDX to get the specimens sent in our shop. It's to Richmond Virginia, which is not too far from our location. And how have you been able to order the tests? Is this something that you've used? And what's your experience with the turnaround time?
JUAN MANUEL O'CONNOR: Yeah, in our experience, from our perspective, we observed that the turnaround time for the test, it's appropriate for the timing to add to one chemotherapy prescription. So physicians probably can receive the result of the test in a well managed time frame, so that MDT could take the right decision based on the well documented and accurate result of the patient.
JUAN MANUEL O'CONNOR: A personal decision making is what do we aim in the scientific and medical community. So I think that we are very happy with the turnaround time for our patient when we decided to perform the test.
MATÍAS CHACÓN: Thank you very much, Juan and Benjamin. For us, it's really a pleasure to have you and to discuss between the continents and to the whole world. This is also a very nice opportunity to show to the world at the medical oncology here in Argentina. It's really a very excellent multidisciplinary and transdisciplinary team. So we hope that we can share with you your knowledge, and let's start with this point, and really this sum of precision medicine could improve our patient outcome.
MATÍAS CHACÓN: So really, we appreciate a lot. Thank you very much. [MUSIC PLAYING]
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