Dr Kim on Current Unmet Needs in the Management of Resectable CRC

Richard Kim, MD, service chief, Medical Gastrointestinal Oncology, senior member, Gastrointestinal Oncology Department, Moffitt Cancer Center, professor, oncology, University of South Florida College of Medicine, discusses the current treatment paradigm for patients with resectable colorectal cancer (CRC), as well as unmet needs in this population.

The treatment strategy for patients with resectable CRC often depends on the specific practices of different institutions, Kim begins. Traditionally, surgical resection has been the cornerstone of treatment for resectable CRC. However, current recommendations suggest that the use of neoadjuvant therapy should be considered for patients with more advanced disease, particularly those with T4b tumors or those exhibiting bulky disease, he explains.

For patients whose tumors are mismatch repair–proficient, the standard recommendation is to administer chemotherapy as part of the neoadjuvant treatment plan, Kim continues. On the other hand, for patients with T4b tumors that are mismatch repair–deficient (dMMR), the guidelines advocate for the use of immunotherapy rather than chemotherapy in the neoadjuvant setting, he notes.

Despite these guidelines, there are several unmet needs in the treatment of resectable CRC, especially in the neoadjuvant context, according to Kim. One major challenge is determining which patients truly benefit from neoadjuvant therapy, Kim reports. Current disease staging methods are often inaccurate, with data indicating that staging criteria may overestimate the extent of disease in approximately 15% to 25% of cases, Kim emphasizes. This highlights a need for improved staging techniques to better identify patients who would benefit most from neoadjuvant treatment, he explains.

In dMMR CRC, although neoadjuvant immunotherapy has generated promising results with high rates of complete responses, there are still significant questions to address, Kim adds. These include the number of immunotherapy cycles needed, the post-surgery regimen, and whether organ preservation might be feasible without surgical intervention, akin to approaches used in rectal cancer, Kim says. These are important areas where further research and clarification are needed, he concludes.