Dr. Overman on the Impact of Nivolumab in mCRC

Michael J. Overman, MD, associate professor, Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, discusses the impact of nivolumab (Opdivo) on the treatment of patients with metastatic colorectal cancer (mCRC).

Nivolumab has had a big impact, but the issue is that this therapy is very active, explains Overman. This means identifying patients who will respond is critical. This is a therapy that works extremely well and could potentially cure a fraction of patients, Overman says. It has evolved the idea of universal testing in CRC; meaning that all patients with CRC should have microsatellite instability (MSI) testing. Testing can be done by immunohistochemical staining, evaluation of pathologic complete response, or next-generation sequencing. It does not matter how these patients are found, but they should be identified, says Overman.

According to Overman, a further question is, "How do physicians take what they have learned and apply it to the majority of patients with CRC?" Nivolumab is effective in about 5% of patients with mCRC. It is important to find a way to make it efficacious for the remaining 95% of patients, he says. There is a lot of ongoing work to identify how to move forward, and there are other early signs that might have hints of an approach, Overman adds.