Taking a Multidisciplinary Approach to mCRC Care

Transcript:John L. Marshall, MD: Hello, and thank you for joining this OncLive Peer Exchange, “Therapeutic Strategies in Metastatic Colorectal Cancer.” Management of advanced colorectal cancer ideally involves a multidisciplinary approach and an understanding of the benefits and limitations associated with the available options. The rapidly evolving treatment landscape has both improved survival, but also brought new questions to light in terms of biomarkers and optimal sequencing. Today we will discuss strategies and approaches to managing metastatic colorectal cancer, including the latest research and how it may influence clinical practice today.

My name is Dr. John Marshall, and I’m a professor and chief of the Division of Hematology and Oncology at Georgetown University Hospital and play a bunch of other roles there including associate director for clinical research. So I’m really glad to be here today, where I’m joined by some fabulous friends and world experts in the area of metastatic colorectal cancer. And let me first introduce down to my left, Dr. Tony Saab, who is the section chief of GI Oncology at The Ohio State University James Cancer Center. Next to me on this side, Dr. Johanna Bendell, director of GI Oncology Research and associate director of the Drug Development Unit at the Sarah Cannon Research Institute, now a global cancer center. Johanna, thanks very much for coming. Next to me too, Dr. Charlie Fuchs, Dana Farber Cancer Institute, and also professor of medicine at Harvard. Charlie, thank you very much for taking time to be here. And Dr. Richard Kim, who is a medical oncologist at the GI Oncology Department and an associate professor in the Department of Internal Medicine, the Moffitt Cancer Center, down in Tampa.

Thank you, guys, all for joining us today. We’ve got a lot to cover, so let’s just dive right in. Richard, I’m going to start with you. I think we all recognize that metastatic colorectal cancer is a team sport. It requires interventional radiology, surgery, GI, and decision making about that. I happen to have been pleased to come visit your center once and attended a tumor board there or your multidisciplinary GI conference. Talk a little bit about how you think we should take care of these patients from a multidisciplinary approach.

Richard Kim, MD: In stage IV colon cancer, 10 years ago, patients were just treated with chemotherapy. But now times have changed, with new developments and more data coming out saying that if you have oligometastases to the liver, lung, it could potentially be cured. So some of the patients we see in our clinics get presented in a multidisciplinary tumor board. And in the multidisciplinary tumor board, we have specialists from interventional radiologists, we have our surgeons, we have radiation oncologists, and we have pathologists to help us to make that decision. And it’s very important because even though patients may have stage IV disease, isolated to the liver and lung, those patients could be cured.

So we want to sequence them in the right way. Do we give chemo first? Do we give surgery up front? Do we give radiation up front? Those are the sequencing decisions that we make at our tumor board, so that we could give the best care for the patient.

John L. Marshall, MD: I was incredibly impressed. I came back and said, ‘We have to do it this way at our place.’ You presented, I think, every case for the week, and you had your practice guidelines on one wall, you had pathology and radiology on another wall, and you made sort of rapid fire decisions. In the mecca of Harvard, how is it done there when you see a patient for multidisciplinary care?

Charles S. Fuchs, MD, MPH: It really does require a multidisciplinary team. And, in fact, I would say it’s often more than one surgeon in these cases. It will be a thoracic surgeon, a surgeon who does hepatic resections, as well as the colorectal surgeon because they’re so specialized. You can’t always get them all in the same room, but you have to engage in a conversation that includes the multiple surgeons, the interventional radiologist, because we’re moving the bar on who we can resect for a cure in metastatic disease. It’s really exciting, but it requires a lot of players.

John L. Marshall, MD: We are lucky. We just walk down the hall and we run into our multidisciplinary team. I worry about the guys who are providing community oncology, where they have to sort of duct tape together this team. We do a lot of community practice. But Johanna, any advice to those guys out there and gals who are trying to pull together this kind of advice for patients?

Johanna Bendell, MD: Well, certainly the multidisciplinary conference also exists in the community, and we have conferences that happen once a week where we go over the different cases with all the different specialties. And for those of you in the community, you all know that we use our cell phones a lot, and a lot of it is calling from one place to the other and making sure that we can get the radiology to the surgeons or to the radiation oncologists so everybody can take a look together. But we do do our own, a little bit more duct taped together form of the multidisciplinary approach.

Transcript Edited for Clarity