Empowering Patients With GI Cancer: Overcoming Immunotherapy Limitations

Among the challenges in treating gastrointestinal (GI) cancers is the limited effectiveness of immunotherapy for these "cold tumors" and the need to better understand how to make them more responsive to immune treatments, said Tiago Biachi, MD, PhD, a colorectal oncologist and GI cancer specialist at Moffitt Cancer Center. He also emphasized the importance of patient-centered care, noting that patients with GI cancer often lack the knowledge about their disease compared with those with other cancers, like breast cancer.

This transcript has been lightly edited for clarity.

Transcript

What do you think is the most significant challenge facing the future of GI cancer treatments?

Immunotherapy is one of those main challenges in the GI cancer field. We know that immunotherapy is a home run for melanoma. It's very important treatment for the kind of tumors in like renal cell [carcinoma] or lung cancer. [But] for most of those GI cancers, they are considered "cold tumors" for the immune system. We do have several approvals for immunotherapy in GI cancers, but usually the benefit is very modest.

First of all, we have to better understand who is getting benefit with those therapies, because usually they're pretty expensive. But I think the main challenge moving forward would be understanding how we can make those GI cancers "hot" for the immune system, so we can use those "regular" immunotherapies, like immune checkpoint inhibitors, or how we can make those other types of cell therapy work in GI cancers like [combination] therapy or CAR [chimeric antigen receptor] T-cell therapy.

How do you think the increasing focus on patient-centered care will shape the management of GI cancers, and what more can be done to address the emotional and psychological needs of patients?

That's a very good point. I think information is the key. I have a lot of discussions with my colleagues in meetings and sometimes meetings with patients [and patient advocates] that focus in patient care, and I have the sensation that compared to other tumors, like breast cancer, for example, I don't feel that our patients with GI cancers have the same knowledge about their diseases.

So this is one point. If you know about your disease, if you know about what kind of a biomarkers your tumor has, you're going to be able to discuss this with your doctor to see if you really need that medication, what kind of benefit you're getting with that medication because it is going to add cost to your care or is going to add toxicity sometimes. This is a extremely important and, of course, when we're talking about access to clinical trials, we still have a lot of patients looking for clinical trials, doing research online, etc. So if you know more about your disease, it's helpful for, for the patient, and I would say even helpful for the provider too. So you can discuss, better kinds of options: What kind of a benefit are we adding with this medication?

This is something I would say probably is challenging. It's not easy. But if you take a look, for example, what happened with our colleagues with the breast cancer—I don't know if because we started with precision oncology much earlier than other diseases like breast cancer—usually patients with breast cancer are aware about those biomarkers, if they have, like, HER2-positive disease or hormone receptor-[positive] disease. But I don't feel like my patients colorectal cancer know if they have like a KRAS mutation or not or a BRAF mutation or not. So there is a huge gap here. And of course, the only way to fill this gap is with education.