Precision Medicine Takes Center Stage in GI Cancer

The recent advances in immunotherapy have revolutionized cancer care and ushered in an era of true precision medicine. But to best utilize these extraordinary therapies, oncologists must be able to recognize specific biomarkers and oncologic drivers associated with an individual patient’s cancer diagnosis. This is true, in particular, for oncologists specializing in the care of gastrointestinal (GI) cancers.

In this issue of ONCOLOGY®, we spoke with John L. Marshall, MD, director of the Ruesch Center for the Cure of Gastrointestinal Cancers at Georgetown Lombardi Comprehensive Cancer Center as well as cochair of the 6th Annual School of Gastrointestinal Oncology® (SOGO®), hosted by Physicians’ Education Resource, LLC (PER®), about the rise of molecular profiling in GI cancer.

“It is so important for us as oncologists to make sure we’re doing good molecular testing,” says Marshall. “You need to do it right from the beginning of metastatic disease. Broad molecular profiling is quickly becoming the standard of care so that you [are able to] know all of the chess pieces on the chessboard. They’re not common and unless you look under every single rock, you’ll never find it.

“I think [the future] is all about precision medicine and biomarker-driven therapies,” adds Marshall, noting that cancer physicians of the future may specialize in mutations and biomarkers rather than tumor type. “There’s one member of my division who thinks that we should be RAS-ologists or [microsatellite instability] MSI-ologists instead of a GI or breast oncologist or a hematologist. I’m not sure we’re there yet. But you can sort of feel like we’re heading in that direction.”

Also in this issue, we published original report investigating the factors associated with treatment refusal and its impacts on survival of patients with small cell lung cancer. The report highlights that more patients than ever are refusing treatment and discusses recommendations for better messaging for health providers and policy makers alike.

We also present a case report of a 65-year-old patient with spinal cord compression and a clinical quandary examining the role of postmastectomy radiotherapy in locally advanced breast cancer. Read on to find out the optimal treatment for both of these challenging cases.

Within these pages, you will also read a review of the clinical data supporting the use of PARP inhibitors as a therapeutic option for patients with advanced prostate cancer. The recent approvals of both rucaparib (Rubraca) and olaparib (Lynparza) offer new hope for this subset of patients that historically have seen adverse outcomes.

I hope you find our journal helpful in caring for your patients through what is likely one of the most challenging times in their lives. As always, thank you for reading.