Podcasts about Colorectal cancer

Kellie Gardner was living her best life with her partner, AFL player Jeremy Finlayson, falling pregnant and giving birth to their beautiful baby girl Sophia in August last year. Then, when Sophia was just 3 months old, Kellie was diagnosed with stage 3 Colorectal Cancer, which she later found out was actually stage 4. After spending a large amount of Sophia's life in hospital, Kellie wants to warn other mums and women to listen to their bodies and get checked if anything doesn't seem right. We're so grateful for Kellie coming on to tell her story, and are glad to hear she's now doing well. To hear more about her story and follow her motherhood journey, check out @kelliegardner__ on Instagram.See omnystudio.com/listener for privacy information.

Colorectal cancer is the third most diagnosed cancer and the second leading cause of cancer deaths worldwide. The current gold standard for screening, the colonoscopy, reduces cancer deaths by 67 percent, according to a 2018 study from Kaiser Permanente. So, we know screening is effective. However, obstacles remain. Colonoscopies are invasive and costs can be prohibitive. An alarming trend has also emerged, with incidence of early-onset colorectal cancer increasing over the last few decades. Today on OncTimes Talk, we interview Anil K. Rustgi, MD, on the current state of colorectal cancer screening, advancements in non-invasive testing, and the mechanisms behind early-onset colorectal cancer. In addition to being a world-renowned leader in the field of gastrointestinal oncology, Rustgi is the Director of the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian/Columbia University Irving Medical Center. His research focuses on tumor initiation, the tumor microenvironment, and tumor metastasis in gastrointestinal cancers.

On Today's episode of Skin Deep , I sit with Consultant Gastroenterologist Dr Ann-Marie Eustace Ryan . My aim was to raise awareness for Colorectal Cancer, given the massive spike in numbers in both men and women aged 25-50, but what I got was my mind blown. I always felt I had a deep understanding about the gut and microbiome but what I had not realized is that its so much simpler than that. It literally boils down to what food choices you make and what biome you choose to feed . Small disciplines repeated with consistency every day lead to great achievements gained slowly over time. This episode will change how you think, change how you speak with your children and most importantly, change how you speak to yourself. @drannmarieeustaceryan @corinna_monicatolanbeauty

Host: Peter Buch, MD, FACG, AGAF, FACP Guest: Aasma Shaukat, MD, MPH Adenoma detection rate (ADR) may help us better detect our patients' risk of developing colorectal cancer. To explore what we need to know about this quality indicator, Dr. Peter Buch joins Dr. Aasma Shaukat from the New York University Grossman School of Medicine to talk about ADR.

Proceedings from a daylong symposium hosted in partnership with Florida Cancer Specialists, featuring key clinical presentations and papers in gastrointestinal cancers. Featuring perspectives from Drs Wells Messersmith and John Strickler, including the following topics: Immunotherapy for Gastroesophageal Cancers; PARP Inhibitors in Pancreatic Cancer (0:00) HER2-Positive Gastroesophageal and Colorectal Cancer; Role of Circulating Tumor DNA/Minimal Residual Disease in Colorectal Cancer (20:21) Colorectal Cancer in Younger Patients; Tumor Microbiome (45:51) Neoadjuvant Therapy for Microsatellite Instability-High Gastroesophageal and Colorectal Cancer (47:53) Novel Agents in Pancreatic Cancer (53:14) CME information and select publications

Lurie Children's is among the only pediatric hospitals with a specialized colorectal center. The multidisciplinary team cares for children with colorectal conditions such as imperforate anus, Hirschsprung disease and severe constipation. Learn more from two of the center's leaders, Dr. Julia Grabowski and Dr. John Fortunato, about how their comprehensive approach to treating children with these conditions stands out.

Featuring a slide presentation and related discussion from Dr Rachna Shroff, including the following topics: Colorectal Cancer (0:00) Gastroesophageal Cancers (19:20) Hepatocellular Carcinoma (27:20) Biliary Tract Cancers (37:59) Pancreatic Cancer (41:33) CME information and select publications

Pets and Well-being, Calcium and Kidney Stones, Cranberries and Memory, and Colorectal Cancer and Folate.

In this episode, we talk to Julien Vos, who is a doctoral student and clinician based at the Department of General Practice at the University of Amsterdam. We're going to discuss his paper about survivorship care for colorectal cancer and patients experiences of GP-led care in the Netherlands. Paper: Patients' experiences with general practitioner-led colon cancer survivorship care; a mixed-methods evaluation at various time pointsAvailable at: https://doi.org/10.3399/BJGP.2022.0104Cancer survivorship care is often complex and requires a multi-dimensional approach. Patients receiving colon cancer survivorship care from either the GP or surgeon rate the received care as of high quality. Roles and responsibilities of patients and physicians need to be clear in order to help organize survivorship care. GPs can take on a more prominent role in cancer survivorship care, but other outcomes, including patients' and physicians' preferences, will also be important.

Pets and Well-being, Calcium and Kidney Stones, Cranberries and Memory, and Colorectal Cancer and Folate. Listen to the latest episode of Live Foreverish as Drs. Mike and Crystal discuss research updates on how pets activate brain regions related to social and emotional situations and engagements; the role of calcium in protection against kidney stones; the benefit of cranberry dietary intake for the aging brain; and folate as a promising nutrient to reduce risk of colorectal cancer.

In this month's Talk Evidence, Helen Macdonald, The BMJ's research integrity editor, is joined again by Juan Franco, editor in chief of BMJ EBM, and Joe Ross, US research editor. They're straying beyond the pages of The BMJ, and discussing an NEJM paper about colonoscopy for colorectal cancer screening. We have a listener request, asking about evidence for England's " NHS Diabetes Prevention Programme" - what do we know about how lifestyle interventions work at a population level? Juan puts on his Cochrane hat to answer the query. We stay with diabetes, and Joe tells us about his research trying to see if routinely collected observational data could be used to match the outcomes of an RCT into drug treatments. Finally, Helen updates us about what she's been doing about a case of plagiarism in one of BMJ's journals - and what that means for researchers who are writing in multiple journals about their work. Reading list Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death https://www.nejm.org/doi/full/10.1056/NEJMoa2208375 Emulating the GRADE trial using real world data: retrospective comparative effectiveness study https://www.bmj.com/content/379/bmj-2022-070717 Expression of concern about content of which Dr Paul McCrory is a single author https://bjsm.bmj.com/content/early/2022/10/11/bjsports-2022-106408eoc

In this month's Talk Evidence, Helen Macdonald, The BMJ's research integrity editor, is joined again by Juan Franco, editor in chief of BMJ EBM, and Joe Ross, US research editor. They're straying beyond the pages of The BMJ, and discussing an NEJM paper about colonoscopy for colorectal cancer screening. We have a listener request, asking about evidence for England's " NHS Diabetes Prevention Programme" - what do we know about how lifestyle interventions work at a population level? Juan puts on his Cochrane hat to answer the query. We stay with diabetes, and Joe tells us about his research trying to see if routinely collected observational data could be used to match the outcomes of an RCT into drug treatments. Finally, Helen updates us about what she's been doing about a case of plagiarism in one of BMJ's journals - and what that means for researchers who are writing in multiple journals about their work. Reading list Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death https://www.nejm.org/doi/full/10.1056/NEJMoa2208375 Emulating the GRADE trial using real world data: retrospective comparative effectiveness study https://www.bmj.com/content/379/bmj-2022-070717 Expression of concern about content of which Dr Paul McCrory is a single author https://bjsm.bmj.com/content/early/2022/10/11/bjsports-2022-106408eoc

Er det mulig å begrense bruken av opioider til smertebehandling etter kirurgiske inngrep? Det har blitt undersøkt i en nylig publisert studie. I en studie fra Japan har forskere sett nærmere på om det er forskjell på utfall etter kirurgi basert på kjønnet til kirurgen. En ny norsk studie har undersøkt effekten av tarmkreftscreening, mens det i en annen studie har blitt sett nærmere på effekten av screening for depresjon og selvmordsrisiko hos unge. Kan seksuell vold forklare noe av forskjellen mellom kjønnene når det gjelder forekomst av psykiske lidelser hos unge? Og hva vet vi om gener og hvor høye mennesker blir? Assisterende sjefredaktør Ragnhild Ørstavik forteller om dette og mer i ukens episode.Tilbakemeldinger kan sendes til stetoskopet@tidsskriftet.no. Stetoskopet produseres av Caroline Ulvin Johansson, Are Brean og Julie Didriksen ved Tidsskrift for Den norske legeforening. Ansvarlig redaktør er Are Brean. Jingle og lydteknikk: Håkon Braaten / Moderne media Coverillustrasjon: Stephen LeeArtikler nevnt:Effect of a Postoperative Multimodal Opioid-Sparing Protocol vs Standard Opioid Prescribing on Postoperative Opioid Consumption After Knee or Shoulder Arthroscopy: A Randomized Clinical TrialComparison of short term surgical outcomes of male and female gastrointestinal surgeons in Japan: retrospective cohort studyThe long road to gender equity in surgeryEffect of Colonoscopy Screening on Risks of Colorectal Cancer and Related DeathUnderstanding the Results of a Randomized Trial of Screening ColonoscopyScreening for Adolescent Depression and Suicide RiskScreening for Depression and Suicide Risk in Children and Adolescents: Updated Evidence Report and Systematic Review for the US Preventive Services Task ForceThe impact of sexual violence in mid-adolescence on mental health: a UK population-based longitudinal studyThe impact of sexual violence in gendered adolescent mental health pathwaysA saturated map of common genetic variants associated with human heightMissing heritability found for heightNew England Journal of Medicine Interviews: Infectious Disease in Africa on Apple Podcasts

A new research paper was published in Oncotarget's Volume 13 on October 19, 2022, entitled, “Platelet-derived growth factor (PDGF) cross-signaling via non-corresponding receptors indicates bypassed signaling in colorectal cancer.” Platelet-derived growth factor (PDGF) signaling, besides other growth factor-mediated signaling pathways like vascular endothelial growth factor (VEGF) and epidermal growth factor (EGF), seems to play a crucial role in tumor development and progression. Previously, researchers Romana Moench, Martin Gasser, Karol Nawalaniec, Tanja Grimmig, Amrendra K. Ajay, Larissa Camila Ribeiro de Souza, Minghua Cao, Yueming Luo, Petra Hoegger, Carmen M. Ribas, Jurandir M. Ribas-Filho, Osvaldo Malafaia, Reinhard Lissner, Li-Li Hsiao, and Ana Maria Waaga-Gasser, from Harvard Medical School, Shenzhen Traditional Chinese Medicine Hospital, University of Wuerzburg, and Mackenzie Evangelical Faculty of Paraná, recently provided evidence for upregulation of PDGF expression in UICC stage I–IV primary colorectal cancer (CRC) and demonstrated PDGF-mediated induction of PI3K/Akt/mTOR signaling in CRC cell lines. In their new study, the researchers sought to follow up on our previous findings and explore the alternative receptor cross-binding potential of PDGF in CRC. “Our analysis of primary human colon tumor samples demonstrated upregulation of the PDGFRβ, VEGFR1, and VEGFR2 genes in UICC stage I-III tumors.” Immunohistological analysis revealed co-expression of PDGF and its putative cross-binding partners, VEGFR2 and EGFR. The team then analyzed several CRC cell lines for PDGFRα, PDGFRβ, VEGFR1, and VEGFR2 protein expression. They found these receptors to be variably expressed amongst the investigated cell lines. Interestingly, whereas Caco-2 and SW480 cells showed expression of all analyzed receptors, HT29 cells expressed only VEGFR1 and VEGFR2. However, stimulation of HT29 cells with PDGF resulted in upregulation of VEGFR1 and VEGFR2 expression despite the absence of PDGFR expression and mimicked the effect of VEGF stimulation. Moreover, PDGF recovered HT29 cell proliferation under simultaneous treatment with a VEGFR or EGFR inhibitor. “Our results provide some of the first evidence for PDGF cross-signaling through alternative receptors in colorectal cancer and support anti-PDGF therapy as a combination strategy alongside VEGF and EGF targeting even in tumors lacking PDGFR expression.” DOI: https://doi.org/10.18632/oncotarget.28281 Correspondence to: Ana Maria Waaga-Gasser - awaaga@bwh.harvard.edu Keywords: PDGF, VEGFR, EGFR, bypassed signaling, colorectal cancer About Oncotarget: Oncotarget (a primarily oncology-focused, peer-reviewed, open access journal) aims to maximize research impact through insightful peer-review; eliminate borders between specialties by linking different fields of oncology, cancer research and biomedical sciences; and foster application of basic and clinical science. To learn more about Oncotarget, visit Oncotarget.com and connect with us on social media: Twitter - https://twitter.com/Oncotarget Facebook - https://www.facebook.com/Oncotarget YouTube – www.youtube.com/c/OncotargetYouTube Instagram - https://www.instagram.com/oncotargetjrnl/ LinkedIn - https://www.linkedin.com/company/oncotarget/ Pinterest - https://www.pinterest.com/oncotarget/ LabTube - https://www.labtube.tv/channel/MTY5OA SoundCloud - https://soundcloud.com/oncotarget For media inquiries, please contact: media@impactjournals.com. Oncotarget Journal Office 6666 East Quaker Str., Suite 1A Orchard Park, NY 14127 Phone: 1-800-922-0957 (option 2)

An interview with Dr. Van Morris from The University of Texas MD Anderson Cancer Center in Houston, TX and Dr. Cathy Eng from Vanderbilt-Ingram Cancer Center in Nashville, TN, co-chairs on "Treatment of Metastatic Colorectal Cancer: ASCO Guideline." Dr. Morris and Dr. Eng review the evidence-based recommendations from the guideline, focusing on areas of uncertainty in the treatment of metastatic colorectal cancer, and highlighting the importance of multidisciplinary collaboration and shared decision-making between patients and clinicians. Read the full guideline at www.asco.org/gastrointestinal-cancer-guidelines.   TRANSCRIPT Brittany Harvey: Hello, and welcome to the ASCO Guidelines Podcast series, brought to you by the ASCO Podcast Network; a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all the shows, including this one, at: asco.org/podcasts. My name is Brittany Harvey, and today I'm interviewing Dr. Van Morris, from The University of Texas MD Anderson Cancer Center in Houston, Texas, and Dr. Cathy Eng from Vanderbilt-Ingram Cancer Center in Nashville, Tennessee - co-chairs on, 'Treatment of Metastatic Colorectal Cancer, ASCO Guideline.' Thank you for being here, Dr. Morris, and Dr. Eng. Dr. Cathy Eng: Thank you. Dr. Van Morris: Thank you. Brittany Harvey: First. I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO Conflict of Interest policy is followed for each guideline. The full Conflict of Interest information for this guideline panel is available online with the publication of the guideline in the Journal of Clinical Oncology. Dr. Morris, do you have any relevant disclosures that are directly related to the guideline topic? Dr. Van Morris: Not personally, but I do have research support to my institution from Pfizer and Bristol Myers Squibb who have products that I'll be discussing on this podcast. Brittany Harvey: Thank you, Dr. Morris. And Dr. Eng, do you have any relevant disclosures that are directly related to this guideline topic? Dr. Cathy Eng: Also, not personally associated with any honorarium specific to this topic. Brittany Harvey: Great. Thank you both. So then, let's talk about the content of this guideline. So first, Dr. Morris, can you provide an overview of the scope of this guideline? Dr. Van Morris: Sure. So colorectal cancer is the second-leading cause of cancer-related death in the United States. And especially in the time of the recent COVID-19 pandemic with people less likely to go for screening colonoscopies, there's great concern that more and more patients will be presenting at the time of their initial diagnosis with later-stage, more advanced colorectal cancer. So with that said, research is moving very quickly for the benefit of patients with colorectal cancer, and we were interested in assembling a multidisciplinary team that consisted of medical oncologists, surgical oncologists, radiation oncologists, pathologists, and radiologists as well, to help us make guidelines that really summarize the most relevant up-to-date practices, based on rigorous literature review for treatment recommendations for advanced metastatic colorectal cancer. Brittany Harvey: Great. And then as you just mentioned, this guideline provides recommendations, and a lot of those focus on areas of uncertainty in the treatment of metastatic colorectal cancer. And I'd like to review those key recommendations that you mentioned for our listeners. So, Dr. Eng, starting with - for patients with previously untreated, initially unresectable metastatic colorectal cancer, who are candidates for chemotherapy plus bevacizumab, is doublet or triplet cytotoxic chemotherapy recommended? Dr. Cathy Eng: For treatment-naive patients, bevacizumab has been approved, and we do agree that it's a very reasonable treatment option with doublet or triplet therapy for our patient population. Obviously, these are guidelines, and it's extremely important to keep in mind that as a provider, you need to discuss the potential side effects with the patient. With bevacizumab, you know, standard concerns must be discussed with the patient, especially in regards to wound healing, if they've had recent surgery or any potential risk factors for a recent cardiac event from a recent thrombosis. So, those things obviously, would preclude the patient from initiating treatment with bevacizumab. But currently, doublet therapy or triplet therapy could be a potential option for patients. Brittany Harvey: Great. And yes, as you mentioned, shared decision-making is paramount to these decisions. So then following that recommendation, Dr. Morris, which patients should be offered pembrolizumab in the first-line setting? Dr. Van Morris: Yeah. So, I think that this represents really one of the exciting advances in the treatment of metastatic colorectal cancer over the past several years. We have great data now that suggests for patients with microsatellite instability-high metastatic colorectal cancer, especially who have not had any prior treatment, we would recommend use of immune checkpoint blockade therapies, really coming from the seminal KEYNOTE-177 trial. This was a phase III international trial that looked at patients with advanced unresectable or metastatic colorectal cancer. And patients were either randomized to pembrolizumab monotherapy, or cytotoxic chemotherapy with FOLFOX, with or without bevacizumab. And this trial did meet its primary endpoint and showed an improvement in progression-free survival, with use of pembrolizumab as a single agent relative to cytotoxic chemotherapy. And based on this trial and the clear benefit that we see in patients with pembrolizumab, the FDA has approved this as an option for patients with MSI-high untreated metastatic colorectal cancer. There are other trials which have looked at use of immunotherapy; the CheckMate 142 trial looked at combination PD-1 CTLA-4 therapy as a single-arm study. And, you know, there's another trial, the CheckMate 8HW, which is looking at one versus two immunotherapy agents in this setting as well. But really, as it stands for now, patients with MSI-high untreated metastatic colorectal cancer are the ones who benefit from the use of immunotherapy. One of the questions that we often get in talking with other clinical oncologists is the FDA approval for pembrolizumab in any cancer type for a TMB, tumor mutation burden, greater than 10. And, we talked about this with our panel in this context, and we don't see that patients with microsatellite-stable metastatic colorectal cancer, who have a tumor mutation burden over 10 benefit from use of immunotherapy. There is one exception to this for patients who harbor pathogenic POLE or POLD1 mutations, these patients oftentimes do experience sustained clinical benefit with immunotherapy. But in general, patients with microsatellite-stable metastatic colorectal cancer, who don't have POLE/POLD1 mutations, we don't favor use of immunotherapy in that context at this point in time. Brittany Harvey: Great. Thank you for reviewing that recommendation and the data behind who benefits and who doesn't benefit from immunotherapy in this setting. So then following that, the next question that this guideline addressed is for treatment-naive RAS-wild type metastatic colorectal cancer. So, for these patients, Dr. Eng, is anti-EGFR therapy recommended for patients with right or left sided primary tumors? Dr. Cathy Eng: That is such an important question, and thank you for asking this. We know based upon pivotal data from CALGB/SWOG 80405, that right-sided tumors treatment-naive, even if they're RAS-wild type, these patients should not receive anti-EGFR therapy. But also, we've learned from 80405, FIRE-3, and PEAK, which was a phase two study, that there appeared to be some benefit versus anti-VEGF therapy for left-sided tumors based upon studies that have been conducted. So, at this year's ASCO, actually, the PARADIGM trial was specifically a phase III trial, more focused on left-sided tumors. It was amended twice before it decided to focus on the left-sided patient population. And it was a phase III study where patients were randomized to FOLFOX plus panitumumab versus FOLFOX and bevacizumab. And the primary endpoint was overall survival. And we added this data to our guidelines. This data just came out, hot off the presses in June, at this year's ASCO. And the primary endpoint was fulfilled. And basically, it prospectively demonstrated that the data from the other three trials, based upon a pooled analysis, suggested left-sided tumors fare better with anti-EGFR therapy. And in fact, the PARADIGM trial basically validated those findings. Obviously, the PARADIGM trial just recently presented, we have not seen the final publication, we do not know much about the maintenance setting, but specifically, when thinking about anti-EGFR therapy, it is very reasonable to consider it in a left-sided tumor, all RAS-wild type patient population. I would like to mention though, and we do highlight this also in the guidelines, which is critically important, is that there was another study, which is a phase III trial called, TRIPLETE, that was presented as well, looking at FOLFOXIRI plus panitumumab versus basically, standard treatment. And what it noted is that there is no additional benefit for FOLFOXIRI plus panitumumab in left-sided tumors in regards to response or progression-free survival, there was no additional benefit. So, FOLFOX plus panitumumab seems very reasonable, FOLFOXIRI plus panitumumab is not necessarily needed in left-sided tumors. Brittany Harvey: Great. Thank you for that explanation, and also for the work of the panel to rapidly include this new information recently presented at ASCO. So then following those recommendations, Dr. Morris, what recommendation did the panel make for patients with previously-treated metastatic colorectal cancer with a BRAF V600E mutation? Dr. Van Morris: Yeah. So, this recommendation was made essentially based on one randomized phase III clinical trial, which reported out about three years ago now, the BEACON trial. This is looking at patients with BRAF V600E mutated metastatic colorectal cancer, which we know accounts for probably eight to 10% of all patients with advanced colorectal cancer, and when found, really harbors a poor prognosis relative to BRAF-wild type counterparts. So, the BEACON trial was a trial that looked at patients with previously-treated metastatic colorectal cancer, who have BRAF mutations, either kind of standard of care cytotoxic chemotherapy, or a BRAF/EGFR combination with encorafenib and cetuximab or alternatively, a BRAF/EGFR/MEK combination. That trial showed that improvement in survival outcomes with a BRAF/EGFR-targeted approach, as well as the BRAF/MEK/EGFR. However, because there was no difference in survival with the addition of the MEK inhibitor, the FDA subsequently approved encorafenib and cetuximab as the recommended treatment for patients with BRAF V600E previously-treated metastatic colorectal cancer. Because the MEK combination with binimetinib was not recommended by the FDA, you know, we did not include that analysis in our guidelines for ASCO. But as it stands right now, we do strongly encourage all clinicians to check for their BRAF V600E mutation status in their patients with metastatic colorectal cancer, with the goal of getting them to a targeted therapy approach over their treatment course. Brittany Harvey: Great. Thank you for providing that information. So, following that, Dr. Eng, what are the recommendations for patients with colorectal peritoneal metastases? Dr. Cathy Eng: The current recommendations for colorectal cancer with peritoneal disease, really, there's no strong evidence to support the role of heated intraperitoneal chemotherapy. We now know based upon the literature from one of the largest studies to date, the PRODIGE data, demonstrating that there may be some potential benefit from cytoreductive surgery for the patients in regards to overall survival. But these patients are at high risk for bowel obstruction, potentially for perforation, and obviously, quality of life is an issue. So, these patients should always be discussed in a multidisciplinary tumor board whenever possible, and hopefully, to meet with a surgeon that is more experienced, specifically, in treating peritoneal disease, because these patients do require a lot of multidisciplinary care and discussion. So currently, based upon the existing data, we don't recommend heated intraperitoneal chemotherapy, but there may be a role for cytoreductive surgery. Brittany Harvey: Thank you, Dr. Eng for going over those recommendations. So then following that, Dr. Morris, for patients with unresectable liver-limited metastatic colorectal cancer, which liver-directed therapies are recommended? Dr. Van Morris: So, this is I think a really good question and one that just like the prior question with regards to peritoneal surgery, is one that we felt was a challenging one, but a common one that we wanted to address. And specifically, I think this is an example of where level of evidence comes into the strength of recommendation. So, for patients with unresectable liver-limited metastatic colorectal cancer, we looked at the questions of, "What is the role of SBRT - stereotactic body radiotherapy, and what is the role of SIRT, which is selective internal radiotherapy?" And for both of these, we felt that the level of evidence was weak, and I think that it's very important to make note of that in assessing the recommendations. But to start with, for SBRT, we looked at one meta-analysis for patients with oligometastatic colorectal cancer, and also analyzed 18 non-randomized control trials in this setting. Most of the patients in these studies had one to five liver metastases, with the majority having one or two liver metastases. From the meta-analysis, we saw kind of a one-year local control rate of around 67%, a two-year control rate of 59%. So, based on those and recognizing the limitations of non-randomized trials and making recommendations, the panel did feel that it was reasonable to consider use of SBRT for oligometastatic colorectal cancer. The SABR-COMET trial is one that had looked at the role of radiotherapy for treatment of oligometastatic colorectal cancer, and I just want to make the point as well, that we did not include that in our analysis or recommendations at this point in time, because this really didn't include a lot of patients with colorectal cancer that we felt warranted inclusion. Now, with regards to SIRT, we looked at kind of one meta-analysis and three randomized control trials for patients with mostly liver-limited metastatic colorectal cancer. All patients had liver disease, but there were about 40% of the patients we looked at in the meta-analysis, had extra hepatic disease as well. In the frontline setting, there really was no difference in progression-free survival or overall survival with the use of SIRT. And more recently, we've seen in a second-line trial, it was called the EPOCH trial, reported several years ago, this looked at patients with previously-treated metastatic colorectal cancer in the second-line setting. Patients were randomized to either chemotherapy with, or without transarterial radioembolization with Y90. While there was an improvement in overall response rate, there was no meaningful improvement in overall survival with the use of SIRT. But there were significant increases in grade 3 or grade 4 toxicities when SIRT was added to chemotherapy. So, kind of given this, we didn't feel at this point in time that SIRT should be recommended for patients with metastatic colorectal cancer. Although, again, I do want to highlight that really these discussions should be happening at high-volume centers, kind of with a multidisciplinary group of clinicians. Brittany Harvey: Definitely. And thank you for highlighting that multidisciplinary collaboration. And the last section of recommendations, Dr. Eng, what is recommended for patients with metastatic colorectal cancer, and potentially-curable oligometastatic liver metastases? Dr. Cathy Eng: So, another controversial topic. And once again, this is why we decided to include this as part of the guidelines, because this is a common scenario where patients are potentially curable, following liver resection for oligometastatic disease. We cannot highlight enough the importance of multidisciplinary discussion. Prior data has not been strong regarding specific guidelines following liver resection. We do recommend that based upon the existing data, there is no level one evidence to say, you should go one way or another following metastatic resection, and whether or not adjuvant therapy is warranted in that setting. But we do recommend multidisciplinary management and engagement and discussion. So, although it's not definitive, it basically suggests that there is a role for resection. It does provide improved five year survival relative to systemic chemotherapy, if the patient is potentially resectable, but does require multidisciplinary discussion. And it is a shared decision-making process. Brittany Harvey: Great. Thank you. And I appreciate you highlighting the importance of shared decision-making throughout this guideline. So then, Dr. Morris, what is the importance of this guideline in your opinion, and how will it impact clinical practice? Dr. Van Morris: Yeah. So, I think that we understand that management of metastatic colorectal cancer is extremely complex given the various molecular annotations and the multimodality therapies which are possible for our patients. So, we tried to limit the guidelines here to include what we feel are the most recent updates, but also kind of the most clinically-relevant multidisciplinary questions that get asked for treatment of metastatic colorectal cancer. We also recognize that things are changing quickly. And for example, we didn't decide to include at this point in time, management of HER2 neu amplified metastatic colorectal cancer, although we are seeing more and more data coming out, suggesting targeted therapies. So, I think it's important for clinicians to realize that these are guidelines which are ever-changing, given the updates with new therapies available for our patients. And the other thing I think that's very good about these guidelines is that, even though we may be making recommendations about controversial topics in the management of metastatic colorectal cancer - specifically, I think the use of HIPEC with cytoreductive surgery, locally-directed therapies to the liver, and the role of perioperative chemotherapy and metastasectomy - I think it's important for oncologists to realize that these recommendations come with varying strengths of level of evidence and that we as oncologists should be considering the level of evidence that's out there when making recommendations that affect our patients as well. So, we really wanted to support these guidelines and recommendations and empower clinicians to know and understand the quality of evidence that exists in the management of patients with metastatic colorectal cancer. Brittany Harvey: Excellent. And yes, those are key points on the level of evidence and the strength of recommendations throughout the guideline. And then finally, Dr. Eng, you've talked a bit about shared decision-making and the importance of this guideline for patients. So, how will these guideline recommendations affect patients with metastatic colorectal cancer? Dr. Cathy Eng: The reason that we created these guidelines is to help patients, their caregivers, and providers, learn of the most recent developments in colorectal cancer, and the best approach based upon the information that we have personally reviewed with our multidisciplinary team of faculty members that participated in this exercise. We really just want to make sure that patients do get optimal care. And we hope that these guidelines also will help provide a foundation for some of the clinical trials that may be under development, or for other clinical trials that are being considered. So, we really just want to provide the most up-to-date information to all individuals that are interested in colorectal cancer so we can help guide their care better. Brittany Harvey: So, I want to thank you both so much for your work on these guidelines, and all of the time it's spent developing these recommendations, and thank you for your time today, Dr. Morris, and Dr. Eng. Dr. Van Morris: Thank you. Brittany Harvey: And thank you to all of our listeners for tuning into the ASCO Guidelines Podcast series. To read the full guideline, go to: www.asco.org/gastrointestinal-cancer-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app available in iTunes or the Google Play store. If you have enjoyed what you've heard today, please rate and review the podcast, and be sure to subscribe, so you never miss an episode.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy, should not be construed as an ASCO endorsement.  

Chest pain evaluation in the ED, peer review, the NordICC trial, and a surgeon lost too early are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Chest Pain Consensus Pathway - ACC Issues Guidance on ED Evaluation of Acute Chest Pain https://www.medscape.com/viewarticle/982302 - 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee https://www.jacc.org/doi/10.1016/j.jacc.2022.08.750 - 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines https://www.ahajournals.org/doi/10.1161/CIR.0000000000001030#d20522356e1 II. Peer Review - Big Name Researchers May Get Special Treatment, Limiting New Science https://www.medscape.com/viewarticle/982193 - Nobel and Novice: Author Prominence Affects Peer Review https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4190976 - Editorial peer review for improving the quality of reports of biomedical studies https://www.cochrane.org/MR000016/METHOD_editorial-peer-review-for-improving-the-quality-of-reports-of-biomedical-studies III. NordICC - Colonoscopy Lowers CRC Risk and Death, but Not by Much: NordICC https://www.medscape.com/viewarticle/982143 - Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death https://www.nejm.org/doi/full/10.1056/NEJMoa2208375 - The arrogance of preventive medicine https://www.ncbi.nlm.nih.gov/pmc/articles/PMC117852/ - Five-Year Outcomes of the Danish Cardiovascular Screening (DANCAVAS) Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2208681 IV. Domenico Pagano - Surgeon Domenico Pagano Has Died, EACTS Announces https://www.medscape.com/viewarticle/982351 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Welcome back to this week's #FridayReview!   Today, I'd like to share with you the best of the week, reviews & research on:   Free TherAid BioEnergetic Bio Band Herb of the Week: Shilajit Antidepressants & Stroke  (research) CT Scan & Colorectal Cancer Screening (research)   We're going to review all this and much more on today's #CabralConcept 2443 – Enjoy the show and let me know what you thought in the comments!   - - - For Everything Mentioned In Today's Show: StephenCabral.com/2443 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!

Howie and Harlan check in on new research and health issues in the news, including studies on colonoscopies and the timing of hypertension medication, the state of the monkey pox and polio outbreaks, and the wave of legislation restricting treatment of trans youth. Links: “Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death”  “Monkeypox Cases Are Declining in New York City and Globally”  “WHO declares monkeypox a global health emergency as infections soar”  “Evening dosing of blood pressure medication not better than morning dosing”  “Arkansas cannot enforce ban on gender-affirming care for trans kids, court rules”  “Watch Jon Stewart Calmly Excoriate the Arkansas Attorney General on Anti-Trans Legislation”  “Yale's Emily Wang and two alumni win MacArthur ‘genius' awards” Learn more about the MBA for Executives program at Yale SOM. Email Howie and Harlan comments or questions.

In this episode, Jonathan Sackier is joined by David Crosby, Head of Prevention and Early Detection Research at Cancer Research UK. The pair discuss Crosby's career, providing insights into Cancer Research UK's mission, and his role within the organisation. Further discussion points include the challenges and solutions for prevention and early detection of cancer.

Welcome to the Paint The Medical Picture Podcast, created and hosted by Sonal Patel, CPMA, CPC, CMC, ICD-10-CM. Thanks to all of you for making this a Top 15 Podcast for 2 Years: https://blog.feedspot.com/medical_billing_and_coding_podcasts/ Sonal's 7th Season has started and Episode 5 features her Newsworthy Grab Bag session. Trusty Tip features Sonal's compliance recommendations for co-insurance changes to colon cancer screenings. Spark inspires us all to reflect on purpose and impact based on the inspirational words of Beyoncé. Paint The Medical Picture Podcast now on: Anchor: https://anchor.fm/sonal-patel5 Spotify: https://open.spotify.com/show/6hcJAHHrqNLo9UmKtqRP3X Apple Podcasts: https://podcasts.apple.com/us/podcast/paint-the-medical-picture-podcast/id1530442177 Google Podcasts: https://podcasts.google.com/feed/aHR0cHM6Ly9hbmNob3IuZm0vcy8zMGYyMmZiYy9wb2RjYXN0L3Jzcw== Amazon Music: https://music.amazon.com/podcasts/bc6146d7-3d30-4b73-ae7f-d77d6046fe6a/paint-the-medical-picture-podcast Breaker: https://www.breaker.audio/paint-the-medical-picture-podcast Pocket Casts: https://pca.st/tcwfkshx Radio Public: https://radiopublic.com/paint-the-medical-picture-podcast-WRZvAw Find Paint The Medical Picture Podcast on YouTube: https://www.youtube.com/channel/UCzNUxmYdIU_U8I5hP91Kk7A Find Sonal on LinkedIn: https://www.linkedin.com/in/sonapate/ And checkout the website: https://paintthemedicalpicturepodcast.com/ If you'd like to be a sponsor of the Paint The Medical Picture Podcast series, please contact Sonal directly for pricing: PaintTheMedicalPicturePodcast@gmail.com --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/sonal-patel5/message Support this podcast: https://anchor.fm/sonal-patel5/support

Welcome back to this week's #FridayReview where I can't wait to share with you the best of the week!   I'm looking forward to reviewing:   20% off EquiLife Single Labs Herb of the Week: Schisandra Berry Thera360 (product review) Fatty Food Cravings (research) Processed Food & Colorectal Cancer Risk (research)   For all the details tune into this week's #CabralConcept 2429 – Enjoy the show and let me know what you thought!   - - - For Everything Mentioned In Today's Show: StephenCabral.com/2429 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!

A new research paper was published in Oncotarget's Volume 13 on September 14, 2022, entitled, “Site of analysis matters – Ongoing complete response to Nivolumab in a patient with HIV/HPV related metastatic anal cancer and MLH1 mutation.” Anal cancer is a rare disease with increasing incidence. In patients with locally recurrent or metastatic disease, which cannot be treated with chemoradiotherapy or salvage surgery, systemic first-line chemotherapy with carboplatin and paclitaxel is standard of care. For patients who progress after first-line therapy and are still eligible for second-line therapy, programmed cell death protein 1 (PD-1) antibodies are potential therapeutic options. However, prediction of response to immunotherapy is still challenging, including in patients with anal cancer. “Altogether, there is little data on PD-1 treatment in HIV infected patients.” In a new study, researchers Melanie Demes, Ursula Pession, Jan Jeroch, Falko Schulze, Katrin Eichler, Daniel Martin, Peter Wild, and Oliver Waidmann from Universitätsklinikum Frankfurt and Centrum für Hämatologie und Onkologie reported a case of an HIV infected patient with anal cancer, microsatellite instability (MSI) high status, a high mutation frequency regarding tumor mutational burden (TMB) and an ongoing response to Nivolumab. “We report here to our knowledge the first anal cancer case with microsatellite instability (MSI) due to MLH1 mutation and a deep and ongoing response to Nivolumab treatment.” Thorough analysis of the primary tumor as well as metastatic sites by next generation sequencing (NGS) revealed that MSI was formally only found in the metastatic sites but not in the primary tumor. Concomitantly, tumor mutational burden (TMB) was higher in the metastatic site than in the primary tumor. The researchers concluded that all anal cancer patients should be tested for MSI and whenever possible molecular analysis should be performed rather from metastatic sites than from the primary tumor. “According to our results, we propose to assess mutational status in tissue from metastasis rather than from the primary site when additional molecular analyses are performed for treatment decisions.” DOI: https://doi.org/10.18632/oncotarget.28274 Correspondence to: Oliver Waidmann – Emails: oliver.waidmann@kgu.de Keywords: anal cancer, microsatellite instability, immunotherapy, high-throughput nucleotide sequencing, nivolumab About Oncotarget Oncotarget is a primarily oncology-focused, peer-reviewed, open access journal. Papers are published continuously within yearly volumes in their final and complete form, and then quickly released to Pubmed. To learn more about Oncotarget, please visit https://www.oncotarget.com and connect with us: SoundCloud - https://soundcloud.com/oncotarget Facebook - https://www.facebook.com/Oncotarget/ Twitter - https://twitter.com/oncotarget Instagram - https://www.instagram.com/oncotargetjrnl/ YouTube - https://www.youtube.com/OncotargetYouTube LinkedIn - https://www.linkedin.com/company/oncotarget Pinterest - https://www.pinterest.com/oncotarget/ Reddit - https://www.reddit.com/user/Oncotarget/ Media Contact MEDIA@IMPACTJOURNALS.COM 18009220957

Phil Decker returns to the podcast to share about his next journey -- running the Chicago Marathon to raise money for the I Know Jack Foundation and Children's Cancer Connection. Phil, who is also in active treatment for colon cancer, talks about how treatment is going and the continued support he receives from the Nassif Community Cancer Center.If you'd like to contribute to Phil's campaign, visit https://secure.qgiv.com/for/philschicagomarathon/To learn more about Phil's cancer journey, read this story: https://www.communitycancercenter.org/news/running-for-a-cause-colon-cancer-patient-running-the-boston-marathon-to-raise-awareness/ If you are over 45, talk to your doctor today about colon cancer screening, or call St. Luke's Gastroenterology at (319) 366-8695. Visit Phil's website at https://tell5friends.org/Learn more about the I Know Jack Foundation at https://www.iknowjack.org/Learn more about Children's Cancer Connection at https://childrenscancerconnection.org/Do you have a question about a trending medical topic? Ask Dr. Arnold! Anything from COVID-19 to the latest technologies and procedures to general questions about a service provided at UnityPoint Health - Cedar Rapids. Submit your question and it may be answered by Dr. Arnold on the podcast! 

Dr. Refky Nicola discusses Y-90 radioembolization for patients with metastatic colorectal cancer with Dr. Daniel Brown.  Survival and Toxicities after 90Y Transarterial Radioembolization of Metastatic Colorectal Cancer in the RESIN Registry. Emmons et al. Radiology 2022; 305:228–236.

Guest: Rishi D. Naik, MD, MSCI Colorectal cancer may be more prevalent than you think, underscoring the importance of colorectal cancer screening. Join us as we explore the latest screening recommendations and available modalities with Dr. Rishi Naik, Assistant Professor of Medicine in the Department of Gastroenterology, Hepatology, and Nutrition at Vanderbilt University Medical Center in Nashville, Tennessee.

Guido Baechler is CEO and Director at Mainz Biomed (NASDAQ: MYNZ) a leading developer of market-ready molecular genetic diagnostic solutions for life-threatening conditions. The Company's flagship product is ColoAlert, an accurate, non-invasive, and easy-to-use early detection  test for colorectal cancer.Guido has 30 years of global experience leading public & private life sciences companies having held senior executive roles at Singulex and SummerBio, and at Roche, where he led Roche Molecular's global program management. Learn more @MainzBiomed

Gastrointestinal cancer experts Dr. Aparna Parikh and Dr. Kristin Ciombor discuss the treatment implications of the phase 3 PARADIGM trial and other advances in colorectal cancer with guest host and ASCO Daily News Associate Editor, Dr. Shaalan Beg.   TRANSCRIPT Dr. Shaalan Beg: Hello, and welcome to the ASCO Daily News Podcast. I'm Dr. Shaalan Beg, your guest host of the ASCO Daily News Podcast today. I'm an adjunct associate professor at UT Southwestern's Simmons Comprehensive Center and vice president of Oncology at Science 37. I'm delighted to welcome Dr. Aparna Parikh, and Dr. Kristen Ciombor to the podcast today. Dr. Parikh is an assistant professor of Medicine at Harvard University and a GI medical oncologist at the Mass General Hospital Cancer Center. Dr. Ciombor is an associate professor of Medicine and GI medical oncologist at the Vanderbilt University Medical Center. Today, we'll be discussing exciting new approaches using EGFR inhibitors as frontline therapy in colorectal cancer, and promising advances with immune therapy in the treatment of rectal cancer. Our full disclosures are available in the show notes, and disclosures of all guests on the podcast can be found in our transcripts at: asco.org/podcasts. Dr. Parikh, and Dr. Ciombor, it's great to have you on the podcast today. Dr. Aparna Parikh: Thanks so much. Dr. Kristen Ciombor: Thanks so much for having us. Dr. Shaalan Beg: We've seen some exciting advances in GI oncology this year. Let's start with colorectal cancer. Dr. Parikh, there have been many trials looking to compare EGFR and VEGF inhibitors in colorectal cancer. We've heard about the IDEA studies, the FIRE trials, and CALGB 80405. At the 2022 ASCO Annual Meeting, we heard the results of the PARADIGM trial. Have we finally answered the question of when to use EGFR inhibitors as frontline therapy for colorectal cancer? Dr. Aparna Parikh: Thanks so much, Dr. Beg, for this great question. It has been a really exciting year for colorectal cancer across the board. So, the anti-EGFR story is really interesting and has evolved. And maybe just for a little bit of background, we know that colorectal cancer originating from both the right and left side of the colon differ. So, they differ embryologically, and epidemiologically; there are different genetic and molecular aspects to right and left sides of colon cancers. And we have learned over time that in the era of targeted therapy, the primary tumor location has been found to play a very important role, not only in the prognosis of patients but to predict treatment response. We know that patients that have left-sided colon cancers-- and when we think about left-sided colon cancers, we think about cancers that originate from the splenic flexure and descending colon, sigmoid colon, rectosigmoid junction, and sometimes include the rectum in this as well. The rectals have slightly different molecular features than distal colons. And we know that these left-sided patients, overall, have better survival benefits than patients that have right-sided CRC. And that includes again, cecum, ascending colon, hepatic flexure, and transverse colon. So, we know that that had prognostic implications, but what about the predictive implications? And with ASCO, we saw some really exciting data with the PARADIGM study, as Dr. Beg highlighted. We have seen many examples in the past showing the predictive power of anti-EGFR therapy, and anti-EGFR therapy showing a detriment for patients on the right side of the colon. But all these results historically have been obtained by retrospective analysis. So, retrospective analysis of the pivotal CALGB 80405 study, which is the first-line biologic trial. FIRE-3, which is a similar study, but done out of Europe, and KRYSTAL. So all these studies show the same finding but were all obtained basically by retrospective analysis. And what we saw with PARADIGM this year, which is exciting to see, is that this was the first prospective trial to test the superiority of an anti-EGFR inhibitor panitumumab versus bevacizumab in combination with standard doublet first-line chemotherapy for patients that were RAS-wild type. I guess I forgot to mention that again, anti-EGFR therapies are only eligible for patients that are RAS-wild type. We know that RAS-mutant patients and RAS, KRAS HRAS patients don't respond to anti-EGFR therapy. So, the study was looking at RAS-wild type patients, and again, asking the question “was panitumumab better than bevacizumab in combination with chemotherapy for these RAS-wild type patients and for left-sided tumors?” It was a multicenter trial done in Japan-- and I always commend the Japanese on their work and their designs and ability to do these studies that ask really important questions. And, overall survival was the primary endpoint of the study in patients with left-sided tumors, but they also did a full set analysis including patients that didn't have left-sided tumors. They had 823 randomized patients. Many patients, a handful did not receive per-protocol treatment, and some were excluded for other reasons relating to inclusion criteria. And they had 400 patients that ultimately received panitumumab and 402 patients that received bevacizumab in the full set analysis. And of those patients, there were 312 and 292 respectively had left-sided tumors. And although the PFS was comparable between the treatment group, we saw that panitumumab in the left-sided patients actually did improve the OS in both patient populations. But when you looked at the left-sided tumors, the difference was 37.9 versus 34.3 months meeting statistical significance. So, this was an exciting study because it confirmed prospectively what we have seen time and time again, and really behooves us to do early biomarker testing and know RAS status early for these patients with right-sided tumors, as they do derive benefit from anti-EGFR. Maybe I'll just pause there and open it up for more questions or comments from Dr. Ciombor as well. Dr. Kristen Ciombor: Yeah, Dr. Parikh, I thought these data were encouraging. And as you mentioned, the first prospective data that we have in this setting now that we know this primary tumor sidedness matters. Just on a practical note, what do you do in practice? Do you give a lot of anti-EGFR in the first-line? I find that the toxicity can be challenging sometimes and patients may not want to do that. So, it leaves us in a quandary sometimes. Dr. Aparna Parikh: Yeah. So, what's interesting and I don't think we have this data clearly answered yet is, I had, especially for kind of a fit patient-- with the previous data that we've seen with TRIBE and others showing a survival benefit with triplet chemotherapy for first-line therapy, my inclination had actually been to prefer triplet-- and we know that triplet and anti-EGFR toxicity-wise is really, really tough to manage, and really no benefit there that we've seen with OS or PFS, even though you maybe do get a little bit of a better response rate with that. And so where I have sort of struggled is triplet versus just doing first-line doublet plus anti-EGFR. You know, we are not having a discussion about triplet today, but we also saw some data at ASCO showing that perhaps the benefit of the triplet, with the triplet study, is not as much as we had hoped it would've been too. So, it's a good question. I do tend to prefer triplet, I guess, overall, for the healthy, good performance status patient. And then, if not, then doublet. And we, unfortunately, don't have kind of rapid EGFR testing, we're pushing for that. In practice, I think having RAS/RAF status up front would be entirely helpful. It's lumped into our pan-tumor profiling, comprehensive genomic panels. We get microsatellite instability (MSI) status, which I know we'll talk about here next right away. But I think another reason that oftentimes we don't add it right away, is because we don't have the RAS status right away. So, you just start with a doublet and you may end up sneaking it on later. And then, I'd love to, maybe in another podcast, where we can discuss second-line anti-EGFR therapies and what people do in practice for those right-sided patients should they never get anti-EGFR and later-lines of therapy too. And I would argue, perhaps not, because we do see some patients that do benefit, but it can be challenging sometimes with a fresh new patient to make these decisions. But at least, feel encouraged that we're doing the right thing by adding anti-EGFR therapy if they can tolerate it for the left-sided RAS-wild type patient. How about you? What do you do? Dr. Kristen Ciombor: Yeah. Largely, it's a great question. And I don't love giving anti-EGFR therapy. We have an additional issue where I am geographically in that we don't ever give cetuximab because of the high rates of an infusion reaction. So, we pretty much stick to panitumumab and are glad to have that option. But I have started to talk to patients about toxicity and I'm really upfront with the survival data. And it's interesting how people choose differently in terms of what's important to them. And whereas a few extra months in the overall survival may be overshadowed by the toxicity that they have to go through to accomplish that. So, it's good to have many options though, and that's the important thing, and I think the takeaway, as well. Dr. Shaalan Beg: So, kind of brings it back to the fundamentals of practicing medicine, right? Bringing our patients and giving them the options that are most available to them. But I'm going to ask both of you one by one: So, if we have our patient with left-sided colorectal cancer, known as KRAS RAS-wild type, do you recommend EGFR therapy and VEGF therapy and allow the patients to decide, or do you feel that we decide if their profile is such that we should continue with VEGF therapy instead? Dr. Ciombor, do you want to go first? Dr. Kristen Ciombor: Yeah, I think both are good options. I don't only do bevacizumab in the first-line by any means because we do have that survival data. It mostly comes down to a discussion with the patient in terms of toxicities and survival and how well those balance out. Dr. Aparna Parikh: Yeah, very similar. I think we have also gotten a little bit more adept at managing toxicity. I'm pretty aggressive about prophylaxis with even doxy and topicals for managing the rash. And so, for some of my younger patients who are wanting to be "aggressive" and want the exposure to anti-EGFR early but are still very mindful of how it's impacting their day-to-day semblance of self, especially for the younger patients, try to be very proactive about side effect management. And then, of course, we have the patients that have the electrolyte wasting and things too that sometimes if it's bad, we are stuck with infusions frequently and you may end up dropping for those patients. But I think the rash at least I feel like for most patients we can manage if you're aggressive about it too. And I think we have gotten better at that than we were many years ago. Dr. Kristen Ciombor: Never thought we'd be dermatologists, did we? In training, that was definitely not a path I was good at. Dr. Shaalan Beg: Dermato-Oncology, rapidly growing field. So, Dr. Ciombor, the rectal cancer space has evolved very rapidly in recent years, especially when we hear about total neoadjuvant therapy, short-course radiation, watch-and-wait, for those with complete clinical responses. So at ASCO this year, we heard results on immune therapy and rectal cancer. Can you summarize where we are with immune therapy and rectal cancer? Dr. Kristen Ciombor: So, yes. We heard a lot this year at ASCO; both at ASCO GI and ASCO, from the Memorial group and Dr. Cercek's group. And this has been a really exciting advance that we're starting to see and potentially paradigm-shifting data. So, we know-- as you mentioned, that our treatment of rectal cancer, specifically, locally advanced rectal cancer has changed a lot in the last few years with a shift to more Total Neoadjuvant Therapy. And what the Memorial data showed was that for the patients who have microsatellite instability or mismatch repair deficiency, which admittedly, is a small group, but certainly ones that we see in clinic, those patients, on their trial were treated with six months of dostarlimab as neoadjuvant therapy prior to any other treatment; before radiation, surgery, et cetera, and no chemotherapy. And what they found was that actually, six months of dostarlimab in the first 14 evaluable patients actually induced a 100% clinical complete response rate. So, it's really unheard of in most of our trials to see 100%. And I think that caught everyone's attention for sure. I think we have to keep in mind who these patients were and are because they are currently being followed. So, for instance, these were patients that had pretty bulky node-positive disease, almost all these patients did. These were not really early-stage tumors. We did see that 100% were BRAF-wild type, so it does tell us maybe this is not completely the population that we're all seeing when we do see microsatellite instability since we see a lot of sporadic tumors with BRAF mutations. But on the whole, I mean, these were all MSI-high patients and treated with dostarlimab; the six months, that was the total amount of treatment that they received, though a few patients achieved that clinical complete response earlier at about three months, at the three-month reassessment. And what the clinical complete response rate was, was looking both radiographically, as well as endoscopically, and not seeing any sign of residual tumor. I think the important thing here is that median follow-up is still pretty short. There are a few patients who are approaching now two years past that dostarlimab therapy and have not had tumor recurrence, but overall, the median follow-up is still quite short. So, I think we do need to continue to follow these patients. We don't have overall survival data yet either. I think we still have a lot to learn, but this is a very encouraging start and certainly, something that could be really treatment-changing for these patients, which again, as Dr. Parikh was saying, we need this molecular profiling early to make treatment decisions right off the bat, not even only for metastatic now, but even for these locally-advanced rectal cancer patients. Because if you think about it, we've all taken care of patients who have to go through chemoradiation, and chemo, and surgery, and have a lot of morbidity from those treatments so that even if you cure them, they're left with a lot of toxicity. So, if we could avoid some of that, even potentially, surgery, that would be wonderful. But I do caution that this is not the standard of care yet. This is only based on 14 patients with short follow-ups at the current time. But the trial is ongoing, and there are other trials open in this space for patients who don't live in New York or can't get to New York. And for instance, ECOG-ACRIN study 2201 is treating these same patients with nivo and ipi, as opposed to dostarlimab. And that trial is open in about 80 sites now across the US. So hopefully, geographically near all of these patients. Dr. Shaalan Beg: I think a lot of us and a lot of our listeners, that Monday after the results were announced on ASCO had our phone lines and our patient secure messaging lines blowing up. Dr. Kristen Ciombor: We should have warned our nurses and our treatment teams that they would be fielding these questions, yes. On one hand, it's wonderful that our data and the science is getting out to patients. But I think we also have to be really careful as to what is reaching them because many of them didn't realize it was for this subset of patient populations. But great that they're asking those questions and wondering-- being advocates for themselves too. Dr. Shaalan Beg: You use the term clinical complete response. Can you talk about how we determine someone has a complete clinical response and what their follow-up looks like? Dr. Kristen Ciombor: Yeah. In the context of this study, it was actually, as I mentioned, it was both radiographic complete response, as well as endoscopic. So that's one thing that is a little bit tricky when you think about surveillance of these patients. So, it requires a lot, both in frequent surveillance, MRIs, FLEX SIGs often, digital rectal exams, sometimes doing PET scans or CTs, and patients who-- not only on this kind of study but also in non-operative management; watch-and-wait - really have to commit to very close, very frequent follow-up because if the cancer recurs, we don't want to miss that and lose our chance to cure them. So I think that's a little bit different everywhere, how that watch-and-wait approach really manifests, but I think we're learning how to do that, and working in a multidisciplinary group to make sure that patients get the surveillance that they need. Dr. Aparna Parikh: Yeah. I totally agree. If we offer, for the MSI-high patients, if we ultimately end up offering neoadjuvant immunotherapy-- and actually, I'm looking forward to your study, Dr. Ciombor, too, I think the monotherapy versus doublet, too, is going to come up for these patients. But I had a patient just a week or two ago that was starting on this approach with neoadjuvant immunotherapy, but for now, as a group, if we're proceeding down that and they do get a clinical complete response, we're deciding to forego even the radiation and surgery. We're following what they did in the OPRA study, which was pretty aggressive surveillance on the backend, both with direct visualization and MRIs, and you're seeing these patients every three months or so. Dr. Shaalan Beg: Well, thank you Dr. Ciombor and Dr. Parikh for sharing some valuable insights with us on the podcast today. Dr. Aparna Parikh: Thanks so much for having us. It was a lot of fun. Dr. Kristen Ciombor: Thanks for having us on. Dr. Shaalan Beg: And thank you to our listeners for your time today. If you value the insights that you hear on the ASCO Daily News podcast, please take a moment to rate, review and subscribe, wherever you get your podcasts. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Follow today's speakers: Dr. Kristen Ciombor @KristenCiombor Dr. Aparna Parikh @aparna1024   Dr. Shaalan Beg @ShaalanBeg Listen to additional episodes on advances in GI oncology: Novel Therapies in GI Oncology at ASCO22 ASCO22: Key Posters on Advances in GI Oncology Follow ASCO on social media: @ASCO on Twitter ASCO on Facebook ASCO on LinkedIn Disclosures: Dr. Shaalan Beg: Employment: Science 37 Consulting or Advisory Role: Ipsen, Array BioPharma, AstraZeneca/MedImmune, Cancer Commons, Legend Biotech, Foundation Medicine Research Funding (Inst.): Bristol-Myers Squibb, AstraZeneca/MedImmune, Merck Serono, Five Prime Therapeutics, MedImmune, Genentech, Immunesensor, Tolero Pharmaceuticals Dr. Kristen Ciombor: Consulting or Advisory Role: Merck, Pfizer, Lilly, Seagen, Replimune, Personalis Research Funding (Inst.): Pfizer, Boston Biomedical, MedImmune, Onyx, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Merck, Novartis, Incyte, Amgen, Sanofi Recipient, Bristol-Myers Squibb, Array BioPharma, Incyte, Daiichi Sankyo, Nucana, Abbvie, Merck, Pfizer/Calithera, Genentech, Seagen Travel, Accommodations, Expenses Company: Array Dr. Aparna Parikh: Stock and Ownership Interests: C2i genomics Consulting or Advisory Role: Eli Lilly, Natera, Checkmate Pharmaceuticals, Pfizer, Roche/Genentech, Inivata, Biofidelity, Guardant Health Research Funding(Inst.): PMV Pharma, Plexxikon, Bristol-Myers Squibb, Genentech, Guardant Health, Array, Eli Lilly, Novartis Pharmaceuticals UK Ltd., PureTech, Mirati Therapeutics, Daiichi Sankyo

Colorectal cancer is the third most common cancer diagnosed in the U.S. Early detection leads to greater survival rates, so doctors recommend regular screenings starting at age 45. For a number of reasons, not everyone has access to screening. That's where a $1 million CPRIT grant awarded to Drs. John Kidwell, Rebeccah Baucom and Rakshanda Rahman will help that underserved population. The grant will provide fecal immunochemical testing (FIT) at no cost to 15 counties in the Texas South Plans. 

Dr. Westin and Dr. Justin C. Brown discuss how physical activity can improve disease-free and overall survival in colorectal cancer and its potential application across all cancer types.   TRANSCRIPT   The guest on this podcast episode has no disclosures to declare. Dr. Westin: Hello, everybody, and welcome to another episode of JCO After Hours, the podcast where we get in depth on recent manuscripts published in the Journal of Clinical Oncology. And it is my great pleasure today to tell you we're going to be talking about a really important manuscript: “Physical Activity in Stage III Colon Cancer: CALGB/SWOG 80702 Alliance Study.” And this was published in the JCO on August 9th, 2022.   All participants in the podcast have no conflicts of interest.   And I am very excited to welcome the first author on this important paper, Dr. Justin C. Brown. He is the Director of the Cancer Metabolism Program and Assistant Professor in Cancer Energetics at the Pennington Biomedical Research Center at Louisiana State University.   Welcome, Dr. Brown. Thank you for being here. Dr. Justin C. Brown: Thanks so much for having me. Dr. Westin: So, this is some really important work, and I think we're starting to see more and more really objective data around the importance of physical activities. But before we get too far down the road, I do want to level set because this was a study in colon cancer. So, just because we have a really mixed audience, give us a quick bit of information about the standard treatment for colon cancer and where we are with survival outcomes. Dr. Justin C. Brown: Yeah. So, for most patients with early colon cancer, they'll get upfront surgery. And then a subset of patients who have high-risk features for recurrence, or have positive lymph nodes or tumor deposits, will get three or six months of chemotherapy. And outcomes have improved over time for this population, but there is still a lot of heterogeneity, in that, some patients do better than others. And you know, a lot of patients ask as they finish therapy or as they're starting therapy, "Are there things I can do that potentially could improve my outcomes?" And so, we think that this data will provide physicians with a lot of really important information regarding the benefits of physical activity during chemotherapy, as well as after therapy, for patients with stage three colon cancer. Dr. Westin: Okay, that's great. And so, again, continuing on that level-setting piece, before this study, what did we know about the impact of physical activity on outcomes in colon cancer? Dr. Justin C. Brown: So, we knew that there was some association between physical activity during chemotherapy and after chemotherapy with disease-free survival and overall survival. There have been studies that have linked those two things. There was some uncertainty about, what is the best exercise or physical activity prescription? And so, a lot of the current recommendations before this study basically said encourage patients to avoid sedentary behavior, encourage them to be as active as they can be, because some activity provides benefits over no activity. But for the patient who really wanted the specifics of how much should I be doing, when should I be doing it, what types of activities should I be doing, should I avoid certain things, the evidence was really absent. And so, what this study provides is a lot of important clarity for both physicians and patients about the types of activities that can maximize their disease-free survival and overall survival. Dr. Westin: I think that's so important because you're exactly right. We all have those patients that you give them a vague, and they're like, "No, I need instructions. I need to know how much time. I need to know what I'm doing." And it can be really frustrating because—I know personally, I'm like, "Well, this is what I do.” And I'm like, is that enough? I have no idea. So, this is really important work.   And before we get into the specifics of the work, can you just give our listeners a little information? Do we know anything else about physical activity in other cancer types? Like, beyond colon cancer, is this something that's broad-based across everybody?   Dr. Justin C. Brown: Yeah. So, there is emerging observational evidence that physical activity after diagnosis of early breast cancer, of early prostate cancer, is associated with improved disease outcomes, so disease-free survival, overall survival; that's observational data. We do have randomized clinical trial data on other quality of life endpoints and biologic endpoints in a variety of tumor types. And we know that patients who engage in physical activity or exercise during and after treatment tend to have better quality of life, they have less fatigue, they have improved physical functioning, they have reduced inflammation, improved insulin sensitivity. So, there's a variety of short, medium and potential long-term benefits to being physically active after your diagnosis of cancer. Dr. Westin: Perfect. And how did you end up here? What made you interested in this work? Dr. Justin C. Brown: So, my story dates back all the way to 2002. So, my father died from metastatic colorectal cancer. Dr. Westin: I'm sorry. Dr. Justin C. Brown: No, no, it's okay. I mean, if that didn't happen, I wouldn't be here today. And so, he is with me every day. And, when he asked his physician, "Is there anything I can do to improve my long-term outcome?" This was 2002 before we knew how patient lifestyle factors really improved or impacted disease outcomes. And so, my whole life's mission has been focused on trying to empower cancer survivors, so people from the point of diagnosis on, with information about how the choices they make outside of the oncology clinic have a profound impact on how they feel, function, and survive. And so this has come full circle for me because now I'm able to generate evidence that hopefully will inform clinical practice about how patients who are exactly like my dad and wanted to know what they could do to improve their outcomes, we now have the data that we can provide more precise recommendations about what patients might consider doing to improve their long-term disease outcomes. Dr. Westin: Great. Wow. It's so inspiring, and again, I am sorry for your loss. But I'm glad that you're really transitioning it into positive things. So, let's help everybody understand first just the overall design of the trial that you utilized, the CALGB/SWOG 80702 clinical trial. Dr. Justin C. Brown: Yeah. So this trial was a two-by-two factorial trial, and it randomized patients to three years of Celecoxib; the anti-inflammatory drug, or three years of placebo. And that was the primary analysis. The primary hypothesis was that Celecoxib would improve disease-free survival versus placebo. And that paper was published by my mentor, Jeff Meyerhardt, in JAMA last year. And that analysis showed that Celecoxib did not improve disease-free survival over placebo. The other factor of the two-by-two design was a randomization to three months of FOLFOX therapy, 5- fluorouracil and oxaliplatin, or three months of FOLFOX. And that analysis contributed to an international pooled consortium called the IDEA Consortium. And that analysis was published in 2018 in New England Journal of Medicine, and the follow-up overall survival analysis was published in Lancet Oncology in 2020. And that showed that while overall, three months of FOLFOX was not inferior to six months, there were some lower-risk patients that achieved good disease control with a shorter regimen of chemotherapy. And so, that has changed practice, and now there are certain lower-risk patients that are getting treated with three months of FOLFOX chemotherapy instead of six months. But patients with high-risk features still continue to get six months of therapy. That was the primary questions that that study was designed to answer: the Celecoxib versus placebo and then the contribution to the international pooling project to answer the question of three versus six months of postoperative therapy. Dr. Westin: Well, that's a really clever design. And then I love how you have an additional question built in here. So, why don't you explain how you incorporated your exercise objectives and also what this nested cohort design is? Dr. Justin C. Brown: Yeah. So, this is a unique opportunity to leverage an ongoing clinical trial to conduct an observational study. So, what we did is, about midway through chemotherapy, we asked patients if they wanted to participate in a lifestyle substudy. And if they chose to participate in the lifestyle substudy, they were asked questions about their physical activity and their dietary patterns and how much they weighed. And we measured those things midway through chemotherapy, and then we also measured them again about six months after patients finished their chemotherapy. And so, what this allowed us to do is to leverage all of the amazing resources that were put into place in the randomized clinical trial—that is, a homogenous patient sample, uniform treatments—and systematically ascertain disease outcomes to answer a question in an observational setting—that is, "Does physical activity relate to disease-free survival and overall survival?" So that is the nested cohort within the larger randomized clinical trial. Dr. Westin: Okay, perfect. And then just tell us how you measured the physical activity and the questionnaire that you utilized. Dr. Justin C. Brown: Yeah. So physical activity was measured by a self-reported questionnaire, and the questionnaire is included as a supplement to the JCO paper. So, if people are interested in using this questionnaire, it is available. And it asks 10 different types of physical activities, and it asks the frequency with which those activities are done in the past two months. And using the answers that the patients provided, we were able to calculate which patients were more physically active versus those that were less physically active. And we were also able to understand were the activities that they participated in more vigorous or less vigorous. So, it provided us with a lot of important details regarding the types of physical activities that patients reported during and after chemotherapy. Dr. Westin: Great. That's so interesting. And then, of course, we know diet is important, right? So, you did assess diet as well in this group. You want to give us a little bit of detail on that? Dr. Justin C. Brown: Yeah. So, we measured diet with what's called a Food Frequency Questionnaire, and it asks a series of questions regarding habitual dietary intake. And we know that people who are more physically active tend to be more mindful about what they eat. And so, that's an important confounding variable in trying to understand the relationship between physical activity and disease-free survival. So, we measured diet using that questionnaire. At the same time, we measured physical activity during and after chemotherapy. And that was included in our analysis so that we can attribute the association that we observed to the physical activity per se. Dr. Westin: Okay. And how often did you assess these time points? I'm sorry if I missed it. Dr. Justin C. Brown: So, we measured physical activity and diet two times. We measured it midway through chemotherapy, and then about six months after patients finished their chemotherapy. Because we know that activity, as well as diet, changes from when patients are being actively treated to after they finish their systemic therapy. Dr. Westin: Okay. Perfect. Great. All right, so let's hear it. What were your primary findings? Dr. Justin C. Brown: So, the benefit for the simple messaging is that any activity is better than no activity. That is, if patients need to know the bottom line, my advice is that they find an activity that they like to do and they do it for the rest of their life. For patients who want a little bit more precision, we can think about physical activity on a spectrum of intensity. So the examples I would give a patient is we can do walking, we can do jogging, and we can do running. And jogging is more intense than walking, and running is more intense than jogging. And so, if you decide to do more intense activities, you don't have to do them as much in a week. If you choose to do walking, you need to do more walking than if you choose to do running. And so, this will help to clarify what types of activities are beneficial. So, some people might choose to play tennis, which is a vigorous activity, one day a week. And that would provide them—from our analysis, that provides them with a disease-free survival and overall survival benefit. If a patient says, "My joints are too old and too achy that I can't play tennis, but I can walk around my neighborhood," then we know that those patients may need to do a little bit more activity, maybe a 20 to 30 minutes a day, three to five days a week, in order to achieve a meaningful disease-free survival benefit. So, this helps us to understand with a little bit more precision what we should be advising patients. And if patients say, "I can't do this” or “I prefer to do that," that helps us to have evidence-based recommendations about what is likely to be beneficial and worthwhile to improve their long-term disease outcomes. Dr. Westin: It's so awesome. And I think it's so great to have just very clear guidelines that we can give our patients. I know I've said it already during this podcast, but every time I—because I think we all get so frustrated with these vague recommendations, like, "Okay, drink water, eat healthy." You know, really, I want bullet points of what I can do. Now, we talked a little bit about some of the findings in other cancer types that were already existing. So, can we extrapolate your findings to other cancer types? Dr. Justin C. Brown: I think there is a reasonable expectation that our findings can probably generalize to early-stage breast cancer and maybe to prostate cancer. And the reason I say this is because these are tumor sites where there is existing evidence that being more physically active is associated with improved long-term disease outcomes. Now, the specific magnitude of benefit, I'm not sure if that will generalize. But I do think that this study provides a framework to start thinking about how we can understand the specific characteristics of physical activity that might be more or less important in terms of maximizing long-term disease outcomes. Dr. Westin: That is perfect. So, tell me, what are your next steps with this work? Dr. Justin C. Brown: So, one of the findings that this study reported was that patients who were more physically active during their chemotherapy were more likely to receive more of their planned chemotherapy. They had a higher chemotherapy RDI. So, some of us on this paper have been very fortunate that we received funding from the National Cancer Institute to launch a Bayesian Adaptive Trial of exercise, aerobic exercise, during chemotherapy, and the primary study endpoint is chemotherapy relative dose intensity. So, what we're going to be able to do is to understand, in a randomized clinical trial setting, does different doses of aerobic exercise have a causal effect on improving chemotherapy RDI? Because one of the hypothesized mechanisms through which we think physical activity may improve disease-free survival and overall survival is it enhances a patient's ability to tolerate systemic therapy. And so, we have the funding. We are in the process of planning that study. It should begin later this year, and that will provide us with concrete randomized evidence to understand if exercise during chemotherapy for colon cancer has a causal effect and can improve adherence to systemic therapy. Dr. Westin: That's outstanding. And can our listeners potentially participate in that? Are you looking for sites? Dr. Justin C. Brown: So this study will be launched at Pennington Biomedical Research Center, where I am, in Baton Rouge. This study will also take place at Kaiser Permanente, Northern California, so if there are people on the West Coast listening, as well as at Dana-Farber Cancer Institute in Boston. And so, we are part of a larger consortium of four studies that are trying to understand the benefits of both exercise as well as nutrition and their role in impacting how patients feel, function, and tolerate anti-cancer therapy in a variety of cancer sites. And we are focused on colon cancer, specifically. Dr. Westin: Well, that's great. I hope our listeners will get involved. And those of our listeners that are survivors, you heard some very clear data on what you can do to help impact your overall survival, as well as quality of life. So, I hope you'll implement that. Thank you again so much for being here, Dr. Brown. The time just flew by. And again, for the listeners, this was the JCO manuscript published August 9th, 2022, “Physical Activity in Stage III Colon Cancer: The CALGB/SWOG 80702 Trial.” And until next time, we'll see you at JCO After Hours. Take care.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.  

Myriad  Live episodes are recordings of an open-forum webinar hosted by Dr. Thomas Slavin. The opinions and views expressed in this recording do not necessarily represent those of Myriad Genetics or its affiliates. To participate in a future recording, visit https://myriad.com/live/ for a list of dates, times, and subjects.

September 25th, 2022 is the annual Walk Cancer Away event in Bayonne, NJ, raising funds for colorectal cancer research. Walk founders Nick Rentas and Michael Furmaniak talk about lifesaving research, the importance of screening and honoring the memory of James N. Rentas. For more, visit walkcanceraway.com

Men who consumed high rates of ultra-processed foods were at higher risk for developing colorectal cancer than men who consumed much smaller amounts.

Think twice before you grab ready-made meals or snacks. A new study links ultra-processed foods to colon cancer in men. Viv Williams has details in this episode of NewsMD's "Health Fusion."

Cancer is a ruthless disease, which is why the traditional treatment methods are so aggressive. But does everyone need chemo? Dr. Jeanne Tie doesn't think so. She's created a blood test that determines whether chemotherapy is necessary for patients living with colon cancer. Learn more: https://radiohealthjournal.org/why-chemotherapy-may-not-always-be-the-best-option/

Adherence to the Mediterranean Diet decreases the risk of cardiovascular disease. The Seven Country Cohort Study clearly showed https://www.yourdoctorsorders.com/2022/08/the-modern-mediterranean-diet/ (this). But what about cancer? Does the Mediterranean Diet impact cancer or cancer prevention? To study this, another cohort study began called the https://epic.iarc.fr/index.php (EPIC) study. Uniquely, the EPIC showed not only a decreased risk of cancer but also mortality from cancer. All vegetables, even the green ones, have nitrates. It turns out that the components of The Mediterranean Diet decreases the risk of cancer, decreases the risk of cancer recurrence, improves survival from cancer, and decreases overall mortality. EPIC StudyThe European Prospective Investigation into Cancer and Nutrition (EPIC) is a large cohort study involving over 521,000 individuals from 23 centers from ten countries. Adherence to the Mediterranean Diet and LongevityThe EPIC researchers developed a simple scoring system to determine adherence to the Mediterranean Diet.  Greater adherence to the Mediterranean Diet was associated with https://pubmed.ncbi.nlm.nih.gov/12826634/ (longevity). The Scoring SystemThe Mediterranean Diet is scored on a scale of one to nine. Nine being a perfect Mediterranean Diet Score, and zero being poor. Great adherence to the Mediterranean Diet is a score of seven points or more. Eating more of these foods gives you pointsThe Mediterranean diet is rich with vegetables, legumes, fruits and nuts, whole grains, and fish. You get a point for consuming 9 ounces or more of vegetables a day. If you consume less than nine ounces, you get a score of zero. Legumes will net you a point if you consume two ounces or more per day. Fruits and nuts are one point for nine ounces or more. Likewise, whole grains are worth a point for nine ounces or more. Fish is an average of an ounce a day, or two main meals per week. Thus,  by consuming a diet rich in these five components can score five points. The weight is based on pre-cooked food. Lentils are a legume, and if you consume more than 2 ounces per day, you will score one Mediterranean Diet point. They are high in protein and fiber and low in saturated fat. Eat Less for MorePeople from the Mediterranean didn't eat much meat or dairy.  By consuming less of these, you can achieve Mediterranean Diet points. Eating less than  4 ounces of meat a day  is worth one point Consuming 1.5 ounces of hard cheese a day or LESS is worth one point Consuming less than 8 ounces of dairy is worth one point (mostly consume yogurt). Thus by eating less dairy and meat, or none, you can score two additional points. You might think that 6-ounce burger is small, but if you eat less than four ounces of meat a day, you get one Mediterranean Diet point. Eat more than four ounces, and you get zero points. AlcoholAlcohol is a component of the Mediterranean Diet but in moderation. For ethanol, a value of 1 was assigned to men who consumed between 10 and 50 g per day and to women who consumed between 5 and 25 g per day. This corresponds to 5 ounces of wine for women or 10 ounces for men. Olive OilOlive oil is an important component of the Mediterranean Diet. The type of fat in olive oil is mainly monounsaturated. The ideal ratio of olive oil or monounsaturated fats to saturated fats should be at least 60%. The best olive oils come from the US. Interventions in the Mediterranean DietIncreasing the score in the Mediterranean Diet by two points in the Mediterranean diet led to an 8% reduction in https://pubmed.ncbi.nlm.nih.gov/12826634/ (mortality). Imagine a simple dietary intervention leading to a decrease in mortality. Colorectal Cancer and the Mediterranean Diet ComponentsIn a recent update of the Mediterranean Diet they found a higher consumption of fruits and vegetables combined led to a decrease in colorectal https://pubmed.ncbi.nlm.nih.gov/34684583/...

On this episode, we're featuring discussions about data in colorectal cancer that were presented at the 2022 ASCO Annual Meeting. Dr. Michael Overman, of The University of Texas MD Anderson Cancer Center, speaks with two presenters about guiding therapy with circulating tumor DNA and refining treatment strategies for RAS wild-type metastatic disease.To listen to more podcasts from ASCO, visit asco.org/podcasts.

While colorectal cancer is still the third leading cause of cancer deaths in the U.S., continuing improvements in screening and treatment mean many people diagnosed with colorectal cancer now can expect to survive long after diagnosis. The American Cancer Society estimates there are more than 1.5 million survivors of colorectal cancer in the U.S. But what happens after treatment for colorectal cancer treatment is complete? Do survivors of colorectal cancer return to life as they knew it before their diagnosis?"I think there are three main things that I see our patients really concerned with when they start thinking about finishing their treatment for colorectal cancer," says  Dr. David Etzioni, a colorectal surgeon and chair of the Department of Surgery at Mayo Clinic in Arizona. "The first and biggest concern they have is whether or not their disease will completely go away and stay gone. And this is, I think, a fundamental concern for any patient treated for cancer of any kind." Dr. Etzioni explains the other two common concerns for survivors of colorectal cancer are how the treatment will affect their day-to-day quality of life, and whether or not they will need an ostomy bag temporarily or permanently.An ostomy is a surgically created opening in your abdomen that allows waste or urine to leave your body and be collected in a bag or pouch. For survivors of colorectal cancer, this may be temporary to give the colon time to heal. But, depending on the extent of surgery to remove the cancer and the location of the cancer, sometimes a permanent ostomy bag is needed.Dr. Etzioni says education can alleviate the fears patients have about needing an ostomy bag."When I do have a patient who's worried what the bag is and what it might mean for their life — it might be a temporary or permanent bag — we have a lot of educational resources here at Mayo available to them. We often will send them to our osteo nurses, so they can actually try just wearing the appliance before they've undergone the surgery. They can see what it might be like to wear that underneath their clothes," explains Dr. Etzioni. "We also have a support group that consists of patients who have an ostomy. They discuss with each other what challenges they faced, and they're very supportive with each other. And I have a group of patients who are now with an ostomy who I can call on to reach out to a new patient of mine and talk about what it might mean to live with an ostomy. And that's something that I found to be very effective and can really help patients to get over that hump to accept that possibility for cancer treatment."Finally, Dr. Etzioni says the support of family, friends and loved ones is an important part of the journey for patients with colorectal cancer."The patients who undergo treatment with a strong, consistent, omnipresent support system, they simply do better — not just emotionally, but also just in terms of the ability to tolerate treatment," says Dr. Etzioni. "I think they literally have better medical and surgical outcomes."On this Mayo Clinic Q&A podcast, Dr. Etzioni discusses what people can expect after colorectal cancer treatment ends, and how to achieve the best possible quality of life.

We're checking in with Craig Melvin, Dylan Dreyer and Lindsay Czarniak who are on the golf course at The Bottom's Up Invitational and raising money for the Colorectal Cancer Alliance. Plus, TODAY's Checklist – with back-to-school season in full swing, sports medicine physician Dr. Jordan Metzl shares tips on treating any injury. And, Eve Hewson stops by Studio 1A to chat about her new dark, comedic murder mystery show “Bad Sisters.”

 Welcome to this episode of Physician's Weekly podcast. I am your host, Dr. Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician's Weekly. The phrase "prevention is better than a cure" is often attributed to the Dutch philosopher Erasmus around 1500 AD.  But in the US, most people are more familiar with Benjamin Franklin telling Philadelphians in 1736 that  “An ounce of prevention is worth a pound of cure.” One hundred years later, Thomas A. Edison said “The doctor of the future will give no medication but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease". For the last 50 years, preventative medicine has been gaining tremendous ground, and we are steadily learning more using clinical research.Today's episode features two interviews with an inDEPTH look at prevention. Professor John Mathers from Newcastle University, UK, discusses just-published data from the groundbreaking CAPP2 study that puts an interesting twist on how aspirin could prevent colorectal cancer. Also, Dr. Nanette Wenger, clinical cardiologist and professor emerita at Emory University School of Medicine has “buckets of research” to share on cardiovascular disease prevention in women, beyond the more than 1,300 scientific papers she's had published.   Enjoy listening!Additional readingBurn J, et al. Cancer prevention with aspirin in hereditary colorectal cancer (Lynch syndrome), 10-year follow-up and registry-based 20-year data in the CAPP2 study: a double-blind, randomized, placebo-controlled trial. Lancet. 2020 Jun 13;395(10240):1855-1863. Mathers JC, et al. Cancer Prevention with Resistant Starch in Lynch Syndrome Patients in the CAPP2-Randomized Placebo-Controlled Trial: Planned 10-Year Follow-up. Cancer Prev Res (Phila). 2022 Jul 25:OF1-OF12.Wenger NK, et al. Call to Action for Cardiovascular Disease in Women: Epidemiology, Awareness, Access, and Delivery of Equitable Health Care: A Presidential Advisory From the American Heart Association. Circulation. 2022 Jun 7;145(23):e1059-e1071Oliveira GMM, Wenger NK. Special Considerations in the Prevention of Cardiovascular Disease in Women. Arq Bras Cardiol. 2022 Feb;118(2):374-377. 

This week we talk to our friend Clayton Smith! Clayton is a self-described "autoimmune disease magnet" who lives with Crohn's, Celiac, Rheumatoid Arthritis, Lupus, a rare cardiac and soft tissue disease and who has also had 2 bouts with colon cancer. We talked to him about traveling to developing countries with IBD and how to prepare for that, we talk to him about rural vs. urban vs. tribal health systems, we talk about struggling with body image and mental health, we talk a lot about how running and getting involved in charity running events helped him connect with other people living with IBD (including Robin!), we hear some great stories about Robin, and we laughed a whole lot. We hope you enjoy our conversation with our talented friend as much as we enjoyed our 2 hours of recording. Thank you to our sponsor- Romanwell! Links: An interesting journal article about traveling to developing countries with IBDLOTS of information on traveling with IBD- Crohn's & Colitis CanadaInfo on Colorectal Cancer and IBD- Crohn's & Colitis Foundation IBD and Colon Cancer- Expert Q&A video - UChicago MedicineFollow us on Instagram!Follow us on Facebook! 

When fixing a problem, you cut it right at the source.   Jason A. Duprat, Entrepreneur, Healthcare Practitioner, and Host of the Healthcare Entrepreneur Academy podcast, talks about the potential of Functional Medicine and how it can help improve our current Healthcare system. In this episode, Jason shares his personal story about how the alarming state of Western Medicine has affected his family and how Functional Medicine could have been the key to preventing that outcome.   EPISODE HIGHLIGHTS Jason's sister recently passed away due to Stage 4 Colorectal Cancer. The US spends more on healthcare than any other country in the world, but among developed countries, is at the bottom in terms of health outcomes. Functional Medicine aims to find the root cause of a disease or illness and focuses on Health Optimization. Integrative Medicine is when a clinician uses Traditional forms of Medicine along with others (e.g. Acupuncture, Massage, and Chiropractic). Wikipedia articles are not credible sources as they can be edited by anyone. Examples of Functional Medicine are the following: Jason interviewed a Podcast Guest who specializes in "Pharmacogenetics," studying how a person's genes impact how they respond to medications. Genova Diagnostics uses the "GI Effects Comprehensive Stool Profile" wherein patients send in stool samples and test for various indicators of gut health. Toxins in mattresses due to flame-retardants turn into carcinogenic gaseous vapors, which is an example of what Functional Medicine looks out for. Functional Medicine is newer, evolving, backed by legitimate studies, and is a great opportunity for clinicians who want to do Medicine right.   3 KEY POINTS Functional Medicine is a newer approach that addresses the root cause of diseases. Western Medicine has much room for improvement. Functional Medicine will greatly improve our Healthcare System in several years.   TWEETABLE QUOTES “Mark my words: In the next several years, Functional Medicine is going to take hold and gain traction” .– Jason A. Duprat “Be the best clinicians and advocates you can be for your patients.” – Jason A. Duprat CONNECT WITH JASON DUPRAT LinkedIn | Facebook | Instagram | Youtube Email: support@jasonduprat.com   RESOURCES Want to become a Ketamine Therapy provider? Enroll NOW in The Ketamine Academy course: ketamineacademy.com/presentation Have a healthcare business question? Want to request a podcast topic? Text me at 407-972-0084 and I'll add you to my contacts. Occasionally, I'll share important announcements and answer your questions as well. I'm excited to connect with you! Do you enjoy our podcast? Leave a rating and review: https://lovethepodcast.com/hea Don't want to miss an episode? Subscribe and follow: https://followthepodcast.com/hea   #HealthcareEntrepreneurAcademy #healthcare #HealthcareBoss #entrepreneur #entrepreneurship #podcast #businessgrowth #teamgrowth #digitalbusiness

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog/ BioBalance Health® has always been on the cutting edge of the newest medical methodology available. In the fight against cancer, we are now using he newest genetic methodology to find cancers early, when they are treatable. Throughout my almost 40 years of practicing medicine, I have believed that medicine should embrace preventive care and be based on the belief that we should only react to a disease that is already established.  Now we finally have one test that screens for 72% of the cancers that we can't screen for.  It is hard to believe that  out of the 55 types of cancer we can only screen for  5 Cancers!   Medicine has only developed 5 screening tests that are currently in use to find cancers early.   Galleri is one simple blood test that screens for 50 types of cancer, to find them at early treatable stages, before they create symptoms, metastasize, or produce any symptoms. Galleri was created for those patients who have a positive family history of cancer, or those patients who are fearful of getting cancer of any type, and for those patients who have been successfully treated for cancer who want to find out early, if they have a recurrence!  Galleri It is the dream child of a company who has been testing and retesting it with the finest geneticists in the US. We are offering this test through our office as an option for those who need it to truly practice preventive medicine!  With Galleri, you have a good chance of being cured of cancer through very early detection! Before Galleri® was invented patients only had 5 cancers that could be detected early by screening tests.  The following list enumerates the 5 cancers we have screening tests for. Breast cancer: Mammography can find cancer after it has been growing for 11 years. Cervical Cancer: Pap and HPV Test only finds the virus and possibly the cells that might be cancer. Colorectal Cancer, Colon Cancer: Colonoscopy and stool tests Lung Cancer: Low Dose C-T Scan Prostate Cancer: PSA Test Routine screening tests are recommended because they have been proven to save lives by detecting some cancers earlier.3 The Galleri test does not preclude the use of the 5 screening tests that are currently in use, however there are more than 50 cancers that Galleri® can test for, and you receive your results in 10 working days. It is time to look at cancer more broadly, in addition to the 5 cancers that are routinely screened for today. The most important cancer is the one that you or your loved one may have — and curing cancer starts with knowing you have it! If cancer runs in your family, and you lose sleep worrying about it you should take the Galleri® Test.  If your genetic relatives (father mother, aunt or uncle, sisters or brothers or children have had cancer then testing yourself for cancer with Galleri® will answer the question as to whether you have it or not. Our patients at BioBalance Health® are offered this test yearly for high-risk patients and as needed, often less often than yearly.  The test is not covered by insurance as it is a new test…but can you wait until it is covered?   Worrying about cancer can make you literally sick by stimulating your adrenal gland's production of cortisol.  This worry impairs your immune system that protects you from cancer, putting you at higher risk! The only risk of Galleri® is the cost…$ 1,250 paid directly to the Galleri® company at the time of your blood draw.   50 Types of cancer detected by Galleri® The Galleri test is a multicancer early detection test that detects a common cancer signal across more than 50 types of cancer through a simple blood draw. A Adrenal Cortical Carcinoma Ampulla of Vater Anus Appendix, Carcinoma B Bile Ducts, Distal Bile Ducts, Intrahepatic Bile Ducts, Perihilar Bladder, Urinary Bone Breast C Cervix Colon and Rectum E Esophagus and Esophagogastric Junction G Gallbladder Gastrointestinal Stromal Tumor Gestational Trophoblastic Neoplasms K Kidney L Larynx Leukemia Liver Lung Lymphoma (Hodgkin and Non-Hodgkin) M Melanoma of the Skin Merkel Cell Carcinoma Mesothelioma, Malignant Pleural N Nasal Cavity and Paranasal Sinuses Nasopharynx Neuroendocrine Tumors of the Appendix Neuroendocrine Tumors of the Colon and Rectum Neuroendocrine Tumors of the Pancreas O Oral Cavity Oropharynx (HPV-Mediated, p16+) Oropharynx (p16-) and Hypopharynx Ovary, Fallopian Tube and Primary Peritoneum P Pancreas, exocrine Penis Plasma Cell Myeloma and Plasma Cell Disorders Prostate S Small Intestine Soft Tissue Sarcoma of the Abdomen and Thoracic Visceral Organs Soft Tissue Sarcoma of the Head and Neck Soft Tissue Sarcoma of the Retroperitoneum Soft Tissue Sarcoma of the Trunk and Extremities Soft Tissue Sarcoma Unusual Histologies and Sites Stomach T Testis U Ureter, Renal Pelvis Uterus, Carcinoma and Carcinosarcoma Uterus, Sarcoma V Vagina Vulva The Galleri test is intended to detect a cancer signal and predict cancer signal's origin to inform diagnostic evaluation. Cancer cases enrolled in CCGA Study1 were assigned a ​“cancer type” as defined in the American Joint Committee on Cancer (AJCC) manual (8th edition)2 (For this list of Cancer types detected, some of the names were modified/​edited to organize for easy reference). Cancer signals were detected across more than 50 AJCC-cancer types, which supports the potential for the Galleri test to detect a cancer signal over a diverse range of cancers across a wide biologic spectrum.  If you are a Biobalance Health® patient you can ask your Nurse Practitioner to make an appointment to have your blood drawn at our office.  The Galleri Test was created by GRAIL. 

Colorectal cancer is one of the leading causes of cancer death, but is remarkably treatable if caught early. Unfortunately, because of the invasive nature of the colonoscopy, many elect not to have this procedure done in a regular and timely manner. Colorectal cancers advance from normal cells through several distinct neoplasias, each with distinct patterns of gene expression. Today's guest is Dr. Erica Barnell from Geneoscopy.  They have devised a test to identify evidence of precancerous gene expression in the stool.  This advance makes early detection more feasible, along with a higher likelihood of frequent testing, at a significantly lower cost than outpatient procedures. Genoscopy Information:Website:     www.geneoscopy.comLinkedIn:     @GeneoscopyTwitter:        @GeneoscopyCo    Facebook:  @GeneoscopyCo

In this episode, Dara Schlueter discusses colorectal cancer incidence, screening, and factors related to screening. She explains the success of the Colorectal Cancer Control Program and it's importance against a preventable condition. This episode references the article titled "Factors That Support Sustainability of Health Systems Change to Increase Colorectal Cancer Screening in Primary Care Clinics: A Longitudinal Qualitative Study" by Dara Schlueter, MPH, Amy DeGroff, PhD, Cindy Soloe, MPH, Laura Arena, MPH, Stephanie Melillo, MPH, Florence Tangka, PhD, Sonja Hoover, MPP, and Sujha Subramanian, PhD.

In this episode, we continue to highlight research presented at the 2022 ASCO Annual Meeting. We'll first hear a discussion between two researchers on Plenary Abstract LBA1, which may establish a standard first-line combination regimen for patients with RAS wild-type and left-sided metastatic colorectal cancer. Then, we'll hear about a study that highlighted the need to increase participation in clinical trials amongst Black women with metastatic breast cancer. To listen to more podcasts from ASCO, visit asco.org/podcasts.

Stay in your present. Stop talking about your problems, your fears of a future that's unknown, because it's robbing you of your daily joy. If you enjoyed this episode, make sure and give us a five star rating  and leave us a review on iTunes, Podcast Addict, Podchaser and Castbox. Sign up for the next Follow-Through Challenge Follow me on Social Media:Amy on IGAmy on Facebook Resources:AmyLedin.comLean Bodies Consulting (LBC)LBC University