New drug combo that shrinks colorectal cancer by 90% could help halt epidemic among young people, scientists hope
A new immunotherapy treatment could halt the growth of colorectal cancer, which has risen to epidemic levels in young people.
Researchers in New York City found the drug botensilimab (BOT) shrunk tumors by around 90 percent and pushed them out of the bowel wall, making the cancer less likely to spread and become terminal even if it is not eradicated.
Though the research is early, the authors believe BOT could eliminate the need for chemotherapy after surgery and fulfill an ‘unmet need’ in colorectal cancer patients who otherwise don’t respond to this type of treatment.
Dr Pashtoon Kasi, director for colon cancer and liquid biopsy research at Weill Cornell Medicine in NYC, told DailyMail.com: ‘There’s a rise of patients who are young individuals in their 20s, 30s, and 40s, who are getting diagnosed with colorectal cancers that tend to be advanced, or metastatic.’
‘Usually, when things spread, they often can’t be cured, so there’s been an unmet need to have more treatment options for our patients with colorectal cancers.’
The above graphic shows a colorectal tumor being pushed from the deeper layers of the colon out through the bowel wall. This makes the tumor less likely to spread and can even ‘destage’ it from stage 3 to stage 1
Immunotherapy, which uses a patient’s own immune system to fight cancer, has produced ‘phenomenal’ results in the past, Dr Kasi said, but it doesn’t work for most patients.
The patients it doesn’t work for are ‘mismatch repair deficient,’ meaning their tumors produce highly mutated cancer cells that don’t respond to immunotherapy. About 85 percent of colorectal cancer patients are mismatch repair deficient.
These unresponsive tumors are considered ‘cold,’ while responsive ones are ‘hot.’
BOT, on the other hand, shows promise in those patients.
‘The main focus of the study is on the unmet need of immunotherapy for patients where immunotherapy doesn’t work,’ Dr Kasi said.
In the study, published Thursday in the journal Oncogene, Dr Kasi and his team looked at 12 colorectal cancer patients aged 26 to 78 in stages 1 through 3 of the disease, meaning the cancer hadn’t spread to other parts of the body.
The researchers gave patients two doses of the drug through a 30-60-minute infusion two weeks apart. They could then have surgery as soon as a week later.
‘The treatment plan was as simple as possible. I don’t think there could be any simpler study, Dr Kasi said.
The researchers found ‘significant killing of the cancer by one’s immune cells,’ Dr Kasi said, about 80 to 90 percent. As the research is still early, the team doesn’t have an exact figure yet.
None of the patients had their surgeries delayed, and the main side effect was fever, which was more common in female participants.
Additionally, the tumors started behaving unexpectedly. Normally, as colon cancer progresses, tumors go through several layers of the colon to become more advanced and invade other organs. But with BOT, the tumors were pushed out through the bowel wall.
‘The trash, so to speak, was being mopped up all the way to the door,’ Dr Kasi said.
This kept the cancer from spreading and reduced it, in some cases, from stage 3 all the way back to stage 1.
Dr Kasi said that this could eliminate the need for chemotherapy altogether. He also believes that in the future, this type of treatment could be applied to other types of cancer.
Evan White is pictured above with his fiancée Katie Briggs and their dog Lola. The pair had started dating when Evan had cancer and got engaged when his condition stabilized. However, he passed away after four years fighting the disease
Marisa Maddox, pictured, was diagnosed with colon cancer at age 29. It has made her infertile, robbing her of the chance to have the large family she always wanted
The study does have several limitations, including the small sample size of just 12 participants. Additionally, the findings are preliminary and only published two patients’ results.
Colorectal cancer rates are on the rise worldwide, causing an epidemic in young people.
Rates are expected to double in young people by 2030, and colorectal cancer is also expected to become the leading cause of cancer deaths in people under 50 by the end of the decade.
This is based on data from JAMA Surgery, which found that between 2010 and 2030, colon cancer will have increased by 90 percent in people ages 20 to 34. Rectal cancer will have spiked by 124 percent in the same age group.
Cancers of the colon and rectum are the third most common type in the US and the third leading cause of death in both men and women.
The American Cancer Society (ACS) estimates about 153,000 colorectal cancer cases will be detected this year, including 19,500 among those under 50 years old.
Some 52,550 people are expected to die from the disease.
Evan White, 24, from Dallas, was one of them. Mr White had just graduated from the University of Arkansas with a degree in finance when he was diagnosed with colon cancer after dismissing his main symptom – tiredness – for months.
The tumor was not spotted until it had progressed to stage three, meaning it had spread outside the colon, making it much harder to treat.
He had been on track to marry his girlfriend and move to California, but his dreams were cut short when he died after a four-year battle with the disease.
Mr White’s mother, Dana, told DailyMail.com that the diagnosis of her then-24-year-old son ‘is just not something you would expect for someone so young.’
Data from JAMA Surgery showed that colon cancer is expected to rise by 90 percent in people ages 20 to 34
The same data shows that rectal cancer will rise by 124 percent in the youngest age group
Marisa Maddox, a paralegal, survived the disease but was robbed of the chance of having the big family she had always hoped for after her colon cancer diagnosis at 29 made her infertile.
Experts are still working to unravel the cause of this devastating epidemic.
They have commonly blamed unhealthy diets, alcohol consumption, and sedentary lifestyles on this shift.
A study from the Cleveland Clinic suggested that eating red meat and sugar could lead to a higher chance of young people developing colorectal cancer.
However, some research suggests otherwise.
A 2021 study, for example, found that early-onset cancer patients were less likely to be obese or be smokers than their older counterparts.
A study published in April examined how being born via C-section influenced the chance of developing early-onset colorectal cancer. The researchers found that females born via C-section were more likely to develop colorectal cancer earlier in life than those born vaginally. There was no association among males.
Additionally, antibiotic use has been shown to impact this risk. One study in the journal Gut found that prolonged antibiotic use increased risk of early-onset colon cancer. However, it was also associated with a lower risk of rectal cancer.
And one study showed that the fungus Cladosporium sp. was more common in the tumors of young patients than the older individuals.
It’s still unclear how Cladosporium sp. could lead to this increase in cases, but the researchers think it could damage cell DNA. This could make them turn into cancerous cells.
These environmental factors have a lasting impact on the gut microbiome, which experts think could increase the risk of colorectal cancer, even when exposure is limited to early life.
Part of what makes colorectal cancer difficult to diagnose is its symptoms, which can often be attributed to other conditions. However, some stand out more than others.
A study published earlier this year in the Journal of the National Cancer Institute found that the most reported symptoms were abdominal pain, blood in the stool, diarrhea, and iron-deficiency anemia.
Additionally, in a 2020 survey by Colorectal Cancer Alliance, 68 percent of participants said they experienced blood in their stool. The average participant age was 42.
The same survey also found that many patients with colorectal cancer symptoms were initially misdiagnosed or dismissed.
Spending longer amounts of time without a diagnosis could allow colorectal cancer to advance to later stages, making it more difficult to treat.
Amid concerns over the rising rate among younger adults, in 2021, the US Preventive Services Taskforce lowered the screening age from 50 to 45 years old.
This is usually a colonoscopy, where a camera is inserted into a person’s rectum, searching for growths or changes to their intestine.
The rest of the study results are expected to be published in a few weeks, and an expanded trial is currently underway.
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