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Personalising treatment shows promise in eradicating bowel cancer sooner

A new approach to treating aggressive bowel cancer has shown promising signs of eradicating the cancer sooner and avoiding the debilitating complications of surgery for at-risk patients.

Called personalised Total Neoadjuvant Therapy, or pTNT, the innovative program is being run through the Royal Adelaide Hospital’s Colorectal Unit and involves personalising the patient’s treatment order based on their risk profile at presentation.

The RAH is the only place in Australia implementing an algorithmic approach to TNT. The program is being led by Colorectal Surgeon Associate Professor Tarik Sammour and Head of Unit Dr Michelle Thomas, with funding from The Hospital Research Foundation.

“Traditionally what happens with really aggressive rectal cancers is that patients would get radiation, followed by surgery, and then finally chemotherapy last,” A/Prof Sammour said.

“We’ve found that by the time patients get to that last step (chemotherapy), they’ve had complications and a very long treatment journey; and they just either refuse to have the chemotherapy or they can’t have it because they’ve had a complication from the surgery.

“Unfortunately, this can also mean that these patients don’t get the benefit of chemotherapy which can be quite important in patients with advanced disease.”

 

Personalising treatment for bowel cancer patients

“So we have introduced a program where the treatment order is personalised. High risk patients are offered the option of having chemotherapy before surgery, and either before or after radiation depending on the whether the patient is most at risk of local disease or of distant cancer spread.

“If we can achieve a situation where we can identify the highest risk patients early, and intervene at a time when they’re still well by delivering more intensive and better targeted treatment, then perhaps their cancer and quality of life outcomes will be improved.”

While the program is in its early stages, the results so far have been very promising!

“We’ve had a few situations now, more than we expected, where patients at the end of their initial treatment had no cancer left and therefore didn’t necessarily need surgery, thus avoiding the complications and trauma of surgery completely,” A/Prof Sammour said.

“The funding we’ve received from The Hospital Research Foundation allows us to collect data from this group and closely monitor their progress in a prospective way.”

“Internationally TNT is showing the same promising results, but no other unit is evaluating this personalised approach with prospective data collection, so we are very much looking forward to sharing our results soon.”

 

Identifying at risk bowel cancer patients

A/Prof Sammour said the team uses imaging scans to identify which patients are most at risk of aggressive bowel cancer.

“We use MRI scans and CT scans which tell us how big the cancer is, how far through the bowel wall it’s gone and whether it’s spread to the lymph nodes around the cancer or to other organs.

“We’re pretty good at identifying the highest risk patients that we think have more aggressive biology when they turn up to see us.

“Our research is very patient centred and the first question we always ask ourselves when we’re thinking about a research project is – is there a direct benefit to the next patient we see?

“In this case we are really hoping there will be, and the research program is vital in understanding that, and in continually improving patient care.”