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Colorectal cancer (CRC) is one of the most common cancers diagnosed nowadays, as it is estimated that 1 in 24 people is to have colorectal cancer in their lifetime1. Furthermore, CRC is a heterogeneous disease representing the third most common cancer in men and women worldwide and the second leading cause of cancer-related death.

In honor of Colorectal Cancer Month, we interviewed Dr. Noelia Tarazona, medical oncologist at the Hospital Clínico in Valencia, and América Bueno, biomedical research engineer at  INCLIVA Research Institute, to find out how precision medicine and radiomics could impact the diagnosis and treatment of CRC disease.

How is colorectal cancer diagnosed? Are there new methods?

For most types of cancer, biopsy is the only way for the doctor to know whether an area of the body has cancer. However, biopsies lead to biased samples and tumor heterogeneity. 

To make patients’ lives better and thanks to medical imaging, nowadays it is possible to perform a virtual biopsy. They allow a more accurate and earlier prediction of disease relapse, avoiding the possible contraindications of a standard biopsy.

What needs do you foresee in the diagnosis and treatment of the disease?

When identified early, cancer is more likely to respond to treatment and can result in a greater probability of survival with less morbidity and less expensive treatment. Significant improvements can be made in the lives of cancer patients by detecting cancer early and avoiding delays in care.2

Pathological staging is still the most important prognostic factor and currently guides our treatment decisions. The standard treatment for patients with localized CRC is surgery with curative intent followed by adjuvant chemotherapy. However, approximately 40% of patients will relapse despite optimal initial treatment.

At present, we do not know who is cured and who will recur. Therefore, the identification of novel predictive and prognostic markers could identify patients at high risk of relapse, and establish potential therapeutic strategies to optimize adjuvant therapy. In this context, t’s in this context where Radiomics and Precision Medicine are key.

What are the limitations of liquid biopsy as a treatment response evaluation? Is there a place for imaging?

Liquid biopsy is currently an attractive concept for detecting circulating (ct)DNA; however, up to 18% of patients are considered false negative, and 10% are false positive. To overcome these limitations, we have developed some strategies, and I absolutely agree that Radiomics has a place in this setting. We need to increase the sensitivity to detect Minimal residual disease (MRD) and identify those patients at higher risk of recurrence. I think the combination of ctDNA analysis and Radiomics could improve our ability to evidence MRD and thus improve patient outcomes.

Do you think precision medicine and radiomics will impact how colorectal cancer is managed? Do we expect important insights in predicting outcomes?

Medical imaging plays a key role in these aspects. The future of imaging is clearly the extraction of quantitative and objective information (imaging biomarkers) from medical images.

Advancing in research techniques to extract cancer radiomics features is how combined AI and engineering contribute to precision medicine. In addition, relevant insights from the images can be linked to clinical outcomes, like treatment response or survival, among others, helping to improve patient care and patient journey day after day.

1 – Colorectal Cancer: What You Need to Know, Summit Medical Group https://www.summitmedical.com/blog/crcmonth

2 – Cancer.
https://www.who.int/news-room/fact-sheets/detail/cancer#:~:text=When%20identified%20early%2C%20cancer%20is,and%20avoiding%20delays%20in%20care.

Katherine Wilisch Ramírez

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