Gene test may identify recurrence risk for stage II colorectal cancer
2011 Gastrointestinal Cancers Symposium
A gene expression test was able to predict which patients with stage II colorectal cancer were most likely to recur, according the results of a validation study conducted in Germany.
Robert Rosenberg, MD, a surgeon and assistant professor at the University Hospital of the Technical University in Munich, presented the results during a press conference ahead of the 2011 Gastrointestinal Cancers Symposium in San Francisco. He said most patients with stage II disease can be treated successfully with surgery alone, but physicians have long sought a way to predict which patients were most likely to recur and would benefit from adjuvant chemotherapy.
Rosenberg and colleagues evaluated tumor samples collected from 233 patients who underwent curative resection for stage II or III colon cancer from 1987 to 2003. Researchers hybridized the samples and determined the 18-gene ColoPrint index.
In univariate and multivariate analyses in stage II, ColoPrint was the only significant parameter to predict the development of distant metastasis, Rosenberg said. ColoPrint is able to predict the development of distant metastasis of stage II colon cancer patients and facilitates the identification of patients who might not need additional chemotherapy.
Of the 135 patients with stage II disease, 74% were classified as low risk, according to the ColoPrint gene expression test. The remaining patients were considered high risk. Five-year distant metastases-free survival was 94.9% (95% CI, 90.6-99.2) in the low-risk group vs. 79.9% (95% CI, 67.6-93.4) in the high-risk group. On univariate analysis, ColoPrint was the only significant factor to predict the development of distant metastases (HR=4.13; 95% CI, 1.31-13.01).
Rosenberg said the addition of the ASCO risk factors (T4, high grade, perforation, emergency presentation and fewer than 12 assessed lymph nodes) did not significantly improve identification of high-risk patients.
The value of the gene signature test in risk assessment for recurrence is being prospectively compared with clinical risk factors in the Prospective Analysis of Risk Stratification using ColoPrint (PARSC) trial, an international, multicenter, clinical study of patients with stage II colon cancer. ColoPrint is also being evaluated for use in patients with stage III colorectal cancer. by Jason Harris
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Disclosure: Dr. Rosenberg has no relevant financial disclosures.
We're already assaying colorectal cancer for KRAS and BRAF status. These sorts of studies certainly suggest that there may be new biomarkers we can use to follow. We don't quite know how to use all that information yet. Physicians are looking for a panel we can use to quickly stratify which patients need chemotherapy and which patients don't. We're heading in that direction. We're still years away from that being reality, but these sorts of studies are showing that there are a series of biomarkers that are going to be significant in colorectal cancer.
Steven A. Curley, MD
Director, Multidisciplinary Care Center,
University of Texas MD Anderson Cancer Center
Disclosure: Dr. Curley has no relevant financial disclosures.
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