Investigators at the NYU Cancer Institute are leading innovative laboratory research to predict how and why colorectal cancer spreads, and evaluating novel treatment combinations aimed at slowing cancer growth. Examples of this research include:
Studying Colon Cancer Metastasis to the Liver
When colon cancer metastasizes (spreads), it most commonly travels to the liver. But it is not known why this happens, nor is it yet possible to predict which patients with early-stage disease are likely to experience metastasis.
In laboratory studies, NYUCI investigators learned that cells that suppress the immune response multiply in the liver early in the development of colon cancer. These immune suppressive cells create an environment that is ripe for the deposition of metastases in the liver.
The scientists studied mice with colon cancer that closely mimics human colon cancer progression. They explored the expansion of immune suppressive cells in the liver from a very early stage of colon cancer development, and found that these cells inhibit immune cells in the liver that would otherwise mount a response against colon cancer. Their findings were published in April 2010 in the Journal of Leukocyte Biology.
Targeting immune suppressive cells in the liver in the earliest stages of cancer development might be a way to prevent liver metastases.
Predicting Peritoneal Carcinomatosis
Although colorectal cancer commonly spreads to the liver, about 5 percent of patients experience metastasis to the abdominal cavity, causing "peritoneal carcinomatosis." When found early, peritoneal carcinomatosis can be treated with heated chemotherapy applied directly into the abdominal cavity after tumor tissue has been surgically removed.
But it is difficult to detect early peritoneal carcinomatosis using modern imaging techniques such as CT and MRI scanning. Some patients undergo "second-look" surgery to check for abdominal metastases, but most of them show no evidence of disease. As a result, peritoneal carcinomatosis is usually not found until it is too advanced to treat successfully.
NYUCI investigators are working to identify proteins in early-stage colorectal cancer that may signal which patients are most likely to develop peritoneal carcinomatosis. Using technology called mass spectrometry imaging, they plan to examine and compare colorectal cancer tissue from patients who developed peritoneal carcinomatosis and those who did not. Their goal is to establish a library of proteins associated with carcinomatosis, which could be used to identify patients at high risk of carcinomatosis who could be monitored closely and treated early.
NYUCI colorectal surgeons are implementing robotic colorectal cancer surgery in select cases. Robotic surgery is associated with the same benefits for the patient as laparoscopy: smaller incisions, less blood loss, less postoperative pain, a shorter hospital stay and recovery, and a quicker return to normal activities. Robotic surgery offers additional benefits for the surgeon: a magnified surgical field, elimination of small hand movements, and the ability to visualize and access cancers in difficult locations, such as those deep within the pelvic cavity. As a result, robotic surgery may allow for more procedures to preserve the anal sphincter, sparing many patients from a permanent colostomy (a bag to collect wastes).
The procedure is not performed by a robot; rather, the surgeon performs the same operation while seated at a console, using hand and foot controls that direct the movements of the surgical instruments. Robotic surgery makes minimally invasive approaches possible for even the most difficult-to-reach colon and rectal cancers.
Clinical Trials of New Drugs and Drug Combinations
Advances in molecular testing over the last decade have led to the identification of certain features that may be used to determine the best chemotherapy drug for a given patient. For example, many colorectal cancers overexpress a protein receptor called EGFR, and may respond to drugs such as cetuximab and panitumumab which target this protein. Moreover, these two drugs are only effective in patients with a normal version of a gene called KRAS.
Therapeutic refinements such as these came about after years of laboratory and clinical research. The future of colorectal cancer treatment depends on the molecular classification of tumors and the use of this information to personalize treatment. The NYUCI offers several clinical trials for patients with both early-stage and metastatic colorectal cancer. For information about clinical trials for colorectal cancer at the NYU Cancer Institute, please call the research nurse at 212-731-5393.