- We are moving towards precision regimens for biliary, pancreatic, and colorectal cancers: these may combine advanced radiotherapy with systemic treatment.
- A better understanding of disease biology is needed to inform patient selection.
- A proposed trial will provide the opportunity to use stereotactic body radiation therapy (SBRT).
Why this matters
- Prognosis in these cancers remains poor.
Metastases are the real killer in GI malignancies, Professor Maria Hawkins (University College London) reminded RCR19 delegates. Oligometastatic disease is therefore a key arena for progress.
Local control does not necessarily improve progression-free survival. New regimens will therefore include both precision radiotherapy and systemic treatment where appropriate, tailored to individual patient characteristics.
- Integrating precision radiotherapy with immuno-oncology – understanding when and how and in whom to combine these approaches is a key goal.
- SBRT should be more widely used, but not all patients can benefit. Prospective data are needed to aid patient selection.
Tumour biology predicts outcome better than clinical characteristics. A proposed new trial – OLIGO1 – will include biological characterisation of oligometastatic disease and provide an opportunity for greater use of SBRT in this setting; usage is currently very low.
The trial will compare standard of care + local control (surgery or SBRT) versus standard of care alone in oesophagogastric, pancreatic, neuroendocrine, and primary hepatobiliary cancer, with a separate master protocol for each.
Advances in physical science, imaging, informatics, artificial intelligence, and cancer biology can all be harnessed to achieve precision treatment. Multidisciplinary working – greater interaction between radiologists, surgeons and medical oncologists – will be vital.