New drug-based treatments and developments for colon cancer

Colon cancer is one of the most common forms of cancer worldwide, with treatment options continually evolving as medical research advances. While surgery, chemotherapy, and radiation remain standard treatments, innovative drug-based therapies and targeted approaches are transforming the way colon cancer is managed. These new developments aim to improve survival rates, reduce side effects, and personalise treatment based on individual tumour characteristics.

Immunotherapy: Harnessing the power of the immune system

Immunotherapy has emerged as a promising approach for certain types of colon cancer, particularly those with high microsatellite instability (MSI-H) or mismatch repair deficiency (dMMR). These tumours are more likely to respond to immune checkpoint inhibitors, such as:

• Pembrolizumab: This PD-1 inhibitor helps the immune system recognise and attack cancer cells, offering long-term remission for some patients.
• Nivolumab: Another PD-1 inhibitor, often used alone or in combination with ipilimumab (a CTLA-4 inhibitor) for advanced cases.

Research continues to explore immunotherapy's potential for a broader range of colon cancer cases, including combination therapies to increase its effectiveness.

Targeted therapies: Precision medicine for colon cancer

Targeted drugs specifically act on molecular changes driving the growth and spread of cancer cells. For colon cancer, key advancements include:

• Anti-EGFR therapies: Cetuximab and panitumumab target the epidermal growth factor receptor (EGFR), inhibiting cancer cell growth. These are effective in patients without RAS mutations.
• BRAF inhibitors: For patients with BRAF-mutated colon cancer, drugs like encorafenib, especially when combined with cetuximab, have shown significant promise.
• Anti-angiogenic drugs: Bevacizumab, ramucirumab, and aflibercept inhibit vascular endothelial growth factor (VEGF), cutting off the blood supply to tumours and limiting their growth.

New oral chemotherapy agents

Traditional intravenous chemotherapy can be challenging for many patients due to side effects and logistical difficulties. The development of effective oral chemotherapy options, such as trifluridine/tipiracil (TAS-102), offers greater convenience and comparable efficacy for advanced or recurrent colon cancer.

Novel drug combinations and research

Clinical trials are ongoing to test the efficacy of combining existing therapies with new agents. Notable areas of exploration include:

• Combination immunotherapy: Pairing checkpoint inhibitors with other drugs to enhance immune response.
• Biosimilars: Affordable alternatives to biologic therapies like bevacizumab and cetuximab are being developed, increasing accessibility to cutting-edge treatments.
• Next-generation targeted drugs: Agents targeting novel pathways, such as KRAS G12C inhibitors, are under investigation to treat previously untreatable mutations.

Liquid biopsies and personalised treatment

Recent advancements in liquid biopsy technology allow for the detection of circulating tumour DNA (ctDNA) in the blood. This enables earlier diagnosis, monitoring of treatment response, and identification of genetic mutations to tailor therapies to individual patients.

The landscape of colon cancer treatment is rapidly changing, with new drug-based therapies and technological advancements offering hope for improved outcomes. Immunotherapy, targeted therapies, and innovative drug combinations are leading the charge in personalising and optimising care for patients. Regular consultation with oncology specialists and participation in clinical trials can help patients access the latest treatments and benefit from these groundbreaking developments.