Meeting Summary

The first State of the Science meeting on gastrointestinal cancer, "Identifying the Unanswered Questions in the Treatment of Colorectal Cancer," looked at advances and areas for improvement in the management and scientific investigation of colorectal cancer. Presentations identified a number of mediators along various mutated pathways with potential utility as therapy targets or predictive markers. Speakers reviewed pathologic staging consensus categories I-III, urging the development of a more flexible staging system able to incorporate molecular markers. Current questions were addressed in chemotherapy, including chemoresistance; radiotherapy, including radiosensitivity; and immunotherapy, including use of monoclonal antibody 17-1A. Surgical management talks covered the pros and cons of a number of techniques, from liver metastasis resection to use of sentinel lymph nodes to TME to laparoscopy to various percutaneous ablation techniques. New perspectives were offered for studying cytostatics, including use of maximum progression rate as the objective. Also offered were promising recent findings in tumor biological profiling for optimizing treatment choice and in correlating pathologic markers to molecular markers. A panoply of new imaging techniques, not yet widely available, were presented (e.g., multidetector CT). Study design problems figured prominently in panel discussions, including statistical pitfalls of current predictive factor studies, paucity of validated endpoints, low levels of tissue submission, barriers to accrual, and lack of standardization of methodology (especially apropos of assays), interpretation, and reporting. A national tumor bank, possibly with mandatory submission, was considered paramount, as was the concomitant development of traditional and translational advances. Speakers urged phase I testing of agents in combination, pursuing risk-adapted therapy, and furthering chemoprevention and screening approaches.