Colorectal cancer is the third most common cancer (after lung and breast), and the fourth leading cause of death from cancer (after lung, liver, and stomach), in the world, and is second only to lung cancer as a cause of cancer death in developed countries, according to the World Health Organization's International Agency for Research on Cancer. In the United States, for example, it is the second leading cancer killer of men and women combined.
Patients can be effectively treated when the tumor is detected and removed early; however, the disease often develops without symptoms until it has reached an advanced stage. Screening is the most effective strategy for decreasing the rate at which colorectal cancer occurs and number of deaths it causes, with incidence and mortality rates declining in countries where screening has been introduced.
Stool or fecal based tests are widely used in Western Europe and Asia and increasingly in the U.S., with testing for blood (the fecal immunochemical test or FIT) as the standard approach. Although FIT has the potential to reduce colorectal cancer mortality by around 30 percent, improvements are needed urgently as approximately one-third of cancers, and more than two-thirds of pre-cancerous lesions, are missed by this test. The sensitivity and accuracy of testing can be greatly improved using molecular stool tests, which detect cancer-specific biomarkers, such as DNA or proteins from cancer cells that are shed from the colon wall. The U.S. Food and Drug Administration recently approved the first stool-based colorectal screening test that detects blood and cancer-associated DNA changes and was better in clinical trial than FIT for detection of colorectal cancer.
The SU2C-KWF Dream Team's goal is to move highly sensitive molecular testing for colorectal cancer to the next level so it can become available to patients in everyday life. Their first aim is to improve molecular stool-based tests by using the best combination of cancer-associated DNA and/or protein biomarkers, so that these tests can go from the individual level to population screening. This new test will be compared directly against the current test in 10,000 individuals participating in the Dutch national population-screening program for colorectal cancer. Their second aim will be to develop a molecular blood test for circulating cancer-associated DNA in order to improve identification of early stage colorectal cancer patients with a poor prognosis. Patients in the early stage generally do not receive chemotherapy after surgery because 80 percent survive the disease. The SU2C-KWF Dream Team hopes to develop a molecular blood test that identifies the other 20 percent of early stage colorectal cancer patients whose survival may be improved by chemotherapy after surgery.
Manon van Engeland, PhD, program leader in oncology, Maastricht University Medical Center
Ernst J. Kuipers, MD, PhD, professor of
gastroenterology, Erasmus University Medical Center, Rotterdam, Netherlands
Evelien Dekker, MD, PhD, professor of gastrointestinal
oncology, Academic Medical Center of the University of Amsterdam, Amsterdam, Netherlands
Miriam Koopman, MD, PhD, medical oncologist, University Medical Center Utrecht, Utrecht, Netherlands