Breaking Down The Importance of Targeted Therapies in Colorectal Cancer Care

Comprehensive biomarker testing is essential for guiding cancer care treatment, including colorectal cancer, for example, according to Dr. Suneel Kamath. According to data from the ALASCCA study, which was shared at the 2025 ASCO Gastrointestinal Cancers Symposium, low-dose aspirin after surgery significantly improved recurrence rates in patients with colorectal cancer who had PI3K mutations.

Although this benefit was only observed in patients with this specific genetic alteration, PI3K mutations are relatively common, affecting more than one-third of patients. However, biomarker testing for such mutations is not routinely performed, particularly in earlier-stage cancers, Kamath emphasized.

In an interview with CURE®, Kamath discussed the outcomes of the ALASCCA study for patients with colorectal cancer, as well as highlighted the importance of utilizing targeted therapeutic options for patients with cancer and the need for next-generation sequencing and testing.

Kamath is an assistant professor of medicine at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, in Ohio.

Transcript:

The big thing is to make sure that you get testing done. The ALASCCA study, in particular, is very interesting because it was taking a relatively low dose of aspirin after surgery for patients with colon cancer, and it showed a very significant improvement in recurrence rate. The recurrence rate was almost 12% better — which is a substantial number for — but it was only for people who had a particular genetic mutation, these PI3K mutations. However, it's not a rare target; more than a third of people have it.

The reason I bring this one up, in particular, is that for people with earlier stages of cancer — the study was mostly for stage two and three cancers — we don't usually do this type of biomarker testing. There are a couple more limited ones that are done, like MSI, but this particular protein or marker would not have been looked for [in] most people. This speaks to the fact that we need to be doing biomarker testing and genomic sequencing, which is often called next generation sequencing. We need to be doing this for patients at all stages of cancer, as it can [change treatment] outcomes. This was a very benign treatment, with again, low-dose aspirin. The benefit was bigger than we [have seen] with chemo. The usual chemotherapies we give in the setting work less well than just aspirin did, according to the study.

Across the board, we should be doing more biomarker and next-generation sequencing testing for people. For the most part, if a target is found, most oncologists will know what to do about it, and how to treat it. It can become easy ... to give the things that are not targeted and don't need a specific test to identify. Sometimes, we can forget that those tests were not done, so the most important thing making sure the testing is done. If we find those targets, we'll know what to do about it.

Transcript has been edited for clarity and conciseness.

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