Editor's Note: The Guangzhou Colorectal Cancer Summit Forum and the 22nd Guangdong Provincial Colorectal Cancer Academic Conference were successfully held from August 5-10, 2024. Reporters from Oncology Frontier conducted an in-depth interview with the conference chair, Dr. Gong Chen from the Sun Yat-sen University Cancer Center, focusing on the highlights of the conference and the precision diagnosis and treatment of colorectal cancer. This article summarizes the interview.A New Chapter in the Guangzhou Colorectal Cancer Forum: Zhongshan’s Unique Highlights
Oncology Frontier: As the chair of this summit forum, could you share some of the main highlights of this conference? What outcomes do you hope the conference will achieve?
Dr. Gong Chen: This summit forum also serves as the 22nd annual meeting of the Colorectal Cancer Professional Committee of the Guangdong Anti-Cancer Association (hereinafter referred to as the Colorectal Cancer Committee). The forum is backed by the multidisciplinary team (MDT) at the Sun Yat-sen University Cancer Center (hereinafter referred to as Zhongshan), led by top experts such as Professors Desen Wan, Ruihua Xu, and Zhizhong Pan. The conference aims to showcase the significant achievements and cutting-edge research in colorectal cancer treatment and prevention in southern China, with Zhongshan at the forefront. The forum is indeed packed with highlights.
One of the key highlights of this conference is the MDT model for colorectal cancer. As the pioneers in establishing a colorectal cancer MDT team in China, Zhongshan has been holding weekly multidisciplinary consultations since 1998, accumulating over 25 years of experience and practice. At this summit, we dedicated nearly two hours to an MDT session to showcase how our well-established MDT team and dynamic young MDT teams work together to analyze complex cases from across the country. Through vivid case demonstrations, we delved into how MDT is implemented in daily clinical practice. This not only continues Zhongshan’s long-standing tradition of single-disease management through a multidisciplinary approach but also demonstrates a comprehensive application of the integrated treatment concept in colorectal cancer. Over the past two decades, this model has achieved remarkable results in colorectal cancer treatment and has become a cornerstone of our continuous exploration and innovation.
Another highlight focuses on the cutting-edge research and innovative practices of the colorectal cancer team at Zhongshan. In addition to the MDT model, we are closely monitoring the latest advances in precision medicine, particularly in the area of minimal residual disease (MRD), which is a hot topic in the field. To this end, we have organized a special MRD session to thoroughly analyze the practical applications of MRD testing in colorectal cancer, discuss current testing challenges, academic controversies, and industry consensus, with the aim of advancing this field further.
Furthermore, our team places great emphasis on the management of hereditary colorectal cancer, and we have therefore established a special session dedicated to hereditary tumors, aiming to enhance the research and comprehensive management of these special cases. As one of the largest cancer prevention and treatment centers in southern China, Zhongshan is often referred to as the “Supreme Court” of the oncology field, handling complex and challenging cases from Guangdong and surrounding areas, and even from across the country. Consequently, this conference also features a special session on difficult cases, where we share and discuss the diagnosis and treatment experiences and challenges associated with these cases.
Liver metastasis from colorectal cancer is one of our specialties and strengths and has been a key driver of the rapid development of the MDT model. The relevant sessions will comprehensively showcase our deep expertise and innovative achievements in this field. We also continue to focus on rare types of colorectal cancer, such as gastrointestinal stromal tumors (GIST) and neuroendocrine tumors (NET), providing a dedicated platform for discussion and exchange for these patient groups.
In summary, this conference offers a rich and diverse agenda, covering topics from cutting-edge technology to special cases, from common challenges to rare diseases, fully reflecting our comprehensive focus and in-depth exploration of the colorectal cancer field.
Precision Diagnosis and Treatment Lead the Way: Striking the Balance Between Intensified and Reduced Treatment
Oncology Frontier: Precision medicine has indeed become a dominant trend in the treatment of colorectal cancer. Could you provide an overview of the current advancements in the field of precision medicine for colorectal cancer?
Dr. Gong Chen: The driving force behind precision treatment is undoubtedly the rapid advancement of technology, which has enabled us to gain increasingly precise insights into the mechanisms of tumor occurrence, development, and progression. Since the concept of precision medicine was introduced a decade ago, we have focused on the in-depth exploration of tumor driver genes, using this as a foundation to gradually build a comprehensive understanding of precision treatment. In the colorectal cancer field, we have moved from the initial targeted interventions for advanced colorectal cancer involving the EGFR pathway (such as mutations in the RAS, KRAS, NRAS, and BRAF genes) to a point where the concept of precision treatment has permeated all aspects of colorectal cancer diagnosis and treatment. Currently, each patient’s treatment plan is tailored based on their unique molecular subtype, a shift that has completely transformed the treatment landscape for advanced colorectal cancer and is gradually extending to locally advanced colorectal cancer.
In advanced colorectal cancer, in addition to traditional surgical radiotherapy, chemotherapy, and targeted therapy, immunotherapy holds great promise. Studies have found that MSI-H colorectal cancer patients are the ones who benefit most from immunotherapy. Therefore, using MSI-H as a key biomarker not only effectively distinguishes the patient groups that will benefit from treatment but has also become a prominent marker in the field of precision treatment for colorectal cancer. Whether in advanced or early-stage colorectal cancer, the MSI-H status will continue to be a focal point for future research and treatment.
In this year’s colorectal cancer sessions, we specifically explored the latest advancements in immunotherapy, focusing on different stages of advanced tumors and early disease. Particularly in the sessions dedicated to advanced tumors, we concentrated on discussing the immunotherapy strategies for patient groups with MSI-H and specific gene mutations. Although, compared to other cancers such as lung and breast cancer, the precision treatment of colorectal cancer at the molecular level may still be catching up, we have firmly embarked on the path of exploring precision medicine.
Given the current limitations of molecular typing technologies, the precision treatment of colorectal cancer also places greater emphasis on the accuracy of clinical practice. For example, in rectal cancer, we utilize high-resolution MRI technology and combine it with the patient’s specific treatment goals (such as the need for sphincter preservation or achieving an R0 resection) to conduct detailed classification and personalized treatment planning. This precision treatment strategy, based on clinical characteristics, is also reflected in the management of advanced tumors, where we not only conduct in-depth molecular analysis but also fully consider factors such as the primary tumor’s location (left-sided or right-sided colon) to compensate for the limitations of single molecular testing.
Additionally, for early-stage colorectal cancer patients, MRD testing and monitoring will become a critical component of future precision diagnosis and treatment. MRD testing can assess whether there are still tumor-related signals in the patient’s blood after surgery, guiding subsequent treatment decisions.
Oncology Frontier: In recent years, MRD has been increasingly applied from hematological malignancies to solid tumors. As a leading expert in the field of colorectal cancer, could you briefly comment on the rapid development of MRD testing technology in recent years? What impact does MRD testing have on precision treatment decisions for colorectal cancer patients in current clinical practice?
Dr. Gong Chen: MRD testing can evaluate the residual cancer cells in a patient’s body after treatment, providing us with crucial information about the patient’s condition. For example, in stage I colorectal cancer, traditional thinking suggests that these patients do not require chemotherapy, but in clinical practice, a small number of stage I patients do experience recurrence, which causes significant distress for both patients and doctors. Now, through MRD testing, we find that these recurring patients are likely MRD-positive from the outset. In the latest studies, we have also found that about 2% to 3% of stage I colorectal cancer patients are MRD-positive, which is associated with a high risk of recurrence.
For stage III colorectal cancer, the traditional approach is to administer standard chemotherapy uniformly, but not all patients benefit from this, which not only places a significant burden on the patient’s body but also results in a waste of medical resources. Today, MRD testing helps us identify those MRD-positive patients who truly benefit from adjuvant chemotherapy, allowing us to personalize treatment plans. For MRD-negative stage III patients, we can consider reducing the intensity of chemotherapy or even exempting them from chemotherapy altogether. For MRD-positive early-stage patients, we may consider intensifying the treatment to ensure its effectiveness.
In summary, MRD testing makes our treatment decisions more precise, allowing us to tailor treatment plans based on the actual situation of each patient. This “addition and subtraction” approach to treatment has completely changed the previous one-size-fits-all model and is driving cancer management toward a more refined direction.
Public Screening and Education Lay the Foundation in the Community: The Colorectal Cancer Committee Continues to Forge Ahead
Oncology Frontier: As the chair of the Colorectal Cancer Committee, could you briefly introduce the unique approaches and significant achievements in colorectal cancer prevention and treatment in Guangdong Province? What lessons can other regions learn from these experiences and outcomes?
Dr. Gong Chen: On the afternoon of August 9, 2024, the Colorectal Cancer Committee successfully completed its election, with Director Zhenhai Lu from Zhongshan being elected as the new chair for the fifth term of the Guangdong Provincial Colorectal Cancer Professional Committee.
The Colorectal Cancer Committee enjoys a high reputation and influence nationwide, thanks to our deep academic foundation and outstanding leadership. The founder of the committee, our mentor, Professor Desen Wan, is not only a former “long-standing” director of our cancer hospital but also one of the leading figures in the field of colorectal cancer in China, alongside Professor Shu Zheng from the Second Affiliated Hospital of Zhejiang University School of Medicine. Since its establishment in 1999, the Colorectal Cancer Committee has made significant achievements over nearly 25 years, earning widespread recognition within the industry.
The Colorectal Cancer Committee has always prioritized public education and early screening. Even before the association was founded, we recognized the importance of screening. With the support of pioneers like Professor Wan, the Guangzhou municipal government successfully incorporated colorectal cancer screening for residents aged 50 and above into major public health projects in 2013. This forward-thinking initiative has had far-reaching implications for reducing colorectal cancer incidence rates and improving public health. We firmly believe that the focus on public education and prevention, starting from the community level, is not only applicable to colorectal cancer but can also provide valuable lessons for screening efforts for other cancers.
At the same time, the Guangdong Provincial Colorectal Cancer Committee is committed to promoting standardized tumor diagnosis and treatment systems. We actively organize standardized training, strengthen team building, and widely promote advanced diagnosis and treatment technologies across the province with the support of various academic platforms. The MDT activities we lead have had a positive impact nationwide, with the “Sailing Forward” competition, one of the most influential MDT competitions in the country, serving as strong evidence of our success.
In emerging fields such as immunotherapy, we are keeping pace with the times, continuously exploring and practicing with the support of our multidisciplinary MDT team. Building on the solid foundation laid by predecessors like Professors Desen Wan, Ruihua Xu, and Zhizhong Pan, we continue to advance from a higher starting point.
Looking to the future, we hope that under the leadership of the new team, the Colorectal Cancer Committee will continue to forge ahead, further improving colorectal cancer prevention and treatment. We also aim to strengthen collaboration and exchange with colleagues nationwide, sharing the Guangdong experience and jointly promoting the development of colorectal cancer prevention and treatment in China. As a frontier of China’s reform and opening-up, Guangdong will continue to uphold the spirit of openness, innovation, and courage, injecting new vitality and momentum into the development of the committee.
Dr. Gong Chen
- Chief Physician, Doctoral Supervisor
- Deputy Director of the Colorectal Department, Sun Yat-sen University Cancer Center
- Academic Roles: Deputy Secretary-General and Executive Director of the Chinese Society of Clinical Oncology (CSCO) Member of the ASCO Academic Committee (2015-2017) Chair of the Guangdong Provincial Colorectal Cancer Professional Committee Recipient of the Third “National Famous Doctor: Outstanding Model” Award in 2019 Deputy Chair and Secretary-General of the CSCO Colorectal Cancer Committee Deputy Group Leader and Lead Writer of the CSCO Colorectal Cancer Guidelines Expert Group Deputy Chair of the CSCO Minimally Invasive Surgery Committee and Geriatric Oncology Prevention Committee Standing Committee Member of the Chinese Medical Doctor Association’s Colorectal Surgery Physician Branch Member of the Chinese Anti-Cancer Association’s Colorectal Cancer Professional Committee Deputy Chair of the Liver Metastasis Branch of the Colorectal Oncology Committee, Chinese Medical Doctor Association First or corresponding author of papers published in: Diseases of the Colon & Rectum Journal of Cancer Research and Clinical Oncology Annals of Oncology International Journal of Colorectal Disease BMC Cancer Cancer British Journal of Cancer PLoS ONE Chinese Journal of Cancer (Cancer Communication) Scientific Reports Cancer Medicine New England Journal of Medicine (NEJM) (correspondence) Journal of Hematology & Oncology ImmunoOncology The Lancet Gastroenterology & Hepatology
