Personalized Medicine in GI Cancer: Transforming Treatment With Technology, Lifestyle Insights

Personalized medicine is having a transformative impact in treating gastrointestinal (GI) cancers, with advances in next-generation sequencing enabling more targeted therapies and enhancing both treatment and patient management, explained Tiago Biachi, MD, PhD, a colorectal oncologist and GI cancer specialist at Moffitt Cancer Center.

He also emphasized the importance of lifestyle factors, such as obesity and lack of exercise, in GI cancer prevention and recurrence and underscored the critical role of interdisciplinary teams in managing GI cancers.

This transcript has been lightly edited for clarity.

Transcript

How has the role of personalized medicine evolved in treating GI cancers?

Actually, precision oncology has, I would say, revolutionized the treatment for patients with a GI cancer. I remember that not too long ago, we used to treat many patients the same way, and now, I would say, mainly because the advance of next-generation sequencing, we are able to treat patients with more targeted therapies—and I would say, not only the treatment itself, but even the approach for diagnosis and how to follow those patients after surgery.

I gave a talk at a conference about circulating tumor DNA, which is brand new technology. Now, we have access to this in clinic and then, we discussed all the possible scenarios that we can use the technology, even for screening for colorectal cancer, for example, to detect minimal residual disease after surgery, or to detect mutations in a specific tumor to treat this patient with a therapy. So we are moving fast in this direction in order to offer the right treatment for the right patient at the right time, which is important.

In your opinion, what role does lifestyle and diet play in the prevention and management of GI diseases, and how can health care providers better educate patients on this?

Lifestyle is crucial, actually, in GI cancers, probably more important than in any other solid tumor. For example, we do know that for most of our GI cancers, obesity and lack of exercise are risk factors for colorectal cancer. This is very well established. We do have data, for example, for patients with colorectal cancer [who were] treated, [and] when we followed those patients, we had data showing that patients with overweight or obesity have a higher risk of recurrence compared to patients with normal weight.

And we know that, for example, patients with liver cancer, one of the most common causes of liver cancer now is fatty liver, [which is] of course related to lifestyle. So there is huge, I would say, room for improvement, mainly on the prevention side, because, as we know, obesity is a pandemic. But also, not only for prevention, but even for those patients previously treated, we know that this is important as well.

How do you see the role of interdisciplinary teams evolving in the treatment and management of GI conditions?

This is probably why I fell in love with GI cancers in the past. This is a kind of specialty where we have to work as a team here. So, for example, tumor boards are crucial for the management of those patients, because it's the time that we can sit and talk with surgeons, intervention radiologists, all the people involved in the care of this patient, to discuss the best treatment for them.

And to be honest with you, all the care that those patients need. I think it's too much for one single provider to take care of. So, for example, patients, of course, have more access to information now. So they have many questions about diet, what kind of exercises they can do, and pain management. So we have to work as a team. It's impossible for just 1 provider to take care of all those aspects related not only to the cancer but the wellbeing of that patient. So it's crucial [for us] to work as a team here.