Why is that?

I mean, I was really going back and forth on this answer.

So there are several options.

As we've seen, some patients have not had CCR by six months.

If you do continue immunotherapy, they may get CCR a little while later, nine months or beyond.

So continuing immunotherapy, I think, is a very good choice.

And also, how should that immunotherapy be? Do you escalate it to dual checkpoint inhibitor at that point? is another thing that I was thinking about.

With clinical relevance, practical utilization of molecular residual disease, MRD analysis in colorectal cancer.

Why is that?

I mean, I was really going back and forth on this answer.

So there are several options.

As we've seen, some patients have not had CCR by six months.

If you do continue immunotherapy, they may get CCR a little while later, nine months or beyond.

So continuing immunotherapy, I think, is a very good choice.

And also, how should that immunotherapy be? Do you escalate it to dual checkpoint inhibitor at that point? is another thing that I was thinking about.

With clinical relevance, practical utilization of molecular residual disease, MRD analysis in colorectal cancer.

I think it's a very forward thinking study.

yeah well thank you for the vote of confidence it was truly a labor of love took many years of designing discussions i'd like to say that i had a lot more hair when i started working on the trial so It was a novel technology, and also the field was somewhat burnt by oncotype really not working out in colorectal cancer.

So understandably, there was a lot of resistance.

What has been really gratifying is that this has truly been an effort where it is research to practice and back.

So we initially, when we started the trial, the eligibility criteria were very restrictive.

For instance, kind of high-risk stage 3 colon cancer patients were not allowed for de-escalation for fear of not knowing how the assay may perform.

But as data accumulated from observational studies, which, by the way, were only possible because these assays were available for use commercially, so data was being generated really quickly, we were able to change the eligibility criteria to broaden it.

in general, thinking about colorectal cancer, what's here now, what's coming ahead, what's exciting you? What are you interested in? Where is the field evolving, I

Can you explain here what happened?

Yeah, that appears to be the theme of the year in the adjuvant setting for colorectal cancer in that these simple, easy, readily available interventions have had outsized and surprisingly impressive benefits.

So in this trial, the Alaska trial, patients with colorectal cancer were screened for alterations in in the PI3K pathway, and they were placed in one of two groups based on where these alterations were.

If they were in the PIK3CA gene, exons 9 and 20, they were group A.

And if there were alterations in other key genes within the PI3K pathway, they were placed in group B.

In total, there were about 40% of these patients.

Each of these groups were randomized to aspirin versus placebo for three years.

But from a clinical clinician's perspective, where do you think right now, and I guess the guidelines maybe haven't exactly caught up yet to what's going on in practice, but right now, where do you see CT DNA fitting in both in escalation and de-escalation of therapy, Arvind?

Hello, I'm Arvind Asari.

I'm a professor in the Department of GI Medical Oncology at MD Anderson Cancer Center in Houston.

Today, I'll be talking about the, uh, care of patients with non-metastatic colorectal cancer as part of the Year in Review series.

We have a total of, uh, eleven studies, uh, to go over.

I broke those up into two slides.

This first slide has the key, uh, trials that will impact standard of care, uh, immediately.

Can you explain here what happened?

Yeah, that appears to be the theme, uh, of the year, um, uh, in the, uh, adjuvant setting, uh, for colorectal cancer, and that these simple, easy, readily available interventions have had, um, outsized and surprisingly impressive benefits.

So in this trial, the ALASKA trial, uh, patients, uh, with colorectal cancer, uh, were screened for alterations in the PI3K pathway.

Uh, they were placed in, uh, one of two groups based on where these alterations were.

If they were in the PIC3CA gene, exons nine and twenty, they were, uh, group A.

And if there, uh, were alterations in other key, uh, genes within the PI3K pathway, they were placed in group B.

In total, there were about, uh, forty percent of these patients.

But right now, where do you see ctDNA fitting in, both in escalation and de-escalation of therapy, Arvind?

Can you explain here what happened?

Yeah, that appears to be the theme of the year in the adjuvant setting for colorectal cancer, and that these simple, easy, readily available interventions have had outsized and surprisingly impressive benefits.

So in this trial, the Alaska trial, patients with colorectal cancer were screened for alterations in the PI3K pathway.

And they were placed in one of two groups based on where these alterations were.

If they were in the PIK3CA gene, exons 9 and 20, they were group A.

And if there were alterations in other key genes within the PI3K pathway, they were placed in group B.

In total, there were about 40% of these patients.

But from a clinical clinician's perspective, where do you think right now, and I guess the guidelines maybe haven't exactly caught up yet to what's going on in practice, But right now, where do you see CT DNA fitting in both in escalation and de-escalation of therapy, Arvind?

Arvind, any thoughts, again, about these data? I'm also curious, do you ever give a sort of lifestyle or dietary thoughts to your patients, MRD or any patients, in terms of trying to avoid recurrence or not necessarily?

Yeah, starting with Dr. Liu's talk, I mean, that was a fantastic tour de force overview of everything that's happened and the prospective space and that is going on.

So I would look at the ongoing efforts as two buckets.

Firstly, taking the available adjuvant therapies and asking the question, can we de-escalate these therapies and can be escalated by adding on known available drugs to these therapies, for instance, adding on ironotekin to oxaliplatin-based adjuvant therapies.

So that's in the post-operative space.

Now, for patients who are on surveillance and who turn ctDNA positive, what the retrospective studies have clearly convincingly shown is that without any therapy, these patients would almost always have a recurrence.

So we're in a situation currently where we do these tests, but then tell our patients we don't know what to do.

I'm curious about the data that you're going to talk about.