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Prevention and Early Detection of Gastrointestinal Cancers Take on New Importance Amidst a Younger Population

27 Jun 2024
  • Emerging research on early-onset gastrointestinal cancers highlights need for better prevention, diagnosis and treatment 
  • Less invasive, smart technologies could improve participation in and efficacy of GI cancer screening
  • Studies presented at the ESMO Gastrointestinal Cancers Congress 2024 could improve outcomes through better patient selection and optimised use of available therapies

MUNICH, Germany – Treatment of gastrointestinal (GI) cancers is catching up with other areas of oncology and offering patients better prospects for survival and quality of life, but a significant uptick in early-onset cases is raising new questions about effective prevention, diagnosis and treatment. This was the subject of much discussion at the press conference – moderated by Angela Lamarca, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain, ESMO Press Officer – of the ESMO Gastrointestinal Cancers Congress 2024 taking place in Munich, Germany, 26-29 June.

Early-onset GI cancers: A growing concern

Gastrointestinal malignancies account for one in four cancer cases and for one in three cancer-related deaths globally, with colorectal cancer being among the three most common tumour types and causing over 900,000 fatalities each year. (1) Although the overall incidence of colorectal cancer has been stable or declining in high-income countries annual new cases of early-onset disease, i.e., in individuals below the age of 50, have risen by 51 percent in these regions since the 1990s. (2) If this trend continues, seemingly associated with a worse prognosis compared to late-onset disease, colorectal cancer could become the deadliest cancer in the 20-49 demographic by 2030. (3)

Research being presented in Munich tends to confirm that young GI cancer patients are more likely to be diagnosed at an advanced stage, a possible explanation for the poorer outcomes seen in this age group. (4) (5) (6) Similarly, one study found that pancreatic cancer displays more aggressive behaviour resulting in worse outcomes among younger individuals. (7) In the area of biliary tract cancers, by contrast, young metastatic patients appeared to have a better prognosis than their older counterparts by virtue of being more likely to have actionable genetic alterations in their tumours making them eligible for personalised therapies. (8)
With almost 455,000 new cases of colorectal cancer diagnosed in Europe in 2022, including 20,000 patients aged between 18 and 49 years, (9) ESMO President Andrés Cervantes highlighted the importance of better understanding the characteristics of this young patient demographic as well as the risk factors they are exposed to in order to help design effective strategies for prevention and early detection. Hereditary cancer risks such as Lynch syndrome make early-onset disease more likely, but these only account for a minority of the cases diagnosed. As the age shift is observed for different gastrointestinal cancers and across high-income countries globally, there is good reason to suspect lifestyle-related factors such as the Western diet, low physical activity or use of antibiotics are playing a role, though these hypotheses still need to be scientifically confirmed.

From prevention to early diagnosis: Extending the reach of GI cancer screening

As a diverse group of diseases, gastrointestinal cancers remain overall an area with high unmet need and in which late diagnosis remains a common issue leading to poor outcomes. “We have a problem with prevention and screening in the GI field, where compliance with invitations to undergo stool testing or colonoscopies is lower than 30% across Europe, compared to adherence to breast cancer screening which is two to three times higher,” Cervantes emphasised, calling for educational efforts and collaboration with primary care physicians to improve awareness and acceptance.

Another pressing issue, according to Florian Lordick, University of Leipzig, Germany, Editor-in-Chief of the journal “ESMO Gastrointestinal Oncology”, is that screening programmes currently focus on older populations: “We are seeing a lot of young patients with advanced colorectal, pancreatic cancers in our clinics, and it will be important to have an intensive exchange about what to do about this in terms of screening,” he said. In particular, Lordick underlined the importance of raising awareness about family histories of cancer and their implications among general practitioners and citizens themselves, to ensure high-risk individuals are identified and monitored in time. 

Opening up new perspectives in this area are technologies to screen for cancers that are not yet clinically detectable. (10) (11) (12) “Multi-cancer early detection tests, mainly in the form of blood tests, are drawing a lot of interest to allow diagnosis of cancer patients at an earlier stage and increase their chances of being cured,” said Benedikt Westphalen, Comprehensive Cancer Centre Munich, Germany, Chair of the ESMO Translational Research and Precision Medicine Working Group, who saw potential for these non-invasive methods to increase participation in GI cancer screening, particularly in younger age groups.     

The recording of the ESMO press conference can be accessed via this link.

Notes to Editors 

Please make sure to use the official name of the meeting in your reports: ESMO Gastrointestinal Cancers Congress 2024 

Official Congress Hashtag: #ESMOGI2024. Follow it to stay up to date and use it to take part in the conversation on X (Twitter), LinkedIn, Instagram, Facebook 

  1. Source: IARC - Global burden of gastrointestinal cancers https://gco.iarc.fr/stories/gastro-intestinal/en
  2. Spaander M. C. W., Zauber A. G., Syngal S., Blaser M. J., Sung J. J., You Y. N., and Kuipers E. J. Young-onset colorectal cancer, 2023. DOI: 10.1038/s41572-023-00432-7
  3. Source: Colorectal Cancer Alliance - Young-Onset CRC Facts
  4. Abstract 139P ‘Young onset colorectal cancer: Clinical and molecular characteristics’ will be presented by Christos Cortas during the Poster Display session, Thursday 27 June, 15:35 – 16:30 CEST in the Foyer.
  5. Abstract 140P ‘Early onset proficient mismatch repair bowel cancer: A retrospective study revealing unique characteristics and outcomes’ will be presented by Anna Militello during the Poster Display session, Thursday 27 June, 15:35 – 16:30 CEST in the Foyer.
  6. Abstract 80P ‘Early onset metastatic colorectal cancer patients as an emerging distinctive clinical and molecular phenomenon’ will be presented by Andrea Pretta during the Poster Display session, Thursday 27 June, 15:35 – 16:30 CEST in the Foyer.
  7. Abstract 365P ‘Pancreatic cancer in young patients under the age of 45 years old: A comparative study with older patients’ will be presented by Ghzel Sirine during the Poster Display session, Thursday 27 June, 15:35 – 16:30 CEST in the Foyer.
  8. Abstract 291P ‘Tumor biology, treatment patterns, and survival outcomes in young-onset biliary tract cancers’ will be presented by Anthony Turpin during the Poster Display session, Thursday 27 June, 15:35 – 16:30 CEST in the Foyer.
  9. Source: IARC - Global Cancer Observatory https://gco.iarc.fr/en
  10. Abstract 165MO ‘Early detection of HCC by routine blood based-AI’ will be presented by Kin Nam Kwok during Mini Oral session 1, Wednesday 26 June, 17:30 – 17:35 CEST in Room 14.
  11. Abstract 437P ‘Early gastric cancer detection with AI-enabled routine blood test: A territory-wide clinical big-data study’ will be presented by Minji Seo during the Poster Display session, Thursday 27 June, 15:35 – 16:30 CEST in the Foyer.
  12. Abstract 442P ‘AI routine blood signature as a tumour marker to predict post-treatment outcomes in gastric cancer’ will be presented by Ka Man Cheung during the Poster Display session, Thursday 27 June, 15:35 – 16:30 CEST in the Foyer.
  13. Abstract LBA3 ‘Final analysis of the phase 3 KEYNOTE-585 study of pembrolizumab plus chemotherapy vs chemotherapy as perioperative therapy in locally-advanced gastric and gastroesophageal junction cancer’ will be presented by Kohei Shitara during the Proffered Paper session, Thursday 27 June, 14:55 – 15:05 CEST in Room 14.
  14. Abstract 279MO ‘Three-year survival, safety and extended long-term survivor (eLTS) analysis from the Phase 3 TOPAZ-1 study of durvalumab (D) plus chemotherapy in biliary tract cancer (BTC)’ will be presented by Do-Youn Oh during Mini Oral session 3, Saturday 29 June, 08:45 – 08:50 CEST in Room 13a.
  15. Abstract 1O ‘Chemotherapy and Liver Transplantation versus Chemotherapy alone in patients with definitively unresectable colorectal liver metastases: Updated results from the randomized TRANSMET trial’ will be presented by Maximiliano Gelli during the Proffered Paper session, Thursday 27 June, 14:00 – 14:10 CEST in Room 14.
  16. Abstract LBA4 ‘Switch maintenance with ramucirumab plus paclitaxel versus continuation of oxaliplatin-based chemotherapy in advanced HER2-negative gastric or gastroesophageal junction (GEJ) cancer: Final results and key biomarkers of the ARMANI phase 3 trial’ will be presented by Giovanni Randon during the Proffered Paper session, Thursday 27 June, 15:05 – 15:15 CEST in Room 14.
  17. Abstract 211MO ‘First-Line Efficacy of [177Lu]Lu-DOTA-TATE in Patients with Advanced Grade 2 and Grade 3, Well-Differentiated Gastroenteropancreatic Neuroendocrine Tumors by Tumor Grade and Primary Origin: Subgroup Analysis of the Phase 3 NETTER-2 Study’ will be presented by Simron Singh during Mini Oral session 1, Wednesday 26 June, 17:35 – 17:40 CEST in Room 14.
  18. Abstract LBA1 ‘Pembrolizumab in combination with xelox and bevacizumab in patients with microsatellite stable (pMMR/MSS) metastatic colorectal cancer (mCRC) and a high immune infiltrate: a proof of concept study. Preliminary results of FFCD 1703 POCHI trial’ will be presented by David Tougeron during Mini Oral session 2, Friday 28 June, 16:35 – 16:40 CEST in Room 1.
  19. Abstract LBA2 ‘Efficacy interim analysis of REGINA, a phase II trial of neoadjuvant regorafenib (Rego), nivolumab (Nivo), and short-course radiotherapy (SCRT) in stage II-III rectal cancer (RC)’ will be presented by Francesco Sclafani during Mini Oral session 2, Friday 28 June, 16:30 – 16:35 CEST in Room 1.
  20. Abstract 6MO ‘Evaluation of plasma assessed comprehensive genomic profiling before first line treatment with FOLFIRI plus cetuximab in RAS/BRAFV600E wild type metastatic colorectal cancer patients in the CAPRI 2-GOIM trial’ will be presented by Giulia Martini during Mini Oral session 1, Wednesday 26 June, 16:35 – 16:40 CEST in Room 14.
  21. Abstract 7MO ‘Combined analyses of ctDNA and Immunoscore in stage III colon cancer patients: a post hoc analysis of the IDEA-France and -Greece trials’ will be presented by Julien Taieb during Mini Oral session 2, Friday 28 June, 17:00 – 17:05 CEST in Room 1.

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