A complete chain of expertise
The Montpellier site features a high concentration of clinical and research teams who have developed specific expertise in the field of colorectal cancer. Clinical research activity on colorectal cancer is under constant development, and the health facilities of the Languedoc Roussillon region have been involved in many clinical trials as a centre of development, coordination and investigation. In parallel, the work of basic and applied research teams plays a major role in increasing knowledge about the molecular and cellular characteristics of colorectal cancer.
In pursuit of this dynamic, around the theme of colorectal cancer expertise in medical oncology, the SIRIC today groups together oncologic surgery, clinical research, molecular biology, histopathology, genetics and epigenetics, cell biology, signalling pathways and biochemistry.
This multidisciplinary network of clinicians and researchers covers a wide field of research on colorectal cancer in a continuum ranging from basic research to clinical research. Their work includes study of its initiation, progression and invasion, resistance mechanisms and recurrence.
The Colorectal Cancer Program is coordinated by Dr. Eric Assenat, Digestive Oncologist at the ICM and the CHRU (Montpellier University Hospital), and by Dr. Philippe Jay, Head of the Oncology Department and of the ‘Auto-renewal differentiation of epithelia’ team at the IGF of Montpellier.
This program aims to increase knowledge of the mechanisms involved in the phenomena of tumour invasion and metastasis in colorectal cancer, thus enabling innovative and customised therapeutic strategies to emerge. The actions of the program revolve around three main axes:
WP1 – The early stages of tumorigenesis
An important axis of research on colon cancer focuses on the early steps of this disease. This includes studies aiming to characterize risk factors to develop colorectal cancer, to identify the fraction of polyps that will transform into malignant lesions, as well as to predict which stage 2 colorectal cancers have a high probability to relapse after surgery. Because the study of the earliest stages of colorectal tumorigenesis is currently limited by the availability of tissue samples, the establishment of a bank of tissue samples representing the earliest lesions has been identified as a priority within the framework of the SIRIC.
In parallel, several research groups analyse different aspects of tumour initiation, including the identification of predisposing genetic and epigenetic factors, the role of progastrin, a prohormone over-expressed in the early stages of tumorigenesis, plus the validation of biomarkers and other useful methods of detecting and/or characterising the early stages of tumorigenesis (circulating tumour cells, the functional analysis and expression profile of new molecular players in a collection of biopsies).
WP2 – Individualised treatment of locally advanced rectal cancer
Locally advanced rectal carcinoma raises the issue of both the oncological control, local and general, and the therapeutic morbidity. Surgery alone can cure only one out of two patients, pre-operative radiochemotherapy improves the local control but the metastatic risk remains about 30%, with enhanced postoperative morbidity and poor functional results. Tumor response to preoperative treatment is the major prognostic factor which reveals tumor aggressiveness. Nevertheless, at present, there are no predictive markers of tumor response.
Relying on the expertise of Montpellier teams in this pathology, this axis is to develop innovative research transfer around the issue of customising the management of non metastatic rectal cancer that combines individualized therapy and identification of prognostic/predictive factors, to ultimately improve oncologic prognosis and reduce post therapeutic functional disorders.
The effective management of metastatic colorectal cancer (mCRC) currently requires a multidisciplinary approach to define the proper drug/dose needed, the best way to combine the sequence treatments to ultimately deliver the “right treatment to the right patient”. Nowadays, systemic treatment optimization ensues from the challenging question of therapeutic personalization, taking into account the molecular basis of individual susceptibility.
The identification of new clinical biomarkers is crucial to optimize the systemic treatments in metastatic illnesses. This area involves the undertaking of a program of translational research on large cohorts of clinical trials in order to develop new innovative therapeutic combinations and to validate biomarker candidates and new therapeutic targets.