Digestive Tract Cancers - Thierry André, md, phd

My name is Thierry André. I am the medical director of the gastrointestinal oncology unit at   Saint-Antoine Hospital in Paris.  I am a clinical oncologist and am pleased to be here.  The reason I am here is that I spent fifteen years of my career at Tenon Hospital, I began my career at Tenon, and I was named Professor of Clinical Oncology at Tenon Hospital.  It is with great pleasure that I recall all those positive years, remembering that APREC helped me a great deal throughout my medical career and helped me to undertake a fair number of research projects, notably on gastrointestinal cancers, which are the focus of my research.

Clinical research on gastrointestinal cancers is advancing, as is research on all forms of cancer, and we have made enormous progress.  There are two broad categories of treatments for gastrointestinal cancers:

  • The first one is represented by the adjuvant treatments, treatments given after the removal of a gastrointestinal  cancer which does not show signs of metastasis, the goal of which is to increase the prospects for the patient’s cure.  This is largely what I am working on.  I worked a great deal in this area in collaboration with APREC at the beginning and, now, with a group called GERCOR. We have conducted a number of trials and have established notably in colon cancer that FOLFOX, the combination 5FU/Oxaliplatin, was a treatment that enabled close to 15% of patients following the removal of a colon cancer to be cured.  This means that the surgeon cures approximately 60% of patients, and with chemotherapy, we cure an additional 15%, thanks to FOLFOX chemotherapy.  The FOLFOX chemotherapy is the result of the work of APREC and of the work of the GERCOR group, and it is now the standard everywhere throughout the world.  In all gastrointestinal cancers, adjuvant therapy is essentially chemotherapy, which is becoming increasingly effective.  We are trying to decrease both the toxicity of the drugs and other side effects they may have on patients, and we are currently undertaking a large trial to attempt to reduce the length of adjuvant chemotherapy for gastrointestinal cancers.  This trial compares three with six months of chemotherapy using the aforementioned FOLFOX protocol.  This trial involves an international collaboration in which more than 11,000 patients have been included, and we hope that at the outcome of this trial we will reduce the length and toxicity of treatments.
  • The second broad category of treatments for gastrointestinal cancers is aimed at the patients whose cancer has metastasized.  Sometimes surgery is a way to cure when it is possible to remove the metastases.  But in general, there has been an enormous amount of progress made in gastrointestinal cancers thanks to what is called “targeted therapies”, and thanks to these targeted  therapies, in combination with chemotherapy, life expectancies have increased.  We can’t cure all patients, but when they aren’t cured, we are able to significantly increase their life expectancy, and this is true for almost all gastrointestinal cancers. All this progress is to ascribe to these targeted therapies in conjunction with chemotherapy.

There are two broad categories of targeted therapies. The first one is represented by the    antiangiogenics, which block the vascularization of tumors.  Mainly in colo-rectal cancer and stomach cancer, they have proven, when combined with chemotherapy, to increase patients’s  life expectancy, although there is no factor that enables us to predict who will benefit the most from the treatment.  The second category of targeted therapies are proceeding from a large area  of research, that is seeing great progress, such as in lung cancer or in other cancers. They involve looking at the genetics of the tumor, the genes of the tumor, and determining the “driver” of the tumor so as to be able to decide to continue the same chemotherapy or switch to a different chemotherapy and choose a specific chemotherapy-associated treatment, a specific targeted  therapy.  Thus there are anti- EGF-R targeted molecules, anti- EGF-R monoclonal antibodies.  For colon cancer we are able to determine which patients will truly benefit from these drugs, and, thanks to all this progress, to continue to improve the prognosis of the disease, and above all to administer the right drugs to the right patients.  This is extremely important.

In addition to this clinical research, which is my focus, it is clear that we need to work in the laboratory and collaborate with in vitro research, work on cell cultures, and that we need models in order to discover new associations and determinate how they will operate in our patients.  This   pre-clinical work  leads us to find new combinations that we will develop afterwards, through   phase I (the first applications in humans), then phase II and III clinical trials. All of this  takes time, but we are continuing to make progress in the treatment of gastrointestinal cancers.