96. Jahrestagung der Deutschen Gesellschaft für Pathologie e. V ...

Kolorektales Karzinom 2
VO-005
Translating biology of colorectal cancer into clinical applications
G .A . Meijer 1
1VU University Medical Center, VU University Medical Center, Amsterdam,
Netherlands
Colorectal cancer (CRC) is one of the most common malignancies and
represents a substantial burden for society, in terms of patient suffering
as well as economically. As cancer is an evolutionary process in which
genotype drives phenotype, knowledge of the biological mechanisms
underlying CRC can help to improve patient outcome. Translational research
in CRC mainly focuses on unmet clinical needs in three stages of
the disease, i.e. early detection or screening, prognostication in primary
CRC and prediction of response to drug therapy in metastatic CRC.
As CRC develops over a number of years from a detectable precursor
(adenoma), there is a window of opportunity for early detection and curative
intervention. Our increased understanding of CRC biology, and in
particular adenoma to carcinoma progression, has yielded a number of
markers based on e.g. DNA or proteins that hold great promise for the
next generation CRC screening tests.
In primary CRC, standard UICC staging is still the most important
method for stratifying patients by risk of recurrence. Yet, the substantial
number of stage II patients that do develop recurrences, and the still
small proportion of stage III patients that actually benefit from adjuvant
therapy, underline the need for additional diagnostic arsenal. Since CRC
biologically is a heterogeneous disease, it does not come as a surprise
that there is a large number of markers for which some level of evidence
exists that they could have additional prognostic value. The main challenge
here is to make the next step to get these markers validated and
implemented in routine diagnostic practice.
In a similar way, much translational research has successfully translated
biology of CRC into diagnostic tests that more rapidly have been implemented,
like KRAS testing for anti-EGFR therapy. The fact that these
predictive markers have entered the field much more rapidly than the
prognostic markers most likely is associated with more efficient business
development, stimulated by the companion diagnostic concept. Yet, also
here challenges remain, as because of the complexity of CRC biology it
is much more likely that we will have complex decision trees rather than
single parameter tests to stratify patients for drug therapy. The exciting
developments that will bring whole cancer genome sequencing within
the reach of pathologists will eliminate current barriers for the full exploration
of tumor biology for the purpose of diagnostic pathology.
Keynote Lecture
VO-007
Deep Sequencing - new frontiers in GI-tumor pathology
N . Papadopoulos
Johns Hopkins University, Baltimore, USA
Inflammatory bowel diseases represent a chronic disorder accompanying
mostly young people throughout their life. Thus therapeutic strategies
allowing for a normal life are mandatory. Although the incidence is
increasing and the research of the last decades provides a detailed view
of the pathogenesis, the available therapeutic strategies are still symptomatic.
The primary aim is to induce a stable remission. Depending on
disease localization as well as associated complications such as fistulas,
abscesses and malnutrition, the therapeutic strategies range from local
applications up to systemic immunosuppressive medications. Despite
the availability of highly potent agents including azathioprine, calci-
neurin inhibitors as well as anti-TNF antibodies, there is still a subset
of patients that remains with active disease. Thus it is crucial to predict
the disease course early on, in order to decide whether early aggressive
therapy is required or a less aggressive treatment is sufficient. Some factors
helping with this decision have already been identified. Novel data
suggest that the expression profile of CD8+ cells may help in predicting
the disease course. However, these data will have to be confirmed in
prospective studies. Equally important is the question when immunosuppressive
therapies can be paused with low risk. Do we need clinical,
endoscopic or even histological remission? On a long-term view mucosal
healing gains impact since it reduces the risk of developing colorectal
cancer. The discussed points emphasize that therapeutic strategies in
inflammatory bowel diseases represent an increasingly individualized
therapy in order to allow for a high life quality of our patients.
Primäre Entzündungen im GI-Trakt
VO-008
Clinical view and novel therapeutic strategies in inflammatory
bowel diseases
B . Siegmund1 1Charité – Universitätsmedizin Berlin, Klinik für Gastroenterologie, Infektiologie
und Rheumatologie der Charite Campus Benjamin Franklin, Berlin
Inflammatory bowel diseases represent a chronic disorder accompanying
mostly young people throughout their life. Thus therapeutic strategies
allowing for a normal life are mandatory. Although the incidence is
increasing and the research of the last decades provides a detailed view
of the pathogenesis, the available therapeutic strategies are still symptomatic.
The primary aim is to induce a stable remission. Depending on
disease localization as well as associated complications such as fistulas,
abscesses and malnutrition, the therapeutic strategies range from local
applications up to systemic immunosuppressive medications. Despite
the availability of highly potent agents including azathioprine, calcineurin
inhibitors as well as anti-TNF antibodies, there is still a subset
of patients that remains with active disease. Thus it is crucial to predict
the disease course early on, in order to decide whether early aggressive
therapy is required or a less aggressive treatment is sufficient. Some factors
helping with this decision have already been identified. Novel data
suggest that the expression profile of CD8+ cells may help in predicting
the disease course. However, these data will have to be confirmed in
prospective studies. Equally important is the question when immunosuppressive
therapies can be paused with low risk. Do we need clinical,
endoscopic or even histological remission? On a long-term view mucosal
healing gains impact since it reduces the risk of developing colorectal
cancer. The discussed points emphasize that therapeutic strategies in
inflammatory bowel diseases represent an increasingly individualized
therapy in order to allow for a high life quality of our patients.
VO-010
Microscopic colitis: clinical appearance and therapy
S . Miehlke1 1Magen-Darm-Zentrum, Hamburg
Microscopic colitis (MC) is a chronic inflammatory bowel disease which
is increasingly recognized as a common cause of chronic, non-bloody
diarrhoea. Besides watery diarrhea, many patients also suffer from abdominal
pain, weight loss and fecal incontinence which severely deteriorate
their quality of life. There is a female predominance with an average
age at diagnosis around 60 years. Smoking appears to be a relevant risk
factor. Epidemiological studies have shown a rising incidence in the last
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