Highlights

The elderly patients that have MSI-H, they tend to be concurrent with BRAF mutants a lot. And those are the majority of MSI-H patients anyway. So, it is common to have BRAF V600E mutation with MSI-high tumors in those patients… It’s hard [to compare the efficacy of checkpoint inhibitors and Braftovi in this population] because these are all small subsets of small subsets. But probably the question is – if you have BRAF mutant MSI-H tumors and you’re in second line and have not had either option yet, what’s your
choice going to be? Probably it’s going to be the immunotherapy because the outcomes are just so dramatically better. Now, you may fall back on encorafenib therapies later if they progress. But I think then if you were to pool oncologists they would all pick immunotherapy, and similarly now it’s sort of standard to give this to all first-line patients.

As a GI medical oncologist who already uses anti-HER2 therapy routinely in gastroesophageal cancer, there is evidence mounting for HER2 application in colon, where it’s around 5% of patients… It’s now on the NCCN guidelines to consider using these agents – at least lapatinib and trastuzumab… So, yes, we routinely check for and use HER2 therapies in these patients. Now, clinical trials are always preferred [for non-approved drugs] and there are many of them… But if you can’t get on a study or there’s not one available, then all of these options are available in the US as an off-label approach… I think that if you’re not [screening for HER2] yet, you will be. But we’ve been doing that for some time. And the benefit of doing next-generation sequencing on a panel is that you get it all anyway whether you’re looking for it or not. And so, HER2 is one of many things on these panels then you’ll find it if it’s there. One in 20 patients.