Bowel cancer, also known as colorectal cancer, can affect any part of the colon or rectum; it may also be referred to as colon cancer or rectal cancer, depending on where the cancer is located.
Bowel cancer screening is for people who do not already have bowel cancer, symptoms of bowel cancer, or any reason to have a high risk of bowel cancer.
Patient-centred care is healthcare that is respectful of, and responsive to, the preferences, needs and values of patients and consumers.
Bowel Cancer Australia provides essential support services uniquely designed for bowel cancer patients via our confidential Helpline with specialist telehealth support, as well as a national Peer-to-Peer Support Network and Buddy Program.
Bowel Cancer Australia funds research that has the potential to improve survival and/or help build a path toward a cure and integrates published research into our awareness, advocacy, and support strategies.
Bowel Cancer Australia relies upon donations and the support of hard working and enthusiastic fundraisers across the country to continue our life saving work. We raise funds to continue our life-saving work and inspire others to do the same, so everyone affected by bowel cancer can live their best life.
The development of targeted therapy, or precision medicine, is an exciting step in the treatment of metastatic bowel cancer as it may make it possible to identify and destroy specific cancer cells without harming or damaging other normal healthy cells.
Targeted therapy is usually given in combination with other standard chemotherapy treatment and makes it possible for your oncologist to tailor your treatment program to:
These treatments may:
Types of targeted therapies used in the treatment of bowel cancer including the following:
Monoclonal antibodies are made in the laboratory from a single type of immune system cell.
These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow.
The antibodies attached to the substances and kill the cancer cells, block their growth, or keep them from spreading.
Monoclonal antibodies are given by infusion.
They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.
There are different types of monoclonal antibody therapy:
Angiogenesis inhibitors stop the growth of new blood vessels that tumours need to grow.
Before any new pharmaceutical drug, diagnostic test, medical device, surgically implanted prostheses, medical procedure, or public health intervention becomes available in Australia, it must undergo health technology assessment (HTA).
At what stage is this treatment used?
Bevacizumab (Avastin) is an antibody drug that binds to and neutralizes a protein called VEGF-A.
It is effective as first-line treatment for metastatic bowel cancer and is used in combination with chemotherapy.
The drug is also approved as part of second-line treatment in combination with chemotherapy.
Patients receive bevacizumab as an intravenous infusion every two weeks and can be scheduled on the same day that chemotherapy is given.
Patients may continue bevacizumab even after stopping chemotherapy, as long as the disease is controlled and side effects are manageable.
Is this drug available via the Pharmaceutical Benefits Scheme (PBS) as a subsidised treatment?
Download the Consumer Medicine Information (CMI) for Mvasi.
Encorafenib is an anti-cancer medicine, which belongs to a group of medicines called ‘BRAF inhibitors’.
Braftovi can be used in combination with cetuximab for the targeted treatment of patients with BRAF V600E-variant metastatic bowel cancer who have received prior systemic therapy.
Before you start treatment, your doctor will have tested your tumour to confirm that it has a BRAF mutation.
Download the Consumer Medicine Information (CMI) for Encorafenib.
Cetuximab is used as a first or second-line treatment option for patients with epidermal growth factor receptor (EGFR)-expressing, RAS wild-type metastatic bowel cancer in combination with chemotherapy.
Cetuximab can also be given as a single agent in patients who have failed or are intolerant to oxaliplatin-based therapy and irinotecan-based therapy.
Before you are prescribed cetuximab, your specialist will test your cancer cells to see if they contain either the normal (wild-type) or mutant forms of genes called RAS.
Cetuximab is used to treat patients who express normal (wild-type) RAS genes.
Download the Consumer Medicine Information (CMI) for Cetuximab.
Regorafenib (Stivarga), a targeted therapy that comes in pill form, is a tyrosine kinase inhibitor (TKI).
This kind of treatment is designed to target cancer cells and the blood vessels feeding them by interfering with chemical signals or pathways inside abnormal cells.
Regorafenib targets the signaling of multiple growth factors involved in tumor angiogenesis, including VEGF receptors, Fibroblast Growth Factor (FGF) receptors, Platelet-Derived Growth Factor (PDGF) receptors, and the angiopoietin receptor TIE-2. Additional targets of regorafenib include RAF, BRAF, RET and KIT.
Regorafenib is approved for treating patients with metastatic) bowel cancer in the third-line setting, after the cancer has progressed or has recurred after multiple treatments.
Download the Consumer Medicine Information (CMI) for Stivarga.
Panitumumab is used as a first or second-line treatment option for patients with epidermal growth factor receptor (EGFR)-expressing, RAS wild-type metastatic bowel cancer in combination with chemotherapy.
Panitumumab can also be given as a single agent in patients who have failed or are intolerant to oxaliplatin-based therapy and irinotecan-based therapy.
Before you are prescribed panitumumab, your specialist will test your cancer cells to see if they contain either the normal (wild-type) or mutant forms of genes called RAS.
Panitumumab is used to treat patients who express normal (wild-type) RAS genes.
Download the Consumer Medicine Information (CMI) for Vectibix.
Aflibercept (Zaltrap) is a type of targeted drug known as a fusion protein. This drug is designed to target multiple growth factors involved in cancer and angiogenesis, specifically proteins called VEGF-A, VEGF-B and a related protein called placental growth factor (PlGF).
Aflibercept is approved for use as treatment in second-line therapy in combination with chemotherapy (FOLFIRI) for metastatic bowel cancer.
Immunotherapy is treatment that uses the patient’s immune system to fight cancer.
Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defences against cancer.
This type of cancer treatment is also called biotherapy or biologic therapy.
Your immune system is a collection of organs, special cells, and substances that help protect you from infections and some other diseases.
Immune cells and the substances they make travel through your body to protect it from germs that cause infections. They also help protect you from cancer in some ways.
The immune system keeps track of all of the substances normally found in the body.
Any new substance that the immune system doesn’t recognise raises an alarm, causing the immune system to attack it. For example, germs contain substances such as certain proteins that are not normally found in the human body.
The immune system sees these as ‘foreign’ and attacks them. The immune response can destroy anything containing the foreign substance, such as germs or cancer cells.
The immune system has a tougher time targeting cancer cells, though. This is because cancer starts when cells become altered and start to grow out of control. The immune system doesn’t always recognise cancer cells as foreign.
Clearly there are limits on the immune system’s ability to fight cancer on its own, because many people with healthy immune systems still develop cancer.
Sometimes the immune system doesn’t see the cancer cells as foreign because the cells aren’t different enough from normal cells. Sometimes the immune system recognises the cancer cells, but the response might not be strong enough to destroy the cancer. Cancer cells themselves can also give off substances that keep the immune system in check.
To overcome this, researchers have found ways to help the immune system recognise cancer cells and strengthen its response so that it will destroy them.
Immunotherapy drugs are now used to treat many different types of cancer.
The main types of immunotherapy now being used to treat cancer include:
Monoclonal antibodies are man-made versions of immune system proteins. Antibodies can be very useful in treating cancer because they can be designed to attack a very specific part of a cancer cell.
Immune checkpoint inhibitors are drugs basically take the ‘brakes’ off the immune system, which helps it recognise and attack cancer cells.
Cancer vaccines are substances put into the body to start an immune response against certain diseases. We usually think of them as being given to healthy people to help prevent infections. But some vaccines can help prevent or treat cancer.
Other, non-specific immunotherapies are treatments boost the immune system in a general way, but this can still help the immune system attack cancer cells.
An important part of the immune system is its ability to keep itself from attacking the body’s normal cells.
To do this, it uses ‘checkpoint’ proteins on immune cells, which act like switches that need to be turned on (or off) to start an immune response.
Cancer cells sometimes use these checkpoints to keep the immune system from attacking them. Drugs that target these checkpoints hold a lot of promise as cancer treatments.
Pembrolizumab (Keytruda) and Nivolumab (Opdivo) are drugs that target PD-1 (programmed cell death protein 1).
PD-1 is a protein found on the surface of immune system cells called T cells. It normally helps keep these cells from attacking ‘good’ cells in the body.
When PD-1 attaches to another protein called PDL-1 on a cancer cell, it stops the T cell from killing the cancer cell. PD-1 inhibitors attach to PDL-1 and allow the T cells to kill cancer cells.
Pembrolizumab and nivolumab block the cancer cells’ ability to attach to PD-1, so, the immune system can then ‘see’ the cells as ‘bad’.
This boosts the immune response against the cancer cells and can shrink some tumors or slow their growth.
These drugs can be used for people whose bowel cancer cells have tested positive for specific gene changes, such as a high level of microsatellite instability (MSI-H), or changes in one of the mismatch repair (MMR) genes.
The drugs are used for people whose cancer is still growing after treatment with chemotherapy.
They might also be used to treat people whose cancer can’t be removed with surgery, has come back (recurred) after treatment, or has spread to other parts of the body (metastasised).
Pembrolizumab (Keytruda) is given as an intravenous (IV) infusion. Treatment takes about 30 minutes and is given every three weeks.
Nivolumab (Opdivo) is given as an intravenous (IV) infusion. Treatment takes around one hour and is given every two weeks.
The US Food and Drug Administration (FDA) granted accelerated approval to a treatment for patients whose cancers have a specific genetic feature (biomarker) in May 2017.
This is the first time the agency has approved a cancer treatment based on a common biomarker rather than the location in the body where the tumor originated.
Keytruda is indicated for the treatment of patients with unresectable or metastatic solid tumors that have been identified as having a biomarker referred to as microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR).
This indication covers patients with solid tumors that have progressed following prior treatment and who have no satisfactory alternative treatment options and patients with bowel cancer that has progressed following treatment with certain chemotherapy drugs.
MSI-H and dMMR tumors contain abnormalities that affect the proper repair of DNA inside the cell.
Tumors with these biomarkers are most commonly found in bowel, endometrial and gastrointestinal cancers, but also less commonly appear in cancers arising in the breast, prostate, bladder, thyroid gland and other places.
Approximately five percent of patients with metastatic bowel cancer have MSI-H or dMMR tumors.
Keytruda works by targeting the cellular pathway known as PD-1/PD-L1 (proteins found on the body’s immune cells and some cancer cells). By blocking this pathway, Keytruda may help the body’s immune system fight the cancer cells.
Keytruda is currently listed on the PBS as a first-line treatment for previously untreated unresectable or metastatic deficient mismatch repair (dMMR) bowel cancer.
Download the Consumer Medicine Information (CMI) for Keytruda.
In July 2017, the US Food and Drug Administration (FDA) granted accelerated approval to nivolumab (Opdivo) for the treatment of patients twelve years and older with mismatch repair deficient (dMMR) and microsatellite instability high (MSI-H) metastatic bowel cancer that has progressed following treatment with a fluoropyrimidine, oxaliplatin, and irinotecan.
The approval was based on data from Study CA209142, a multicenter, open-label, single arm study conducted in 53 patients with locally determined dMMR or MSI-H metastatic bowel cancer who had disease progression during, after, or were intolerant to prior treatment with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy.
This was a subset of the 74 patients who received at least one prior regimen for treatment of metastatic disease containing a fluoropyrimidine with oxaliplatin or irinotecan for treatment of metastatic disease. All patients received nivolumab 3 mg/kg by intravenous infusion every 2 weeks until unacceptable toxicity or radiographic progression.
Opdivo has not been approved by the Therapeutic Goods Administration (TGA) for use in Australia as a treatment option for bowel cancer, and is not currently listed on the PBS as a subsidised treatment.
The Patient Access Gap refers to the time in days patients must wait between the date a medicine is authorised for use in Australia – Therapeutic Goods Administration (TGA) approved / Australian Register of Therapeutic Goods (ARTG) listed and the date that it is listed on the Pharmaceutical Benefits Scheme (PBS) and affordably available.
Bowel cancer patients have experienced some of the longest waits, with one life-extending medication taking more than six years and a record eight submissions before being listed on the PBS as a subsidised treatment.
Cancer treatment is time sensitive, and many patients don’t have time to wait, which is why Bowel Cancer Australia advocates for immediate access following approval of a drug, so patients can benefit from treatments, particularly life-saving drugs, while PBAC processes and price negotiations continue.
View our advocacy priorities
Bowel Cancer Australia’s essential support services are uniquely designed for you.
Email, call of video chat confidentially with one of our friendly nurses, nutritionists, or psychosocial support worker, plus access our resources, peer-to-peer buddy program, support group or podcast.