Targeting Tumors: New Weapons in Gastrointestinal Cancer Therapy

Gastrointestinal (GI) cancers remain among the most common and deadly malignancies worldwide, accounting for nearly 1 in 4 cancer-related deaths globally.¹ Despite improvements in screening and diagnostics, many patients are diagnosed at an advanced stage, where treatment options have historically been limited and outcomes suboptimal.

Now, a review published ahead of print in Clinical Advances in Hematology & Oncology highlights several recent advances in GI oncology, particularly for colorectal and pancreatic cancers, offering new hope and new challenges for prescribers and pharmacists alike.²

The New Front Line

Gastrointestinal cancers are among the most common | Image credit: Crystal light | stock.adobe.com

A team of researchers summarized key regulatory approvals, clinical trials, and novel mechanisms of action that are shaping today’s GI oncology treatment landscape. The review highlights several new therapies and expanded indications, including oral tyrosine kinase inhibitors and HER2-targeted therapeutic options.²

Major developments include fruquintinib (Fruzaqla; Takeda), which was FDA-approved in 2023 for refractory metastatic colorectal cancer. This oral VEGFR inhibitor helps block tumor angiogenesis and may offer a new option for patients who have had multiple failed treatments.²

Additionally, the combination of tucatinib (Tukysa; Pfizer) and trastuzumab (Enhertu; Daiichi-Sankyo, AstraZeneca), already used for HER2-positive breast cancer, is now approved for HER2-positive metastatic colorectal cancer (CRC0. This combination offers an alternative to cycotoxic regimens in select patients.²

Finally, trifluridine-tipiracil (Lonsurf; Taiho Oncology) continues to be a cornerstone of late-line CRC management. New data further support its use in combination strategies for prolonged benefit.²

The Pharmacist Battle Strategy: What You Should Know

Oral agents such as fruquintinib and trifluridine-tipiracil require clear counseling on adherence, common toxicities (including hypertension and hand-foot syndrome), and cycle-based dosing schedules. Pharmacists should also be aware that tucatinib is a CYP3A4 substrate, necessitating caution when it is coadministered with common outpatient drugs. Frequent laboratory monitoring for neutropenia, liver enzymes, and blood pressure is essential—particularly in older patients who may have diminished organ function or face increased polypharmacy risks.

Pharmacists play a key role in patient education by helping individuals distinguish between manageable adverse effects and those that require medical intervention, such as febrile neutropenia or severe diarrhea. Consultant pharmacists should closely assess cumulative toxicity and renal dosing, especially in long-term care or assisted living settings where geriatric patients are more vulnerable. In emergency settings, pharmacists must be prepared to recognize complications such as hypertensive crisis or chemotherapy-induced dehydration, ensuring timely intervention and continuity of care.

Clinical Impact

The researchers conclude that staying up to date with these evolving regimens is critical as treatment paradigms continue to shift away from 1-size-fits-all chemotherapy.² Pharmacists across all settings have significant responsibilities in monitoring, managing adverse effects, and improving outcomes through patient education and interdisciplinary collaboration.

As medication experts, pharmacists must remain continuously updated in rapidly evolving fields like hematology and oncology. Staying informed on emerging therapies, expanded indications, and clinical guidelines is essential to delivering safe, effective, and personalized care across all practice settings.

REFERENCES

1. Arnold M, Abnet CC, Neale RE, et al. Global burden of 5 major types of gastrointestinal cancer. Gastroenterology. 2020;159(1):335-349.e15. doi:10.1053/j.gastro.2020.02.068

2. Chong X, Madeti Y, Cai J, et al. Recent developments in immunotherapy for gastrointestinal tract cancers. J Hematol Oncol. 2024;17:65. doi:10.1186/s13045-024-01578-x