Colorectal surgeon Dr. Julio Garcia-Aguilar says there are a growing number of ways to treat colon and rectal cancer including advances in targeted therapy, surgery, and immunotherapy that can also preserve quality of life.
Colorectal cancer, which includes cancer of both the colon and the rectum, is the third most common cancer in both men and women in the United States.
There is encouraging news about the disease on many fronts. Overall, the incidence of colorectal cancer is decreasing, and so are deaths. In 2025, the American Cancer Society said that “colorectal cancer death rates in the past decade have decreased by 1.2% per year for both men and women.” The group credits “earlier detection in screening and improvements in treatment.” Many of these advances have been developed at Memorial Sloan Kettering Cancer Center (MSK).
A disturbing trend involving younger people is undercutting some of these gains, however. Researchers at MSK are racing to understand why more people under 50 are developing colorectal cancer — and dying from it. To help, MSK created the first center in the world devoted to the specific needs of these younger adults, the Center for Young Onset Colorectal and Gastrointestinal Cancer.
The specialists at MSK are determined to help everyone facing colorectal cancer with the latest advances, which help to save lives and preserve a good quality of life.
“The way we approach colorectal cancer has really changed in recent years,” says colorectal surgeon Julio Garcia-Aguilar, MD, PhD, Chief of the Colorectal Service. “We have become much more selective about the treatments we use. We are customizing treatment more for each patient. We are constantly searching for more cure with less treatment, to provide the highest quality of life. That could mean less radiation, or no surgery, or in some cases even using immunotherapy alone.”
Here are the biggest advances in treating colorectal cancer happening now at MSK:
New Targeted Therapy To Treat Colorectal Cancer Caused by KRAS-G12C Mutation
MSK helped develop a new drug combination that received accelerated approval from the U.S. Food and Drug Administration (FDA) for people with advanced colorectal cancer caused by a gene mutation called KRAS-G12C.
The targeted therapy, called adagrasib (Krazati®), is the first KRAS-targeting drug to be approved for colorectal cancer. When given in combination with an older drug called cetuximab, this double-barreled approach stopped or shrank tumors in a clinical trial involving 94 patients that was led by researchers at MSK.
“Since we started this trial, I have had people coming to me from all over to receive this treatment,” says MSK gastrointestinal medical oncologist and early drug development specialist Rona Yaeger, MD. “Now that this drug combination is approved, many more patients will be able to benefit.”
About 4% of all colorectal cancers have the KRAS-G12C mutation. It can be detected with tumor-sequencing tests such as MSK-IMPACT®.
Surgical Advances for Colorectal Cancer That Save Lives and Preserve Quality of Life
Specialists at MSK are committed to maintaining the highest possible quality of life while successfully treating colorectal cancer. That includes using the latest treatments and innovating new advances.
Robotic Surgery for Colorectal Cancer
Robot-assisted surgery is a type of operation called minimally invasive surgery. Minimally invasive surgery requires several small incisions rather than a large one used in conventional surgery.
“This means less postoperative pain, lower infection rates at the surgical site, and a lower risk of complications such as bowel obstruction and abdominal hernia,” says Dr. Garcia-Aguilar.
In robotic surgery, a surgeon sits at a console and uses hand and foot controls to manipulate interactive robotic arms equipped with a high-definition vision system. Surgeons can see the site of operation better because the “eyes” of the device — the camera — can go very close to the tissue and project a 3D image that’s then magnified tenfold. In addition, the robot takes the surgeon’s motions and scales them down.
“These enhancements make it easier for the surgeon to work with more precision, which should lower complication risks even further while maintaining good outcomes regarding the treatment of the cancer,” says Dr. Garcia-Aguilar.
At MSK, close to half of the surgeries just for colorectal cancer are done robotically, says Dr. Garcia-Aguilar. A leader in the volume of robotic colorectal surgeries nationwide, MSK performed more than 700 in 2023 alone.
Avoiding Surgery with a Watch-and-Wait Approach for Rectal Cancer
MSK is also a leader in treating rectal cancer with an approach called “watch and wait.” The aim is to spare people surgery when possible to remove the tumor — the standard of care for rectal cancer. Unfortunately, this operation often compromises quality of life by disrupting bowel, bladder, and sexual function.
Instead of surgery, doctors treat the person’s rectal cancer with radiation and chemotherapy to shrink or eliminate the tumor. Then they closely monitor the patient, watching for any sign that the cancer has grown back. If it does, they’re able to intervene quickly.
Recent research shows the benefits of watch and wait: an enhanced quality of life with survival rates that are identical to patients who have their rectums surgically removed.
“Around 50% of rectal cancer patients at MSK avoid surgery,” says Dr. Garcia-Aguilar. “Some are patients who come here to get a second opinion after being told removing the rectum is the only option for a cure.”
Researchers at MSK are constantly refining their insights into which rectal cancer patients are most likely to benefit from the watch-and-wait approach. And Dr. Garcia-Aguilar reports that there are patients visiting him 10 years after their cancer was successfully treated at MSK without surgery, grateful for their higher quality of life.
Sparing a Rectal Cancer Surgery Patient From Radiation for Rectal Cancer
Another approach to rectal cancer treatment at MSK found that some patients who need to undergo surgery can be spared radiation. In a clinical trial involving more than 1,100 people with rectal cancer that had not spread to other organs, participants who received a type of chemotherapy regimen called FOLFOX alone before surgery did just as well as those who underwent both chemotherapy and radiation before surgery.
Skipping radiation can improve patients’ quality of life, including the preservation of fertility, sexual function, and more.
Preserving Fertility for Colorectal Cancer Patients Despite Radiation
Another innovative approach when radiation is needed to treat rectal cancer preserves a patient’s ability to become pregnant after treatment. A surgical procedure called a “uterine transposition” involves temporarily moving the ovaries and uterus up the abdominal wall and out of the pelvis, away from the direct radiation field.
After radiation therapy is complete, a second procedure moves the organs back, so a patient can conceive and give birth.
Using Immunotherapy for Rectal Cancer Without Surgery, Radiation or Chemotherapy
A small but heralded clinical trial at MSK uses a form of immunotherapy alone to successfully treat patients whose local rectal cancer tumors have a specific genetic characteristic. The genetic mutation, called MMRd (Mismatch Repair Deficient), is found in about 5% of people with rectal cancer.
In the trial, participants were given a form of immunotherapy called an immune checkpoint blockade, which unlocks the power of the body’s own immune system to identify and destroy cancer cells. “We knew that this approach worked in patients with advanced tumors that had spread to other organs, but at MSK we were pioneers in using it in patients with localized rectal cancer,” says Dr. Garcia-Aguilar.
So far, 100% of the more than 40 participants in the trial have seen their tumors disappear, without the need for surgery, chemotherapy, or radiation. Some people who took part in the trial have gone on to have children, which may have been impossible following standard of care treatment.
In late 2024, the approach took a step toward approval by the FDA, which gave the effort “Breakthrough Therapy Designation.” The approach is already being used by doctors around the world. Dr. Garcia-Aguilar says this treatment option “has opened the door” to a new way of treating rectal cancer.
Helping People With an Inherited Risk of Colorectal Cancer
In some families, genetic mutations passed from generation to generation can raise the risk of developing colorectal cancer. For example, Lynch syndrome can significantly raise the risk of colon and rectal cancers. MSK has CATCH, a one-of-a-kind program to help monitor families with Lynch syndrome.
Treating Metastatic Colorectal Cancer
Stage 4 or metastatic colorectal cancer occurs when the tumors spread to other organs, such as the liver or lungs. MSK offers several options for treating stage 4 colorectal cancer including surgery, chemotherapy, immunotherapy, and radiation.
MSK experts are especially skilled at using hepatic arterial infusion (HAI) to deliver chemotherapy drugs directly to the liver through a tiny pump that is implanted under the skin in the lower abdomen. This pump delivers treatment directly to where a tumor is located. This device, the size of a hockey puck, has given patients the possibility of living long term with liver metastases that started in the colon or rectum.
New Colorectal Cancer Clinical Trials
MSK has one of the largest clinical trial research programs in the country. As a result, patients treated at MSK have access to the latest investigational treatments before they are available at other hospitals.
For example, MSK is investigating a therapeutic cancer vaccine for colorectal and pancreatic cancers with certain KRAS mutations in patients who are at high risk of relapse after surgery.
Participants in an early phase clinical trial were given a vaccine to trigger their immune systems to fight the cancer. The vaccine was ready-made (as opposed to being produced individually for each patient.) Preliminary results were promising, and researchers are continuing to analyze whether patients whose immune system responded to the vaccine experienced a longer time without the disease returning.
You can learn more here about current clinical trials for colorectal cancer.
For Dr. Garcia-Aguilar, all of these research and treatment advances make MSK a top choice for people facing a diagnosis of colorectal cancer. “One of the distinctive features of MSK is that we really personalize our care to each individual patient. We have developed or adopted the most innovative treatments in the field. And we treat everyone with compassion, focusing on what matters to them most.”