My second presentation I was asked to talk about the GI oncologist of the future, what is going to happen ten, fifteen, twenty years from now. It’s interesting, the best predictor of future is performance of the past – what did we think would happen ten years ago? Ten years ago people might have thought we might have flying cars right now. We don’t have flying cars but we have the iPhone which was started in 2007 actually. So it shows us information, how we connect with databases is a very critical part that will change in the future too. So I believe that one of the most critical differences between now and what’s going to happen in the future is how we interact with patients, how patients will have access to medical knowledge, to physicians, to their care. I believe that within 10-15 years patients will wear devices which will continuously monitor their performance while in clinical trials and in real life practice we’ll have continuous information transmitted from patients into our hands so that we can look at toxicities early, we can modify treatments early. Patients won’t have to wait to come back for, say, a three or four week appointment. That’s going to change dramatically how we interact with patients.

Then there are other things. I do believe that immunotherapies that are en vogue right now will make inroads into cancers that are not immunogenic right now. We’ll develop tools to get the T-cells into the tumour, activate immunogenicity of cancers and really use immunotherapy in virtually all solid tumours in first line. I don’t think chemotherapy will disappear but chemotherapy and immunotherapy work hand in hand.

The third point is we’ll have different diagnostic tools. Right now when we look at tumour markers we’ll talk about CEA, CA19-9 etc. We’ll change things, we’ll look at more tumour based markers like circulating tumour DNA, like DNA methylation markers. This will completely change the way we follow patients. After surgery, for instance, we’ll not do imaging scans to look for potential metastases that might appear, we’ll look for circulating tumour DNA or other markers that might come up in the future to really monitor patients over time. Get rid of CT scans, get rid of MRI imaging over time but only use them when we identify that patients have a surge in their circulating marker that we are following and then identify whether this patient might be a candidate for surgical intervention.

So we’ll have the interaction piece which will change how we interact with patients, more access to detailed information about patients and databases connected with their cancer. Secondly the circulating markers which we will identify and thirdly, of course, immunotherapy that will make inroads into more and more cancers.