The FP7 APO-DECIDE colorectal cancer research project, has made significant strides in researching better diagnostic and predictive tools for colorectal cancer.

APO-DECIDE is led by RCSI, and also involves the Beaumont Hospital, OncoMark Ltd (Dublin), Queen's University Belfast, Universite Paris Descartes, Optimata Ltd (Israel), Pintail Ltd (Dublin) and Frankfurt's Goethe University Clinic.

The consortium's goal is to develop new clinical decision-making tools that enable personalised medicine approaches to cancer therapy, and more effective/targeted clinical trials design in the future. Predictive tools being developed by APO-DECIDE could potentially improve therapy for up to 70% of high-risk stage 2 and 3 colorectal cancer sufferers who will experience progression of their cancer, despite chemotherapy treatment.

Colorectal cancer is one of the most lethal of all cancers as it has no early symptoms and often remains undiagnosed until the illness is far advanced, and thus is difficult to treat. Even after diagnosis, many patients whose cancer has been detected don't respond to the standard chemotherapy treatment. Different individuals will respond in different ways to various cancer therapy approaches, such as chemotherapy, radiotherapy or drug treatments, but this individual response is difficult to predict; as a result, most patients get similar, worst-case-scenario therapy. Not only does this expose them to harsh treatments and to unpleasant side-effects, but it also delays the decision to use other therapies that might work better for them.

Since the project started in November 2012, the multi-national team, led by RCSI, has made excellent progress addressing the challenges associated with prescribing the appropriate treatments for patients including:

• Towards development of a blood test for colorectal cancer: APO-DECIDE is exploring the concept that specific proteins that circulate in the blood can be associated with good prognosis of colorectal cancer. The presence of these proteins in the blood opens up the possibility of a blood test for colorectal cancer, and potentially simpler, less unpleasant and much cheaper screening for the disease. 
• Computer model to predict response to existing treatments: A computer model of disease progression, developed by the unique multi-disciplinary systems medicine team at RCSI, is already generating data to guide treatment choices for individual colorectal cancer patients. While the model is still in development and testing, the potential for personalised medicine, and for avoiding therapies to which a patient does not respond, is very exciting. 
• Computer model to investigate new treatments: A detailed computer model of how cancer develops in the body, and the cells, proteins, genes and other components that influence whether cancer develops or not, is also being created. This will support the investigation of new therapies and help to suggest better drugs to treat cancer in the future.

Explaining the research, Professor Jochen Prehn, Principal Investigator, Department of Physiology and Medical Physics, said: "A small number of protein biomarkers linked to control of cell death were assessed in colorectal cancer tissues. This panel of biomarkers, when combined together using the sophisticated computational model developed by RCSI, offered predictive ability in terms of determining potential response to classical forms of chemotherapy used in this disease setting."

An advanced image analysis used in the research was developed by the emerging molecular diagnostics spin-out, OncoMark Limited.

Colorectal cancer has the second highest death toll - after lung cancer (men), breast cancer (women)] of all cancers. 1.2 million new cases are diagnosed annually worldwide with one in 20 chance of each individual developing the disease. It results in 608,700 deaths annually, which accounts for 8% of the total of 7.6 million cancer deaths.