Episode 126: In the Clinic - Peri-operative therapy in Colon Cancer with Professor Jenny Seligmann (part2)

Simply Oncology Podcast Recording Perioperative SACT CRC-20260925_110507-Meeting Recording September 25, 2026, 10:05AM 54m 40s Welcome to the second part in of the Simply Oncology podcast, looking at perioperative colon cancer therapy. We are back with the wonderful Professor Jenny Seligman from Leeds, St. James's Cancer Hospital there. Jenny, welcome back.

Jenny Seligmann 54:26 Thank you for having me. It's lovely to be here.

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So Jenny following on from our previous conversation. What's your favourite foxtrot?

Jenny Seligmann 29:02 Well, we're still a bit silly. So our translational is Foxtrot Tango. So, you know, we're... ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 29:07 No, see, see, that's what's confused you. Jenny Seligmann 29:11 We've got, we do, we move, but we move in a in a in a in a fun way. So, so my favourite Foxtrot has got to be Foxtrot 3, so an important thing. So, we are, so number one, we've got Foxtrot 4, so that's in B. Rafputin. So Janet Graham is leading on that. She's doing a great job. It's really hard. There's only about 5% of B. Rafputin patients. So we're picking off those groups. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 29:26 Mhm. Yeah. Jenny Seligmann 29:33 group and treating them with encarafenib and cetuximab, which we discussed earlier. And Foxtrot 7 will be looking at giving immunotherapy, but to PMMR patients. I can't tell you what drugs yet because we haven't signed any contracts, but that's Maybe A, maybe a, maybe a bispecific. Maybe A bispecific. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 30:01 You see what I mean? That's a great question. Thanks. It could be a LAG-3 inhibitor. Lots of things. Jenny Seligmann 30:08 Yeah, so I'll give you that and we're really excited about that because there's some data to suggest if you've got the primary tumour inside you, you're more likely to respond to immunotherapy and there's some initial good results. But back to my favourite Foxtrot, has to be Foxtrot 3 because without an arm for all comers, you can't recruit arms for molecular subgroups. So without without an old comers question, we know this from other trials, you can't recruit to you can't recruit to molecularly selected to the sexy arms without the arm that just keeps things going. So Foxtrot 3 ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 30:31 Mhm. Jenny Seligmann 30:46 Quite simple. Can you escalate chemotherapy? So, giving full Fox to improve responses compared to Fox alone may not be the sexiest question, but it's quite an obvious question. We've recruited 450 patients already. We've got another 400 to go. We're doing serial CTDNAs and things like that to improve patient selection. So, this is our, you know, our ground trial. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 30:47 The. Mhm. Mhm. Jenny Seligmann 31:09 which then the other ones can build off. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 31:14 Brilliant. And so when we pass Foxtrot, you mentioned aerial. Jenny Seligmann 31:14 Yeah. Yeah. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 31:21 I'm guessing it's not the washing up powder. I'm guessing it's something to do with colon cancer. Jenny Seligmann 31:27 Well, it's a really good point because we had a lot of a bit some of our biggest debate of the aerial trial was what would be our trial logo because aerial was different for everyone. And this was this was actually a real, you know, 45 minute conversation. So for me is with you, is with the washing powder. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 31:36 Oh, yeah. Yeah. Jenny Seligmann 31:46 Well, no, it wasn't for me, actually. Mine was The Little Mermaid. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 31:49 I thought, yeah, yeah, under the sea. Jenny Seligmann 31:51 But then our PPI group didn't really like. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 31:55 It might be a little bit of flipping. Jenny Seligmann 31:58 They thought it might be a little bit flippant to have a picture of a mermaid, but washing up powder, aerials on the top of houses, that was kind of my dad's age group. Yep. And in the end, Richard Adams, who had just been on a safari, remembered that there was a gazelle type thing called an aerial. So we ended up with a gazelle. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 32:00 Okay. Oh, yeah, yeah, yeah. He's a different class, isn't he? He's a different class. You know, that's that is that's high class knowledge. Jenny Seligmann 32:17 Um... Yeah, exactly. Yeah, but back to the science. This is in metastatic colon cancer. So I don't know if you know much about EGFR agents. So in the guidelines, we treat half of the colon with anti-EGFR agents and we don't treat the right sided ones. And that is ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 32:28 The. Mhm. I remember this. Noreen's coming back to me. The right and left, it's like the politics. You're either on the right or the left. On the left, it's Panetuna map. It's one of them. Sitaxa map, I'm guessing. Spot on. Yeah. You got it. Well, it just shows I got it. It shows I listen to Noreen. Jenny Seligmann 32:44 Super, super bad. Exactly, and if you're on the left. Well done, so you know more. GI. Yeah, you're doing really well. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 33:01 Oh my god, I'm trying to like, I'm trying to like medical school kind of levels. Jenny Seligmann 33:08 And. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 33:09 Thanks. Jenny Seligmann 33:10 But... You would do fine. An afternoon in my clinic can you do fine. But yeah, this is a really bad way of classifying tumours in 2026, right versus left. I mean, they've got different embryonic origins. So there's lots of difference by the reasons why they're different. But essentially, this is to give some hope to people who are out there doing PhDs and they think that all the stuff that they do in their PhD will come to nothing. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 33:19 Hmm, hmm. Jenny Seligmann 33:34 So as part of my PhD, and many of it did come to nothing, it had to be said. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 33:37 The. There must be, there must be a whole podcast in that, in like the darkness of some moments of a PhD where people stare at the wall and go, what's the point? Jenny Seligmann 33:49 Yeah, you can invite me back for that one. There were, there were, having done it in a pathology lab, there were many, many dark moments. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 33:55 Yeah. Jenny Seligmann 33:59 But essentially, we looked at biomarkers at my PhD for anti-EGFR and actually we found two useful ones called amphiregulin and epiregulin. And on the right side of the colon, if they're high, the hypothesis is that they may predict patients that might still benefit from anti-EGFR. because they're still driven. But the problem is with the stats that they did for right versus left, you had your people that did really bad and people that did okay, and then they got cancelled out in the middle by statistics. But actually, biology wise, we think if they're A reg and E reg high, then with aerial randomises them to have ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 34:18 Mhm. Mhm. Yeah. Jenny Seligmann 34:39 to have anti-EGFR or no anti-EGFR. So that's cool. We've recruited over 100 patients. We've got recruitment starting in Italy, in Spain and in Germany, and Roche Diagnostics doing the testing. So yeah, we'll get our first results out to 160 patients. But that came directly from my PhD, so that's pretty cool. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 35:04 Okay. Oh, well, congratulations. That is actually brilliant. I bet you at the time you didn't realise that would happen. Jenny Seligmann 35:07 Yeah. No, no, no. And we tried to get it funded. So I tried to get it funded by Amgen and they're like, no, because we want to treat everyone. I tried to get it funded by Merck and then they're like, no, we want to treat everyone. And eventually on try #4, the NIHR funded it. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 35:17 Yeah. Yeah. Mm. Jenny Seligmann 35:31 and then Merck have funded the European recruitment and Rocher doing the biomarker testing, but it wasn't a first time, there you go, it was multiple knockbacks. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 35:41 No. And actually, this is looking at like, you know, because the anti-EGFR story is quite old. It's not that new, but it's so it's taking those old tools, but putting them in this new setting. With the new techniques, the new data, new, yeah. Jenny Seligmann 35:56 Yeah, well, there's no other treatment for these people. So they're right-sided. They've not got any other molecular drivers. So they all they get back to the point of normal Ox, MDG, Folfox or Folfiri. So they have no exciting options. So if we can find a group of them, ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 35:59 Yeah. Mm. Mhm. Mm. Jenny Seligmann 36:15 and say, well, this is their driver, then these drugs do work. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 36:22 Jenny, can I bring us back to ctDNA because you've mentioned it a couple of times and we've heard about it in other sites, things like breast cancer and a lot of it, well, yes, you can detect ctDNA. We've mentioned it in things like bladder cancer as well. You detect it and it tells you whether something's going to go bad. or well, and it does it in some people, but not all people. So how interpretable is it? How is this in the perioperative setting in colon cancer? Is this going to be an actual usable in-clinic thing, or is it still very much sort of pie in the sky research? Jenny Seligmann 36:46 Good. No. Um... So different settings. The problem with ctDNA is it's a moving target. So the assays keep getting better. And then everyone says when trials come out, oh, that's only because it was a rubbish assay. And you're like, all right, OK, well, hopeful. So we then have to do another 1000 patient trial with the next assay. So we've got, we then need to ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 37:03 Mhm. Mm. Mhm. Jenny Seligmann 37:20 put localised colon cancer into two groups. We've got the low risk group, so the low risk stage twos, and there was a trial from Australia, the dynamic trial, which showed that using a ctDNA guided approach was non-inferior to standard management. And of course, in that approach, some patients actually got more chemotherapy. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 37:25 Mhm. Mm-hmm. Jenny Seligmann 37:42 because if they were ctDNA positive, they then got chemotherapy when they wouldn't have got chemotherapy. But if they were negative, they were de-escalated. So in low risk stage two, so these aren't people, these are people that wouldn't be eligible for Foxtrot treatment. The data is really quite good. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 37:57 Mhm. Jenny Seligmann 38:00 good. Are we there in the UK and offering this to people? No. I think the ESMO guidelines is going to be very supportive of ctDNA to de-escalate chemotherapy in this situation. In stage 3, it's more contentious. There was the same Australian group did a ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 38:16 Hmm. Jenny Seligmann 38:20 a trial called Dynamic 3, which looked at de-escalation in ctDNA negative patients, and it wasn't non-inferior. And in fact, particularly in patients with T4 or N2 disease, it was a real detriment, like 8% detriment. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 38:27 Mhm. Mm. Jenny Seligmann 38:39 So we should not be de-escalating treatment in these patients at all. However, ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 38:44 That's really unusual because you would have thought in the higher risk patients, there's more chance of like tumour DNA shed that you would actually then have more data to then make these kind of calls. Yeah, and make the call from. Jenny Seligmann 38:59 Yeah, but de-escalation, I just don't think is the right thing to do with these patients. I think we, I think when you get to this group of patients, you think, well, it's great to de-escalate treatment when you can, but there's some patients you shouldn't be de-escalating treatment on because they've got bad cancer. And the problem is the ctDNA isn't great at picking up patients that have ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 39:04 Man. Yeah, mhm. Jenny Seligmann 39:21 peritoneal recurrences, lung recurrences. So for liver recurrences, it's quite good. But for the proportion of patients who are negative, who still came back with cancer was not reassuring. Saying that, Noreen has run the TRAC trial, which I think is nearly close to recruitment. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 39:23 Okay. Mm. Mhm. Jenny Seligmann 39:41 which is asking that question, but with I think the assay will be better. So we'll see where we are. I think the community feel that the de-escalation question, particularly with either T4 or N positive disease, doesn't feel like the right question. And so I think ideally there'll be a there'll be a ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 39:56 Two. Jenny Seligmann 40:00 a balance between the two. So trying to identify the high risk patient at baseline is critical. So the high risk people get neoadjuvant treatment and the lower risk patients go straight to surgery and then they have the decision with ctDNA. So that would be where I ideally saw us moving and I think that is where we're moving. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 40:07 Mhm. But that's exciting. Like giving less, giving less is more. Because every trial is standard of care plus something else. Standard of care plus something else. Actually removing standard of care, especially if it's toxic chemotherapy, massive impact on patients' quality of life. Jenny Seligmann 40:22 It's super exciting, yeah. But only for those that don't need it. I mean, the worst, this is the point is, can you really identify the low risk patient? Can you really identify the high risk patient? And I think that's the biggest question in colon cancer at the moment. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 40:41 Yes, of course, OK. Yeah. So, from your point of view, ctDNA work in progress. Jenny Seligmann 40:58 Yeah. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 40:59 And Noreen Starling is going to try and fix it and the team, the track team, but of course then everyone's going to say, yeah, but the test was rubbish in a couple of years time. Excellent. So we've got Ariel, we've got all of these things. What is the trial that's happening? Maybe you're not involved in it. Maybe you are. That is most exciting that you think on the horizon is coming and you think, oh, that I wish I'd come up with that idea. Or oh, like if that comes off, that's going to knock it. Jenny Seligmann 41:35 Yeah, so I think I think there's so in the perioperative setting, there's using neoadjuvant immunotherapy in PMMR tumours. So we are kind of doing that in Foxtrot 7, but there's two registrational ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 41:39 Mhm. Yeah. Mm-hmm. Oh, oh, oh, oh, just wait, back up, back up, we're rowing back here. Okay, we talked about DMMR and DMMR having a great immunosensitivity, as we've seen with other tumors. We said that PMMR isn't really a fertile ground for immunotherapy. Jenny Seligmann 42:05 Yeah, but... ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 42:05 And then, but we use, but we use it in lots of other. We use it, we use it usually in conjunction with another agent, like a anti-VFTK or with chemo, or with chemo. But this is one of our most exciting ones. Jenny Seligmann 42:19 Yeah, so I'll tell you why. So in the metastatic setting, they did, they've tried every combination. They've tried, they've tried chemotherapy, immunotherapy with chemotherapy, VEGF, anti-EGFR, you name a combination that's been done, all plug negative. The neoadjuvant setting, ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 42:23 Yeah. Mhm. Mm-hmm. OK, and this is what's exciting you. Yeah, OK, I'm gonna shut up. I'll shut up. I'll shut up. Jenny Seligmann 42:38 No, no, no. So I'll tell you what's exciting me. Be patient, be patient. So In the neoadjuvant setting, you've obviously got the tumour in situ, you've got all your nice immune cells, the microenvironment is intact. We've shown this in Nadina and melanoma. It makes a difference to have it in situ. And there's been a trial called the NEST trial that was run in a single centre in the US and as part of the ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 42:49 Mhm. Mhm. Jenny Seligmann 43:04 the niche work that went on in the NKI. And actually, the response rates were actually, you know, pathological complete response rate of 20, 30%. Remembering with chemo, this is 5%. And then the NEST trial, again, there's not been any recurrences. So because of course, you don't need ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 43:18 Mmh. Thank you. Jenny Seligmann 43:23 to have a pathological complete response if you have surgery. So there's a signal that actually within this neoadjuvant setting, you might be getting more bang for your buck with immunotherapy than you do with chemotherapy. So we'll see, we'll see how that plays out. There's ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 43:25 Mhm. But is that, sorry, James to interrupt, is that just immunotherapy on its own or with chemotherapy? Jenny Seligmann 43:44 Immunotherapy on its own. There has been a trial doing doing both. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 43:45 On its own. Okay. Okay. Right. Anyway, I'm confused. I don't like this. I don't like it. So it doesn't work in a metastatic setting. And we know you get tumour heterogeneity, you know, that your mets are not the same as your primary. We see that in lots of different tumors. But if it's not working in the metastatic setting, why is it working so well in the preoperative setting? Tumour infiltrating lymphocytes, the microenvironment, vasculature. Did you just say things that make, is that what you've just said a bunch of things that make up cancer? Yeah, exactly. Jenny Seligmann 44:22 I, I honestly, I honestly think it makes a difference. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 44:22 But all of those same things, all of those same things apply in the metastatic setting. Jenny Seligmann 44:28 I honestly think it makes a difference because you have something for the immune, the immunotherapy to recognise when the tumours in situ. The problem with PMMR, particularly with liver mets, is that they are like an immune desert in the liver. Actually, immunotherapy has been shown to work for patients with non-liver mets, metastatic colorectal cancer, not as well, ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 44:41 Mm. Mhm. Jenny Seligmann 44:50 But I think the issue in the metastatic setting has been liver metastases. It's a complete immune desert. The immunotherapy doesn't recognise. But we'll see. But in the metastatic setting, we've got the RAS inhibitors coming through. So ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 44:57 Okay, well there's an explanation at least. Yes, so very hot in pancreatic cancer at the minute. Jenny Seligmann 45:06 Very hot in pancreatic cancer. It's the panras. It's a bit different in colon cancer. So the one thing that's failed all the time in colon cancer is not giving chemotherapy. So we're not going to see the daroxone rasib used as a single. I know I'm quite impressed that Noreen Starling had to had to tell had to. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 45:13 Yeah. Thank you. But now. Jenny Seligmann 45:27 to show me on multiple occasions how to pronounce it. It's all about the on, the rocks on, because it's an on. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 45:32 And that's a great, that's a great segue 'cause we are talking to her about that, yeah, at some point when we get it organized. Jenny Seligmann 45:38 So she's great with the drug pronunciations as well as many other things. So that is unlikely to be tested, I think. I do think that will move forward. But the KRAS 12D inhibitors, the RAS isoform specifics plus chemotherapy. Remember, this is like 40% of colon cancer. So RAS is massive. We've had absolutely nothing. We've made progress. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 45:51 Mhm. Mhm. Yeah. Jenny Seligmann 46:03 almost every other biomarker type apart from the RAS inhibitors. So we'll see. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 46:06 The not rise. Wonderful. Watch this space. Yeah, I think I think that that does sound exciting. And with the, will the, do you genuinely think, I'm going back to this, PMMR. You genuinely complete, not complete responses, but no relapses after having had the immunotherapy, even if they haven't had a path CR. It's a single stent to studies. It's a single stent, presumably short follow-up. Jenny Seligmann 46:36 We shall see. Is it? We we we should we shall say, well, one of the cohorts has got three years follow up. I think we're all a little bit sceptical about the original about this data. The company is going straight to phase three on the back of this, which I think going to phase two is is the ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 46:45 Okay. Mm. Mhm. Brave. Yeah. Jenny Seligmann 47:00 the better approach. And there is a trial solstice that will be opening in the UK in the next couple of months, which is again going to phase two to then inform a phase three. But there is a phase three that will be opening as well. So there's I mean, the other the other thing to say is that we're seeing lots of young patients with these GI tumors. We need to, whilst we're thinking about de-escalation, we do need to be curing more of these people. So we do need to be looking at beyond full Fox. It's just not going to cut the mustard. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 47:21 Yes. Mhm. And is this a real thing? So is this a little bit like, you know, in head and neck cancer, we've seen this swathe of HPV positive young non-smoking patients. We've got a clear driver in the virus there. Is there something, because I don't treat bowel cancer, but when I speak to people who do this, we've had so many young people recently. And it can't all be Lynch, surely. Must be more than just Lynch. Jenny Seligmann 47:57 No, it's not. It's not Lynch. It's so I think that's the $1,000,000 question. So there's not one biological subtype. So people are coming with all the different the spectrum of the biology people are presenting. The feeling is that it's diet and environment. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 47:59 And what is driving now? The. Okay. Jenny Seligmann 48:17 and microbiome related, but there's not. I know microbiome is the answer to everything nowadays. Oh, I love it too. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 48:17 Mm. I love, I love it. I am so into it. I'm so into it. I think the microbiome is fascinating. Jenny Seligmann 48:29 Well, you should look after your microbiome, speaking as a GI oncologist. I'm glad to hear that. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 48:32 I do. We've we've we've talked about how much cardboard you should be eating per day with Monty Powell in there. Sorry, sorry. Fibre, I meant fibre. Yeah. Jenny Seligmann 48:43 But it's real. But these people are not all, you know, they come to the clinic, they're not all obese, diabetic at all. A lot of them are, the depressing thing is most people are normal people in their 30s and 40s. And I don't know why they're coming to me with really quite horrible cancer. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 48:53 No. Young, fit, and active, yeah, yeah. But, you know, we talk about diet. Our diet now must be better than it was, like, say, in the 70s when people had cooked breakfast for breakfast, cigarettes and a pie for lunch and a pint of beer, then they'd go home and have like a, you know, meat and two veg. Like, when we look at all the things that we're told nowadays to avoid That 2 generations have been doing it before us. Jenny Seligmann 49:29 No, I don't know. I mean, I think it depends where you live. You know, my the catchment area for my clinic is quite vast, I would say. And people, you know, the cheap food in the supermarket is the is the ultra processed food. And that there's no getting away from that. I think ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 49:38 Okay. Yes. Yeah. Jenny Seligmann 49:47 There's a huge societal divide in what we're eating. But again, it's not all patients from low economic status that are presenting with this. So there's a lot of work that's going into this. So CRUK have done a grand challenge looking at young onset gastrointestinal cancers. I don't think we have all the answers yet. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 49:57 No, no. Jenny Seligmann 50:10 but it's not one type, it's across all the biological subtypes. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 50:13 You just feel you just feel like there's going to be some horrible additive that you that we've been using for years, and then all of a sudden surprise. Well, this feels too big, too big for us to kind of round up an episode. Jenny, if you were going to give us three takeaway points for the Perry. Oh, I'll try that again. If you're going to give us 3 takeaway points for the perioperative setting in colon cancer and where we are and where we want to go to, what would those three points be? Jenny Seligmann 50:45 OK, please engage your MDT to care about it and to know the data. Number 2, please, please treat your T4s at the least so that your patients with T4s have got very bad outcomes. Please, please treat your T4s. And #3, please recruit to the trials. because the UK are world leading in terms of the trials. In terms of the surgery, the radiology as well as the oncology. So please support the trials. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 51:17 And watch out for all the Foxtrot results coming through. When are the next Foxtrot things coming through? There is something in Esmo. There must be something in Esmo coming up. Jenny Seligmann 51:26 Not this year, there was last year. We had a joint analysis with Niche last year. I did get on the podium and I didn't do a mic drop because mainly. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 51:28 Yeah. Right. But did you have mic drop data? You can't be doing, can't be throwing mic drops for like standard data, like a bit of an improvement. Jenny Seligmann 51:40 No, no, no, I really, it wasn't my, if I'm really honest with myself, it wasn't my drop data. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 51:45 Now, like, we know, so nowadays, you're all miked up with the stuff. Now, what are you saying? You have to have a hazard ratio of like.5 or less. You have to have curves going north and south, and you have to be able to put a bus between them. Jenny Seligmann 52:00 Yeah, well, let's watch out for Foxtrot 5. So we should have Foxtrot 5 as more next year. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 52:03 Maybe, yes. And ESMO this year, what what call on perioperative thing would you be looking out for? Jenny Seligmann 52:12 So, there's Iracast, which is looking at adjuvant, full Fox Eerie versus full Fox. We shall see. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 52:21 I'm sure you don't sound impressed by that. Well, that's Folfirinox by another name. That's quite punchy, isn't it? I don't think I don't think Jenny's sold just by her face. No one listeners can't see, but. Jenny Seligmann 52:28 Yeah. Yeah. We shall see. We shall see what the we shall see what the results are. So that's presenting and there's some rectal cancer data using again immunotherapy in this PMMR group. So we'll see it. You're totally on board now. I've nearly convinced you, nearly convinced you. But we'll see. It's been a big, I don't think ESMO is going to be massive. We've had big years at ASCO and ASCO GI. So ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 52:37 Yeah. I'm totally on board. Yeah. Mm-hmm, mm-hmm. Jenny Seligmann 52:59 Let's see. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 53:00 You can have a rest, it's alright, that's okay. It's fine. It's like Strava, not every run needs to be a personal best. Jenny Seligmann 53:02 I know, I know. Agreed with that. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 53:08 Not everyone needs Trava either, Jenny. Jenny Seligmann 53:11 I'm with you on Strava. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 53:14 Jenny, thank you so much for your time. It's been a fantastic couple of episodes, actually. Yeah, thank you. And we hope to welcome you back when we've got some more data to discuss. Would you come back if you do have a super duper Foxtrot or aerial 2 result just to kind of come in and just Jenny Seligmann 53:25 Course. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 53:32 or the PMMR, you could feel free to shove that down my throat. Jenny Seligmann 53:36 I will be very happy to shove that down your throat. I have bets on across the world with various people that things will work, so I'm happy to think of one with you as well. ROWE, Michael (ROYAL CORNWALL HOSPITALS NHS TRUST) 53:40 Yeah. But. Jenny, thank you so much. Thank you so much, Jenny. Jenny Seligmann 53:51 You're welcome.