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2014 ; 1
(4
): 209-20
Nephropedia Template TP
Gastrointest Tumors
2014[May]; 1
(4
): 209-20
PMID26676107
show ga
BACKGROUND: Colorectal cancer (CRC) is the second most common type of cancer in
the Western world. The treatment of this disease has evolved greatly,
particularly for patients with metastatic disease. The advent of combination
chemotherapy plus targeted agents has led to more curative resections and
improved survival rates in these patients. A deeper understanding of the
mechanisms of tumorigenesis has facilitated tumor characterization, prognosis and
patient stratification, bringing us one step closer towards personalized
medicine. SUMMARY: There are two main pathways of CRC development: (1)
chromosomal instability, also known as the classical adenoma-carcinoma sequence,
and (2) microsatellite instability, caused by a defective mismatch repair (dMMR)
system. Analysis of these pathways has uncovered key prognostic and predictive
biomarkers to guide patient selection and treatment strategy. This review
summarizes the current treatment regimens and recent advances in the personalized
therapy of CRC. KEY MESSAGE: Understanding of the mechanisms of CRC pathogenesis
has led to new developments in tumor characterization, patient stratification,
prognosis and treatment, bringing us closer to personalized therapy. PRACTICAL
IMPLICATIONS: In the adjuvant setting, the treatment decision is driven by
clinical and histopathological factors. dMMR status is one of the most robust
positive prognostic factors in resected colon cancer. More and more guidelines
recommend refraining from adjuvant chemotherapy in patients with dMMR. In the
metastatic setting, the introduction of effective compounds, including agents
that target the epidermal growth factor receptor and vascular endothelial growth
factor pathways, has significantly improved survival. The presence of wild-type
KRAS and NRAS (all RAS) is a positive predictive factor for epidermal growth
factor receptor antibody treatment. Therefore, analysis of all RAS status is
recommended for all patients with metastatic disease prior to the initiation of
first-line chemotherapy.
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