Metastatic colorectal cancer is a leading cause of cancer-related death across the world. The treatment paradigm has shifted away from systemic chemotherapy alone to include targeted therapy and immunotherapy. The past two decades have been characterized by increased investigation into molecular profiling of colorectal cancer. These molecular profiles help physicians to better understand colorectal cancer biology among patients with metastatic disease. Additionally, improved data on genetic pathways allow for specific therapies to be targeted at the underlying molecular profile. Investigation of the EGFR, VEGF, HER2, and other pathways, as well as deficient mismatch repair, has led to the development of multiple targeted therapies that are now utilized in the National Comprehensive Cancer Network guidelines for colon and rectal cancer. While these new therapies have contributed to improved survival for metastatic colorectal cancer, long-term survival remains poor. Additional investigation to understand resistance to targeted therapy and development of new targeted therapy is necessary. New therapies are under development and are being tested in the preclinical and clinical settings. The aim of this review is to provide a comprehensive evaluation of molecular profiling, currently available therapies, and ongoing obstacles in the field of colorectal cancer.
转移性结直肠癌是全球癌症相关死亡的主要原因。其治疗模式已从单纯全身化疗转向包含靶向治疗和免疫治疗的综合策略。过去二十年的显著特征是针对结直肠癌分子谱系的研究日益深入。这些分子谱系有助于临床医生更好地理解转移性疾病患者的结直肠癌生物学特性。此外，遗传通路数据的完善使得针对特定分子谱系的精准治疗成为可能。通过对EGFR、VEGF、HER2等通路以及错配修复缺陷的研究，目前已开发出多种靶向疗法，并被纳入美国国家综合癌症网络结直肠癌治疗指南。尽管这些新疗法改善了转移性结直肠癌患者的生存状况，但长期生存率仍然不容乐观。需要进一步研究靶向治疗耐药机制并开发新型靶向药物。目前已有新疗法处于临床前和临床研究阶段。本综述旨在对结直肠癌领域的分子分型、现有治疗手段及当前面临的挑战进行全面评述。
Precision Medicine for Metastatic Colorectal Cancer: Where Do We Stand?
肿瘤(癌症)患者之家