Abstract
Colorectal cancer (CRC) remains one of the most common malignancies, with up to a quarter of patients being diagnosed at the metastatic stage. In addition to patient-specific factors, the extent of disease and the biological profile of the tumor are important in selecting treatment for metastatic CRC.
Chemotherapy options include sequential monotherapy, conventional oxaliplatinor irinotecan-based doublets with 5-fluorouracil, or treatment with the FOLFOXIRI triplet. For targeted therapy, knowledge of the molecular profile of the tumour is required - at least, the mutational status of KRAS, NRAS and BRAF genes should be determined, and assessment of microsatellite instability (MSI) and HER2 status is also appropriate.
Standard treatment options based on sequential use of chemotherapy plus anti-EGFR or anti-VEGF targeted therapy with trifluridin/tipiracil and regorafenib being available for heavily pretreated patients have been recently enhanced to introduce encorafenib plus cetuximab regimen in BRAF V600E-mutated mCRC. Immunotherapy in MSI-high mCRC and anti-HER2 therapy in HER2 overexpressed mCRC have yielded some very promising results, however neither immunotherapy nor anti-HER2 therapy are included in current treatment algorithms.
In the future, we can expect increasing complexity of treatment algorithms in line with increasing number of CRC subtypes.