Clinical management of metastatic colorectal cancer in the era of precision medicine
Clinical management of metastatic colorectal cancer in the era of precision medicine
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DOI：
10.3322/caac.21728
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发表时间：
2022-04-26
影响因子：
254.7
通讯作者：
Cervantes, Andres
中科院分区：
文献类型：
--
作者：
Ciardiello, Fortunato;Ciardiello, Davide;Cervantes, Andres
结直肠癌（CRC）约占所有癌症的10%，是癌症死亡的第二大常见原因。约20%的患者出现转移性CRC（mCRC）的初始临床表现。此外，高达50%的局部疾病患者最终发生转移。对这些患者进行适当的临床管理仍然是一个具有挑战性的医学问题。已经做出了重大努力来揭示mCRC的分子景观。这导致了几种可药物化的肿瘤分子靶点的鉴定，目的是为每个患者开发个性化的治疗。这篇综述总结了在精准医学的新兴时代，mCRC患者临床管理的改进。事实上，目前mCRC治疗算法所基于的分子分层，虽然不能完全代表这种疾病的复杂性，但已经是实现更有效治疗方法的临床信息遗传分析的第一个重要步骤。这导致mCRC疾病控制和患者生存率的临床相关增加。mCRC临床管理的下一步将是整合肿瘤基因改变，肿瘤和微环境基因和蛋白质表达谱，宿主免疫能力的综合知识，以及将由此产生的动态变化应用于精确的基于药物的连续护理。这种方法可以识别个体预后和预测参数，这可以帮助临床医生在每个mCRC患者的整个疾病过程中选择最合适的治疗方案。CA Cancer J Clin.2022;72：000-000.
Colorectal cancer (CRC) represents approximately 10% of all cancers and is the second most common cause of cancer deaths. Initial clinical presentation as metastatic CRC (mCRC) occurs in approximately 20% of patients. Moreover, up to 50% of patients with localized disease eventually develop metastases. Appropriate clinical management of these patients is still a challenging medical issue. Major efforts have been made to unveil the molecular landscape of mCRC. This has resulted in the identification of several druggable tumor molecular targets with the aim of developing personalized treatments for each patient. This review summarizes the improvements in the clinical management of patients with mCRC in the emerging era of precision medicine. In fact, molecular stratification, on which the current treatment algorithm for mCRC is based, although it does not completely represent the complexity of this disease, has been the first significant step toward clinically informative genetic profiling for implementing more effective therapeutic approaches. This has resulted in a clinically relevant increase in mCRC disease control and patient survival. The next steps in the clinical management of mCRC will be to integrate the comprehensive knowledge of tumor gene alterations, of tumor and microenvironment gene and protein expression profiling, of host immune competence as well as the application of the resulting dynamic changes to a precision medicine-based continuum of care for each patient. This approach could result in the identification of individual prognostic and predictive parameters, which could help the clinician in choosing the most appropriate therapeutic program(s) throughout the entire disease journey for each patient with mCRC. CA Cancer J Clin. 2022;72:000-000.