An Introduction to the Current Management of Colorectal Cancer in the Era of Personalized Oncology
Until recently, disease indications for anticancer drugs have typically been based on histological findings and cancer staging. Remarkably, several predictive biomarkers have been recently added to conventional schemes to select patients who may be more l
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An Introduction to the Current Management of Colorectal Cancer in the Era of Personalized Oncology Angelica Petrillo, Emanuela Ferraro, Michele Ghidini, and Dario Trapani
Abstract
Until recently, disease indications for anticancer drugs have typically been based on histological findings and cancer staging. Remarkably, several predictive biomarkers have been recently added to conventional schemes to select patients who may be more likely to benefit from treatments. In colorectal cancer, fluoropyrimidine-based chemotherapy is still the backbone of systemic treatment. Other drugs such as irinotecan and oxaliplatin as well as emerging targeted agents combined with 5-fluorouracil have significantly improved survival rates. Moreover, the advent of precision oncology procedures has enabled better decisionmaking algorithms particularly with implementation of molecular pathology and targeted anticancer agents, including immune-checkpoint inhibitors that may radically change the management of this disease and its outcomes in the coming years.
A. Petrillo Medical Oncology Unit, Ospedale del Mare, Naples, Italy University of Study of Campania “L. Vanvitelli”, Naples, Italy E. Ferraro · D. Trapani (*) New Drugs and Early Drug Development for Innovative Therapies Division, European Institute of Oncology, IRCCS, IEO, Milan, Italy Department of Hematology and Oncology, University of Milano, Milan, Italy e-mail: [email protected] M. Ghidini Medical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy # The Editor(s) (if applicable) and The Author(s), under exclusive licence to Springer Nature Switzerland AG 2020 K. El Bairi (ed.), Illuminating Colorectal Cancer Genomics by Next-Generation Sequencing, https://doi.org/10.1007/978-3-030-53821-7_1
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Keywords
Colorectal cancer · Therapy · Biomarkers · Precision medicine
1.1
Introduction: A Brief Overview of the Implications of Translational Medicine to Inform the Clinical Decision-Making in Colorectal Cancer
Colon and rectal cancer (CRC) represents the third most diagnosed and the second cause of death from cancer in the world, accounting for 1.8 million new cases and nearly 900,000 related deaths in 2018 (Bray et al. 2018). The traditional classification of colorectal malignancies takes into account anatomic and histology factors, including the localization, the sidedness, the histology differentiation, and the locoregional and distant invasiveness (Bosman et al. 2010). However, more recently, the traditional paradigm based on the histology classification has been refined by more sophisticated characterizations based on molecular genomics. In 2015, Guinney et al. reported the first consensus molecular subtypes of CRC, aiming to develop a framework for the definition of intrinsic subtypes of this disease (Guinney et al. 2015). The report identified four consensus molecular subtypes (CMSs) with distinguishing features and biological behaviors: (1) CMS1 or microsatellite instability immune, exerting strong immune activation; (2) C
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