Refractory Metastatic Colorectal Cancer: Current Challenges and Future Prospects

被引:15
作者
Lam, Marissa [1 ]
Lum, Caroline [1 ]
Latham, Sarah [1 ]
Smith, Sam Tipping [1 ]
Prenen, Hans [2 ]
Segelov, Eva [1 ,3 ]
机构
[1] Monash Med Ctr, Dept Med Oncol, Clayton, Vic, Australia
[2] Univ Hosp Antwerp, Dept Oncol, Edegem, Belgium
[3] Monash Univ, Fac Med, Clayton, Vic, Australia
来源
CANCER MANAGEMENT AND RESEARCH | 2020年 / 12卷
关键词
molecular targets; genomic profiling; immunotherapy; precision medicine; FOLFOXIRI PLUS BEVACIZUMAB; POSITIVE SOLID TUMORS; OPEN-LABEL; RANDOMIZED-TRIAL; DOUBLE-BLIND; PHASE-II; PERITONEAL CARCINOMATOSIS; POOLED ANALYSIS; ASIAN PATIENTS; BRAF MUTATION;
D O I
10.2147/CMAR.S213236
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Despite advances, patients with metastatic colorectal cancer (mCRC) still have poor long-term survival. Identification of molecular subtypes is important to guide therapy through standard treatment pathways and holds promise for the development of new treatments. Following standard first- and second-line chemotherapy plus targeted agents, many patients retain a reasonable performance status, and thus are seeking further effective treatment to extend life and maintain symptom control. The challenge lies in selecting the most appropriate therapy in the third- and fourth-line settings, from a range of options including the relatively new oral agents TAS-102 and regorafenib, or rechallenge with previous chemotherapy or anti-epidermal growth factor receptor (anti-EGFR) monoclonal antibodies (mAB). Beyond this, therapy consists of trials involving novel agents and new combinations of treatments with theoretical synergy and/or non-overlapping toxicity. There is a great focus on enhancing immunogenicity in mCRC, to reflect the impressive results of immunotherapy drugs in the small cohort with mismatch repair deficient (dMMR) mCRC. Rare molecular subtypes of mCRC are increasingly being identified, including Her2-positive disease, NTRK fusions and others. Clinical trials exploring the efficacy of immunomodulatory and precision agents are plentiful and will hopefully yield clinically meaningful results that can be rapidly translated into routine care.
引用
收藏
页码:5819 / 5830
页数:12
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