Metastatic colorectal cancer. Modern therapy concepts now and in the future

Background. Colorectal cancer (CRC) is the third leading cause of cancer deaths worldwide. In recent years overall survival, particularly in the metastatic setting, could be substantially prolonged. This is not least due to novel options for systemic treatment of metastatic CRC (mCRC). A major contribution to this development came from the increasing understanding of genetic and epigenetic dysregulation in CRC that lead to dysregulated signaling networks in tumors and subsequently to dysregulated cell survival, tumor growth and metastasis. Various strategies have been developed to selectively disrupt vital signaling networks of tumors and novel targeted drugs have a major effect on the tumor and (ideally) only minimal adverse drug reactions (targeted therapies). Aim. This article gives an overview on established and new treatment options for mCRC and discusses novel study results and therapeutic concepts. There is an increasing number of clearly defined molecular therapeutic concepts that show impressive results (e.g. for BRAF mutant tumors, HER2 amplified tumors or mismatch repair deficient tumors) albeit only for small subgroups of patients.