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Yau TO. Precision treatment in colorectal cancer: Now and the future. JGH OPEN 2019; 3:361-369. [PMID: 31633039 PMCID: PMC6788378 DOI: 10.1002/jgh3.12153] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 01/04/2019] [Accepted: 01/14/2019] [Indexed: 12/19/2022]
Abstract
Until recently, a one‐drug‐fits‐all model was applied to every patient diagnosed with the same condition. But not every condition is the same, and this has led to many cases of ineffective treatment. Pharmacogenetics is increasingly used to stratify patients for precision medicine treatments, for instance, the UGT1A1*28 polymorphism as a dosage indicator for the use of irinotecan as well as epidermal growth factor receptor (EGFR) immunohistochemistry and KRAS Proto‐Oncogene (KRAS) exon 2 mutation tests for determining the likelihood of treatment response to cetuximab or panitumumab treatment in metastatic colorectal cancer (CRC). The other molecular subtypes, such as KRAS exon 3/4, B‐Raf Proto‐Oncogene, NRAF, PIK3CA, and PETN, were also reported as potential new pharmacogenetic targets for the current and the newly discovered anticancer drugs. In addition to next‐generation sequencing (NGS), primary tumor cells for in vivo and in vitro drug screening, imaging biomarker 3′‐Deoxy‐3′‐18F‐fluorothymidine positron emission tomography, and circulating tumor DNA (ctDNA) detection methods are being developed and may represent the future direction of precision medicine. This review will discuss the current environment of precision medicine, including clinically approved targeted therapies, the latest potential therapeutic agents, and the ongoing pharmacogenetic trials for CRC patients.
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Affiliation(s)
- Tung On Yau
- John van Geest Cancer Research Centre, School of Science and Technology Nottingham Trent University Nottingham UK
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Tran NH, Cavalcante LL, Lubner SJ, Mulkerin DL, LoConte NK, Clipson L, Matkowskyj KA, Deming DA. Precision medicine in colorectal cancer: the molecular profile alters treatment strategies. Ther Adv Med Oncol 2015; 7:252-262. [PMID: 26327923 PMCID: PMC4543854 DOI: 10.1177/1758834015591952] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
When considering treatment options for patients with metastatic colorectal cancer (mCRC), molecular profiling has become a pivotal component in guiding clinical decisions. FOLFOX and FOLFIRI (fluorouracuil, leucovorin plus oxaliplatin or ininotecan, respectively) are the standard base regimens used for the treatment of mCRC. Biologic agents, such as the epidermal growth factor receptor (EGFR) targeted therapies, cetuximab and panitumumab and the vascular endothelial growth factor monoclonal antibody, bevacizumab, are safe and effective in the first-line setting. The most efficacious use of these agents in terms of timing and selection of the right patient population continues to be debated. Here we review multiple investigations into the effectiveness of treatment options as a function of the mutations present in colon cancers. Early studies have reported that KRAS mutations at exon 2 predict resistance to EGFR targeted therapies. More recently the data have expanded to include KRAS mutations at exons 3 and 4 and NRAS mutations at exons 2, 3 and 4 as well as other biomarkers including BRAF and PIK3CA, leading to the evolution of the treatment of mCRC to a more precision-based approach. As our understanding of relevant biomarkers increases, and data from both molecular profiling and treatment response become more readily available, treatment options will become more precise and their outcomes more effective.
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Affiliation(s)
- Nguyen H. Tran
- Division of Hematology and Oncology, Department of Medicine, University of Wisconsin–Madison School of Medicine and Public Health, Madison, WI, USA
| | - Ludimila L. Cavalcante
- Division of Hematology and Oncology, Department of Medicine, University of Wisconsin–Madison School of Medicine and Public Health, and University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Sam J. Lubner
- Division of Hematology and Oncology, Department of Medicine, University of Wisconsin–Madison School of Medicine and Public Health, and University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Daniel L. Mulkerin
- Division of Hematology and Oncology, Department of Medicine, University of Wisconsin–Madison School of Medicine and Public Health, and University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Noelle K. LoConte
- Division of Hematology and Oncology, Department of Medicine, University of Wisconsin–Madison School of Medicine and Public Health, and University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Linda Clipson
- Department of Oncology, University of Wisconsin–Madison, Madison, WI, USA
| | - Kristina A. Matkowskyj
- University of Wisconsin Carbone Cancer Center, and Department of Pathology and Laboratory Medicine, University of Wisconsin–Madison School of Medicine and Public Health, and William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Dustin A. Deming
- Division of Hematology and Oncology, Department of Medicine, University of Wisconsin–Madison School of Medicine and Public Health, 600 Highland Avenue, K6/544, Madison, WI 53792, USA
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