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Baraibar I, Ros J, Mulet N, Salvà F, Argilés G, Martini G, Cuadra JL, Sardo E, Ciardiello D, Tabernero J, Élez E. Incorporating traditional and emerging biomarkers in the clinical management of metastatic colorectal cancer: an update. Expert Rev Mol Diagn 2020; 20:653-664. [PMID: 32552041 DOI: 10.1080/14737159.2020.1782194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Molecular profiling has led to significantly longer survival in metastatic colorectal cancer (mCRC) patients. Clinical guidelines recommend testing for KRAS/NRAS, BRAF and MSI status, and new biomarkers such as HER2 amplification and NTRK fusions have emerged more recently in refractory CRC, supported by overwhelming clinical relevance. These biomarkers can guide treatment management to improve clinical outcomes in these patients. AREAS COVERED Preclinical and clinical data over the last decade were reviewed for known and novel biomarkers with clinical implications in refractory CRC. Molecular alterations are described for classic and novel biomarkers, and data for completed and ongoing studies with targeted and immunotherapies are presented. EXPERT OPINION Use of targeted therapies based on biomarker testing in CRC has enabled impressive improvements in clinical outcomes in refractory patients. BRAF, MSI, NRAS and KRAS should be tested upfront in all patients given their indisputable therapeutic implications. Other molecular alterations such as HER2 and NTRK are emerging. Testing for these alterations may further improve outcomes for refractory CRC patients. Nonetheless, many key aspects remain to be defined including the optimal timing and technique for testing, the most adequate panel, and whether all patients should be tested for all alterations.
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Affiliation(s)
- Iosune Baraibar
- Department of Medical Oncology, Vall d'Hebron University Hospital , Barcelona, Spain.,Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona, Spain
| | - Javier Ros
- Department of Medical Oncology, Vall d'Hebron University Hospital , Barcelona, Spain.,Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona, Spain
| | - Nuria Mulet
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona, Spain.,Department of Medical Oncology, Institut Català D' oncologia-IDIBELL , Barcelona, Spain
| | - Francesc Salvà
- Department of Medical Oncology, Vall d'Hebron University Hospital , Barcelona, Spain.,Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona, Spain
| | - Guillem Argilés
- Department of Medical Oncology, Vall d'Hebron University Hospital , Barcelona, Spain.,Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona, Spain
| | - Giulia Martini
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona, Spain.,Dipartimento di Medicina di Precisione, Università Degli Studi Della Campania Luigi Vanvitelli , Naples, Italy
| | | | - Emilia Sardo
- Department of Medical Oncology, Vall d'Hebron University Hospital , Barcelona, Spain
| | - Davide Ciardiello
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona, Spain.,Dipartimento di Medicina di Precisione, Università Degli Studi Della Campania Luigi Vanvitelli , Naples, Italy
| | - Josep Tabernero
- Department of Medical Oncology, Vall d'Hebron University Hospital , Barcelona, Spain.,Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona, Spain
| | - Elena Élez
- Department of Medical Oncology, Vall d'Hebron University Hospital , Barcelona, Spain.,Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona, Spain
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