Evolution of care of metastatic colorectal and anal cancer in the era of Molecular Medicine
Abstract
There has been significant recent progress in the treatment of advanced colorectal and anal cancers. Improvements in surgical techniques have allowed increasing numbers of patients with oligometastatic colorectal cancer to undergo potentially curative resections. For patients with unresectable metastatic colorectal cancer chemotherapy remains the backbone in the systemic treatment. However, molecular analysis and associated targeted and immune based therapies are now having a significant impact in treatment for these patients. Antibodies, a decoy receptor, and a tyrosine kinase inhibitor directed at the vascular endothelial growth factor (VEGF) pathway and antibodies directed against the epidermal growth factor receptor (EGFR) have been shown to increase survival. In patients whose cancer shows microsatellite instability resulting from either acquired or inherited defects in DNA mismatch repair, antibodies against programed death receptor 1 (PD-1) have marked anti-tumor activity through immune response to the cancer. Survival now exceed two years for most patients with unresectable metastatic colorectal cancer, with significantly longer survival in some patients. Anti-PD-1 antibody treatment has also recently been reported to have significant response rates in metastatic anal squamous cell carcinoma. Hopefully, continued steady progress in molecular typing of colorectal or anal cancer will impact more rare subsets of these cancers including those with high HER2 expression of BRAF mutations.
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DOI: http://dx.doi.org/10.18103/imr.v2i9.210
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