Emerging treatment options for the management of metastatic colorectal cancer

Abstract

An improved understanding of the molecular landscape of metastatic colorectal cancer (CRC) has opened the door for new treatment options. Clinicians should test for molecular alterations that predict resistance to epidermal growth factor receptor (EGFR) inhibitors, such as KRAS and NRAS, and additionally clinically actionable alterations, including BRAF V600 mutations, HER2 amplification, NTRK fusions, and mismatch repair deficiency. Improved outcomes can be achieved with precision treatment strategies for the various CRC subtypes, although clinical features, such as tumor bulk and patient performance status, still help to guide treatment choice. Immune therapies have also produced impressive results in patients with mismatch repair–deficient/microsatellite instability–high tumors. These newer approaches were recently incorporated into the NCCN Guidelines for Colon and Rectal Cancers. In the future, these newer approaches may be used in earlier treatment settings.