Precision medicine can enhance and treat existing treatments for patients with metastatic colorrectal cancer, according to a study by the Vall d’Hebron Institute of Oncology (VHIO). Colorrectal cancer (CCR) represents approximately 10% of all cancers.
CCR is the second most common cause of cancer. Patients who are diagnosed with metastatic colorrectal cancer (CCRm) from the beginning of the patient represent a 20%. About 50% of patients and those diagnosed with this type of cancer have localized form of severe metastasis.
Despite the fact that these patients are significantly better in the last 20 years with the implantation of the most efficient treatments, this is because in the majority of cases there is an incurable condition.
The complexity of metastatic encephalitis depends on the need for an infusion of precision medicine, in which the treatment integrates the conjugation of the genetic alterations of the tumors, the expression profile of tumors or microenvironment, take control of the nursing home.
A recently published article in A Cancer Journal for Clinicians, which is co-authored by Dr. Josep Tabernero, director of VHIO and head of the Medical Oncology Service at the University of Hebron University Hospital, is reviewing the advances that have been made in the treatment of metastatic colorrectal cancer.
The investigator has studied the precision medicine that can enhance and improve the existing therapies for the patients who have been discharged. “Metastatic colorrectal cancer has a heterogeneous elevation and a complex molecular biology that affects its response to therapy,” he said.
The condition that heterogeneity is the condition of patient supervision. This heterogeneity of the tumor can be found in the initial phases of the disease and is determined by genetic and epigenetic regulations that influence the different molecular profiles of the tumor.
“In this sense, advances in the conjugation of the molecular bases of these tumors are essential for their proper adaptation,” said Dr. Josep Tabernero. Three major carcinogenicities have been identified that allow identifying different phenotypes of this type of cancer.
It deals with the suppressor wave or chromosomal instability, the mutator wave or the microsatellite instability, and the methylador or the methyl phenotype of the CpG islet. These are permissible determinants of conduct from specific point of view, or from specific therapies.
All in all, with the objective of advancing, taking more eggs, needing an individualized handle from these patients, who are following the CCRm, having more than 20 years of translational and clinical investigation direct into the family of crematorial receptor (EGFR) and its intracellular transmission channels.
Elevated levels of EGFR, a tyrosine kinase of the family of human receptors due to epidermal cracking factor, are identified as a component of multiple types of cancer and partially promoting solid tumor growth.
In the case of metastatic colorrectal cancer, a number of specific ligands are detected that result in a complex mechanism of intracellular cell transmission that regulates the proliferation of cancer cells, or its propagation.
They are intended to be used extensively to identify biologically homogenous subtypes of CCR for a specific feature and for the release of new therapies. Ya se han se han defines four molecular subgroups.
The first step is to remove the cancer personalized medicine as well as the definition of different treatment options and sequences, based on the molecular characterization of the tumor. It is the case for investigating alterations of the RAS and BRAF genes and, consequently, HER2-induced.
In addition, the evaluation of the stage of microsatellites is actually the reference criterion for the molecular characterization of CCRm, which is the need to select the most appropriate treatments. Depending on the molecular characterization, there are various factors that influence the selection of the treatment.
Hay que tener en cuenta sus characteristicas (comorbilidades, edad…) y las characteristikas del tumor (cargo tumoral, ubicación de las metastasis…). Currently, the first line of treatment is basically, in principle, chemotherapeutic therapies that include doubles like FOLFIRI or FOLFOX.
Tumor function is triplicated as FOLFOXIRI (folic acid, 5-FU, oxaliplatino, and irinotecan) in determined patients. To apply effective treatment strategies based on Hebrew precision medicine that integrates all the information available about the tumor and its component.
Hacerlo –severely the VHIO experts– from the exhaustive conjugation of the genomic alterations of the tumors and the expression of the genes and proteins of the tumor microenvironment, and their dynamic cambuses in the transcursor of the patient.
In this sense, the molecular stratification over which the actual treatment of CCRm is carried out does not fully represent the complete heterogeneity of genotypes and phenotypes of this genus. Además, there is another factor that complicates the characterization of the disease: the intestinal microbiota.
Some recent studies have shown that there are bacteria that relate to the development and progression of colorrectal cancer, as well as responding to treatments; is a field of investigation in which various groups and international consortia are involved.
Fortunato Ciardiello, Davide Ciardiello, Giulia Martini, Stefania Napolitano, Josep Tabernero, Andrés Cervantes. Clinical management of metastatic colorectal cancer in the era of precision medicine. CA Cancer J Clin. 2022; 72: 000-000.