Use of molecular markers and other personalized factors in treatment decisions for metastatic colorectal cancer

Improvements in DNA sequencing technology and an expansion of available systemic therapies have together resulted in dramatic advances in personalized therapy for metastatic colorectal cancer. As a result, modern multidiscplinary management requires a thorough understanding of “prognostic biomarkers” associated with a likely cancer outcome independent of treatment, and “predictive biomarkers” associated with a differential treatment effect between positive and negative patients. Unique patient details currently utilized as prognostic or predictive biomarkers to inform the personalized multidisciplinary management of metastatic colorectal cancer include disease characteristics, histologic subtype, tumor sidedness, and molecular characterizations of patient pharmacogenetics and tumor tissue. Many additional biomarkers are under active investigation, including immunologic markers, the gut microbiome, circulating tumor cells and cell free DNA. The continuous development of targeted agents hand in hand with ongoing clinical trials evaluating novel systemic therapies on cohorts sharing common biomarkers, together offer promise for further improvements in survival over time.