Systemic treatment for metastatic colorectal cancer

Core Tip

Core Tip: Advances in the molecular profiling of metastatic colorectal cancer allow treatment to be tailored to the biologic characteristics of the tumor for certain patient subgroups. Although cures are still rare, more people can expect to live longer. Genomic profiling enables therapy selection, allowing more individuals to benefit while exposing fewer to the harm of ineffective medicines. An important component in determining treatment results is the choice of an effective first-line therapy, which should consider both clinical considerations and molecular indicators. The systemic treatments used in the first-line regimen determine the second-line regimen. Third-line therapy, which includes epithelial growth factor receptor inhibitors for patients with rat sarcoma virus wild-type, should consider molecular profiling. Patients with high microsatellite instability illnesses may be candidates for immunotherapy with pembrolizumab or nivolumab plus ipilimumab.