Metastatic colorectal cancer- third line therapy and beyond

ABSTRACT

Introduction

The outcome of patients with metastatic colorectal cancer (mCRC) has improved significantly in the last few decades. Metastatic colorectal cancer is a highly heterogenous cancer. Beyond second line chemotherapy, treatment decisions are often based on molecular testing.

Method

In this narrative review, we provide a comprehensive summary of data from key clinical trials and discuss how to integrate these agents into the current treatment landscape of metastatic colorectal cancer.

Expert Opinion

In the era of precision medicine, molecular testing plays an increasingly important role in the management of mCRC. Efforts need to be made to target treatment based on molecular test results.

KEYWORDS:

• Metastatic colorectal cancer
• immunotherapy
• targeted therapy
• biomarkers
• refractory disease

Article highlights

• Multigene panel tests for somatic alterations should be part of standard of care for the management of metastatic colorectal cancer and will guide clinical decision.

• For patients with refractory mCRC without an actionable target, patient selection based on the toxicity profile of Trifluridine/Tipiracil and regorafenib is important although the combination of Trifluridine/Tipiracil and bevacizumab has shown promising results.

• Refractory mCRC without an actionable target is an area of unmet need. Several clinical trials evaluating combination therapies and other target agents are currently ongoing.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.