Predictive and prognostic factors in the complex treatment of patients with colorectal cancer.

摘要: Colon cancer is the second most prevalent lethal cancer. The main cause for high mortality rate that prognosis progressed metastatic colon unfavorable. Recent data suggest disease outcome can be further improved by addition of targeted biological agents to first- or second-line treatment. As a result molecularly anti-EGFR therapies (cetuximab and panitumumab) complementing chemotherapy, liver metastases reduce in size become operable certain patients, which contribute complete recovery patient. problem, however, fact positive response only occurs one third even case chemotherapy combined protocol, side effects are considerable. For application individually tailored treatments, it an urgent need develop system biomarkers predict effect treatment provide information about optimal selection both It should clarified what important requirements good reliable biomarker are. currently there no precise predictive molecular diagnostics at our disposal, oncologists have make two choices: they treat large number patients with has negative on quality life also reduces patient's chances getting appropriate or, if refuse take risks, omit use those whom this would been denied chance short-term survival recovery. Clinical (response rate, time progression (TTP) overall (OS)) 130 colorectal retrospectively analyzed. Patients received different protocols combination anti-VEGF antibody therapies. EGFR expression was evaluated immunohistochemistry, KRAS, BRAF PIK3CA mutations were direct sequencing resolution melting analysis archived formalin-fixed, paraffin-embedded tissue samples. study found similar efficacy first-line therapeutic protocols. Protocols combining achieved better but difference not significant (OS: 35.9 versus 36.7 months). frequency KRAS 44% (n=100). None mutant tumors responded monotherapy. TTP cetuximab monotherapy twice longer (208 months) than (104 One tumor identified (4%) This resistant excluded each other. Except case, status identical primary metastasis. In contrast, heterogeneous 5 out 6 cases mutation New additional clinical benefit subset patients. We identify these probably testing double therapies, we diagnostic tests. candidate might biopsy directly from metastasis evaluate circulating cells judge distant