Current biomarker testing guidelines
for colorectal cancer
John Strickler, MD
Duke Cancer Center, USA
Updates on biomarkers of resistance
to CRC treatment
Erika Martinelli, MD, PhD
University of Campania Luigi Vanvitelli, Italy
Current state-of-the-art first-line therapy for mCRC
Chiara Cremolini, MD, PhD
University of Pisa, Italy
Several genetic alterations play a role in the pathogenesis of mCRC, and testing of these biomarkers is an integral part of disease management for patients.
Most current international guidelines recommend testing patients with mCRC for KRAS, NRAS and BRAF mutations, and microsatellite instability (MSI).
However, with increased availability of novel targeted therapies, there is evidence to support wider biomarker testing and for this to include assessment of less frequently seen genetic changes, particularly in patients with chemotherapy-refractory CRC.
The potential future of genomic biomarker testing and treatment in mCRC
Targeting less common mutations in colorectal cancer
Sebastian Stintzing, MD
Charite University Hospital, Germany
Identification and targeting of rare genomic alterations in metastatic CRC
Heinz-Josef Lenz, MD
University of Southern California, USA
Targeting the uncommon alterations in CRC
Andrea Sartore-Bianchi, MD
ASST Great Niguarda Metropolitan Hospital, Italy
Testing recommendations of predictive genomic biomarkers in mCRC
*NGS panels used may enable rare alterations to be picked up, i.e. NTRK **Emerging biomarkers include HER2, MET, KRAS gene amplification, TGFα, EGFR mutations, and alterations in HER3, PI3KCA, and PTEN ±NTRK and HER2 are recommended for testing at relapse
Colorectal cancer NICE guideline [NG151]. Available at: https://www.nice.org.uk/guidance/ng151/chapter/Recommendations#molecular-biomarkers-to-guide-systemic-anti-cancer-therapy. Published January 2020. Last updated 15 December 2021.
Puccini A, et al. Biomarkers in metastatic colorectal cancer: status quo and future perspective. Cancers (Basel) 2022 Oct 3;14(19):4828.
Rachiglio AM, et al. Colorectal cancer genomic biomarkers in the clinical management of patients with metastatic colorectal carcinoma. Explor Target Antitumor Ther 2020;1(1):53–70.
Sepulveda A, et al. Molecular biomarkers for the evaluation of colorectal cancer: guideline from the American Society for Clinical Pathology, College of American Pathologists, Association for Molecular Pathology, and the American Society of Clinical Oncology. J Oncol Pract 2017;13(5):333–337.
Van Custem E, et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol 2016;27(8):1386–422.
Yu I, et al. Tumor biomarker testing for metastatic colorectal cancer: a Canadian consensus practice guideline. Ther Adv Med Oncol 2022;14:17588359221111705.
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