6533b7dbfe1ef96bd12712b0

RESEARCH PRODUCT

Colorectal Cancer: Metastatic Disease

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Most patients diagnosed with metastatic colorectal cancer (mCRC) develop metastases during the disease course after resection of the primary locoregional cancer. To date, the liver represents the most common site of metastatic involvement. Although several different biological and clinical hallmarks exist between the colon and rectum (different embryological origin, anatomy, and molecular biology), mCRC requires similar staging procedures and systemic treatment strategies (first and subsequent lines) in terms of a multimodal approach treatment as a part of a “continuum of care.” Patients affected by oligometastatic disease should undergo an upfront evaluation by a multidisciplinary team for assessing a potentially curative approach with improved long-term survival rates. So far, the standard of care for treatment of unresectable mCRC has been built on the backbone of 5-fluorouracil (5-FU)-based chemotherapy, including first-line combination treatment with either oxaliplatin or irinotecan (FOLFOX and FOLFIRI, respectively), plus a monoclonal antibody (bevacizumab versus cetuximab or panitumumab). In the era of personalized medicine, genotyping of tumor tissue (either primary tumor or metastasis) for RAS and BRAF testing in all patients with mCRC has been associated with significant prognostic and predictive implications, thus strongly recommended. Primary tumor location appeared to impact both prognosis and prediction of responsiveness to targeted therapy in advanced disease.