Onkológia 6/2020

Current options and strategies for choosing treatment for metastatic colorectal cancer after first-line failure

Colorectal cancer is main health problem as globally as in our country with Slovakia holding the first place in incidence and mortality in European union.Despite improvement of median overall survival to 30 month during the last 20 years cure is not possible for majority of patients.The first line treatment is considered most important for survival yet optimal sequence of chemotherapy and biologicals is not agreed on.In the second line antiangiogenic drugs are indicated for the most patient while anti EGFR drugs have not show survival enhancement.In the third line molecular tumor profiling is important with anti EGFR antibodies use or re-challenge.Also we can use regorafenib or TAS-102 and in MSI-H sugroup immunotherapy is efficient. Molecular profiling expansion led to new options of targeted treatment for HER2 overexpression,BRAF mutations and NTRK fusions. This review goal is to provide physician with base for clinical decision making and also perspective for future .In addition to general information the part od review are challenging clinical scenarios.

Keywords: metastatic colorectal cancer, the first line treatment failure, treatment sequence, molecular profile, re-challenge, targeted treatment, immunotherapy