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Evidence-Based Second-Line Treatment in RAS Wild-Type/Mutated Metastatic Colorectal Cancer in the Precision Medicine Era

Target-oriented agents improve metastatic colorectal cancer (mCRC) survival in combination with chemotherapy. However, the majority of patients experience disease progression after first-line treatment and are eligible for second-line approaches. In such a context, antiangiogenic and anti-Epidermal...

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Autores principales: Giordano, Guido, Parcesepe, Pietro, Bruno, Giuseppina, Piscazzi, Annamaria, Lizzi, Vincenzo, Remo, Andrea, Pancione, Massimo, D’Andrea, Mario Rosario, De Santis, Elena, Coppola, Luigi, Pietrafesa, Michele, Fersini, Alberto, Ambrosi, Antonio, Landriscina, Matteo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8307359/
https://www.ncbi.nlm.nih.gov/pubmed/34299337
http://dx.doi.org/10.3390/ijms22147717
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author Giordano, Guido
Parcesepe, Pietro
Bruno, Giuseppina
Piscazzi, Annamaria
Lizzi, Vincenzo
Remo, Andrea
Pancione, Massimo
D’Andrea, Mario Rosario
De Santis, Elena
Coppola, Luigi
Pietrafesa, Michele
Fersini, Alberto
Ambrosi, Antonio
Landriscina, Matteo
author_facet Giordano, Guido
Parcesepe, Pietro
Bruno, Giuseppina
Piscazzi, Annamaria
Lizzi, Vincenzo
Remo, Andrea
Pancione, Massimo
D’Andrea, Mario Rosario
De Santis, Elena
Coppola, Luigi
Pietrafesa, Michele
Fersini, Alberto
Ambrosi, Antonio
Landriscina, Matteo
author_sort Giordano, Guido
collection PubMed
description Target-oriented agents improve metastatic colorectal cancer (mCRC) survival in combination with chemotherapy. However, the majority of patients experience disease progression after first-line treatment and are eligible for second-line approaches. In such a context, antiangiogenic and anti-Epidermal Growth Factor Receptor (EGFR) agents as well as immune checkpoint inhibitors have been approved as second-line options, and RAS and BRAF mutations and microsatellite status represent the molecular drivers that guide therapeutic choices. Patients harboring K- and N-RAS mutations are not eligible for anti-EGFR treatments, and bevacizumab is the only antiangiogenic agent that improves survival in combination with chemotherapy in first-line, regardless of RAS mutational status. Thus, the choice of an appropriate therapy after the progression to a bevacizumab or an EGFR-based first-line treatment should be evaluated according to the patient and disease characteristics and treatment aims. The continuation of bevacizumab beyond progression or its substitution with another anti-angiogenic agents has been shown to increase survival, whereas anti-EGFR monoclonals represent an option in RAS wild-type patients. In addition, specific molecular subgroups, such as BRAF-mutated and Microsatellite Instability-High (MSI-H) mCRCs represent aggressive malignancies that are poorly responsive to standard therapies and deserve targeted approaches. This review provides a critical overview about the state of the art in mCRC second-line treatment and discusses sequential strategies according to key molecular biomarkers.
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spelling pubmed-83073592021-07-25 Evidence-Based Second-Line Treatment in RAS Wild-Type/Mutated Metastatic Colorectal Cancer in the Precision Medicine Era Giordano, Guido Parcesepe, Pietro Bruno, Giuseppina Piscazzi, Annamaria Lizzi, Vincenzo Remo, Andrea Pancione, Massimo D’Andrea, Mario Rosario De Santis, Elena Coppola, Luigi Pietrafesa, Michele Fersini, Alberto Ambrosi, Antonio Landriscina, Matteo Int J Mol Sci Review Target-oriented agents improve metastatic colorectal cancer (mCRC) survival in combination with chemotherapy. However, the majority of patients experience disease progression after first-line treatment and are eligible for second-line approaches. In such a context, antiangiogenic and anti-Epidermal Growth Factor Receptor (EGFR) agents as well as immune checkpoint inhibitors have been approved as second-line options, and RAS and BRAF mutations and microsatellite status represent the molecular drivers that guide therapeutic choices. Patients harboring K- and N-RAS mutations are not eligible for anti-EGFR treatments, and bevacizumab is the only antiangiogenic agent that improves survival in combination with chemotherapy in first-line, regardless of RAS mutational status. Thus, the choice of an appropriate therapy after the progression to a bevacizumab or an EGFR-based first-line treatment should be evaluated according to the patient and disease characteristics and treatment aims. The continuation of bevacizumab beyond progression or its substitution with another anti-angiogenic agents has been shown to increase survival, whereas anti-EGFR monoclonals represent an option in RAS wild-type patients. In addition, specific molecular subgroups, such as BRAF-mutated and Microsatellite Instability-High (MSI-H) mCRCs represent aggressive malignancies that are poorly responsive to standard therapies and deserve targeted approaches. This review provides a critical overview about the state of the art in mCRC second-line treatment and discusses sequential strategies according to key molecular biomarkers. MDPI 2021-07-19 /pmc/articles/PMC8307359/ /pubmed/34299337 http://dx.doi.org/10.3390/ijms22147717 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Giordano, Guido
Parcesepe, Pietro
Bruno, Giuseppina
Piscazzi, Annamaria
Lizzi, Vincenzo
Remo, Andrea
Pancione, Massimo
D’Andrea, Mario Rosario
De Santis, Elena
Coppola, Luigi
Pietrafesa, Michele
Fersini, Alberto
Ambrosi, Antonio
Landriscina, Matteo
Evidence-Based Second-Line Treatment in RAS Wild-Type/Mutated Metastatic Colorectal Cancer in the Precision Medicine Era
title Evidence-Based Second-Line Treatment in RAS Wild-Type/Mutated Metastatic Colorectal Cancer in the Precision Medicine Era
title_full Evidence-Based Second-Line Treatment in RAS Wild-Type/Mutated Metastatic Colorectal Cancer in the Precision Medicine Era
title_fullStr Evidence-Based Second-Line Treatment in RAS Wild-Type/Mutated Metastatic Colorectal Cancer in the Precision Medicine Era
title_full_unstemmed Evidence-Based Second-Line Treatment in RAS Wild-Type/Mutated Metastatic Colorectal Cancer in the Precision Medicine Era
title_short Evidence-Based Second-Line Treatment in RAS Wild-Type/Mutated Metastatic Colorectal Cancer in the Precision Medicine Era
title_sort evidence-based second-line treatment in ras wild-type/mutated metastatic colorectal cancer in the precision medicine era
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8307359/
https://www.ncbi.nlm.nih.gov/pubmed/34299337
http://dx.doi.org/10.3390/ijms22147717
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