Colorectal cancer (CRC) is the third most commonly diagnosed cancer in males and the second in females. Translational research has led to significant benefits in the management of patients with metastatic disease, and precision medicine is becoming the goal of scientific research.
Recent years have seen remarkable advances in the treatment of all gastrointestinal cancers. Translational research has led to significant benefits in screening and patient management, and precision medicine is fast becoming the aim of scientific research.
Individualized treatment for colorectal cancer in both adjuvant and metastatic settings is increasingly emphasized. In particular, the introduction of molecular-targeted agents has significantly improved patient outcome, but predictive markers of efficacy, especially for angiogenesis inhibition, are still lacking. Furthermore, immunotherapy has recently been implemented into clinical practice. Due to these new therapeutic options, physicians are confronted with new challenges, such as monitoring progression and stratifying patients for appropriate treatments.
The role of genetic alterations in cancer is well established. It is generally accepted, however, that genetic changes alone do not fully account for malignancy. Growing evidence has indeed implicated the involvement of epigenetic alterations in cancer. Unlike irreversible genetic mutations, epigenetic alterations are potentially reversible, which makes epigenetic therapy (modulation of epigenetic states) an appealing strategy for cancer treatment. Alterations of epigenetic marks could also serve as biomarkers for diagnosis, prognosis, and responses to therapies.
A new approach to biomarker detection is the use of liquid biopsy. Free circulating tumor DNA (fctDNA) can be monitored quantitatively and qualitatively for diagnostic, prognostic, or predictive purposes. Liquid biopsy has the potential to replace tumor tissue analysis in clinical practice and could be used to monitor the extent of tumor burden and to detect tumor heterogeneity and molecular resistance to therapy.
Dr Passardi Alessandro
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