New aspects of the first-line chemotherapy in colorectal cancer


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Abstract

Colorectal cancer (CRC) steadily occupies the third position in the morbidity and mortality in the world. Due to advance in chemotherapy,surgery and the use of multidisciplinary approach in patients with metastatic colorectal cancer (mCRC) the CRC treatment algorithms have changed recently. Depending on the clinical situation there are 4 groups of patients with CRC: resectable group, potentially resectable group, unresectable group of patients who could undergo the intensive treatment, unresectable group of patients with concomitant diseases. It was found, that besides mutations in 2 exone KRAS there is a scope of rare mutations (exons 3 and 4 in KRAS gene and mutation in NRAS gene) which determines the resistance to EGFR inhibitors as well. The PRIME study found that 17% of patients, who were included in to the group without mutations (KRAS WT), according to the old type of test, could have these rare mutations. The target choice in first line therapy in mCRC patients RAS mutant is only bevacizumab. In RAS WT patients as EGFR inhibitors, so bevacizumab can be used. The presence of BRAF mutation is a factor of the negative prognosis in patients with mCRC and is correlated with a reduction in life expectancy. Further research in the field of molecular genetic characteristics of the tumor will help to solve the remaining points and to optimize treatment in different patients` groups.

About the authors

E V Artamonova

ФГБУ Российский онкологический научный центр им. Н.Н.Блохина РАМН

д-р мед. наук, вед. науч. сотр.

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