John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive


Metastastic colorectal cancer: second line treatment in the era of personalized medicine Volume 29, issue 7, September 2022


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1 CHRU de Nancy Brabois, Service d’hépato-gastroentérologie, Allée du Morvan, 54500 Vandœuvre-lès-Nancy
2 CHU Pontchaillou, Service d’hépato-gastroentérologie, 2 Rue Henri le Guilloux, 35000 Rennes
Correspondance : M. Muller

In France, colorectal cancer (CRC) is the most common digestive cancer and the second most common cause of cancer-related death. Although considerable therapeutic progress has been made with the advent of targeted therapies and more recently immunotherapy, metastatic CRC (mCRC) remains a major public health issue. In first line treatment, the choice of therapeutic strategy will depend on the patient’s wishes and condition, but will also depend on the tumor’s molecular profile, i.e., the status of the tumor’s RAS gene, BRAF mutation (5-10%) and the detection of microsatellite instability (MSI) in the tumor (15%). At progression, second-line strategies will also depend on the molecular profile of the tumor but will also depend on the first-line treatment administered: the maintenance of anti-angiogenic pressure in case of previous exposition to bevacizumab, discussion of access to immunotherapy in patients with MSI tumors who did not receive it in first-line, and the case of MSS and BRAF-mutated tumors for which dual anti-BRAF/anti-EGFR inhibition must be proposed. At the moment, the other molecular targets recently explored (HER2 overexpression, NTRK fusion gene) have no place in second-line treatment. In mCRC, the correct choice of second-line therapy, based on the molecular profile of the tumor and the treatment received in the first line, is crucial to ensure that patients have the best possible chance of survival.