CHU de Saint-Étienne, Service d’hépato-gastroentérologie et d’oncologie digestive, 42055 Saint-Étienne Cedex 2
Colorectal cancer (CRC) constitutes a public health problem in France, it is metastatic in half of the cases (synchronous in 25% of cases). From the start of treatment, in addition to the positive histological diagnosis and the standard extension assessment, it is important to determine the patient's clinical profile, the resecability of the metastases, the molecular biology of the tumor ; all this elements guide us in the choice of the therapeutic strategy in first line, but also the in the more advanced lines.
In this article, we describe the different therapeutics strategies according to the patient and tumor profiles, but also the place of new treatments in this strategy (BRAF inhibitor, anti-HER2, immunotherapy and NTRK inhibition) and the role of circulating tumor DNA in the treatment monitoring, evaluation of tumor response and therapeutic choice.
Thanks to therapeutic advances and molecular biology, which allow a diagnostic refinement, today we can talk about personalized treatment of CRC given the great heterogeneity of these tumors, with an improvement in patient survival which reach a median of 30 months.