Precision medicine and immunotherapy advances transforming colorectal cancer treatment

Abstract

Background: Colorectal cancer (CRC) is a leading cause of cancer deaths worldwide. Key risk factors include lifestyle, diet, inflammation, and family history. Understanding molecular pathways underlying CRC initiation and progression is critical to guide prevention and treatment. Purpose: This review summarizes recent advances in CRC screening, therapy, and future directions. Main body: New stool DNA panels and blood-based assays offer non-invasive options for early CRC detection, though require further validation. Immuno- and targeted therapies matched to tumor molecular profiles have transformed metastatic CRC treatment. Pembrolizumab elicits durable responses in mismatch repair-deficient tumors, and anti-EGFR antibodies cetuximab/panitumumab improve outcomes for left-sided RAS/RAF wild-type CRC. Larotrectinib and entrectinib are highly active in NTRK fusion-positive CRC. Research focusing on new immunotherapies, leveraging the microbiome, and combining multi-omics data to enable precision medicine holds promise. Disparities across groups remain a challenge. Conclusions: Recent therapeutic advances have significantly improved survival for metastatic CRC patients. Advances in non-invasive diagnostics, next-generation sequencing, and computational approaches will enable more sophisticated molecular profiling and tailored therapy selection. Realizing the potential of emerging immunotherapies and integrating knowledge of the microbiome remain important frontiers.