Late-Line Antitumor Treatment for Metastatic Colorectal Cancer

Abstract

Introduction. Colorectal cancer (CRC) holds one of the leading positions in the structure of oncological diseases. Treatment of metastatic colorectal cancer (mCRC) in the first and second-lines significantly improves overall survival (OS). The main problem of selecting therapy in later lines is to find an effective, improving survival rates treatment with manageable toxicity for pretreated patients.

Aim. To analyze the literature data on modern methods of drug treatment for mCRC in later lines, considering personalization of therapy based on molecular genetic characteristics of the tumor and factors influencing long-term treatment outcomes.

Results. The literature review systematizes the data on therapy options for mCRC in the third and subsequent lines, focusing on personalized treatment based on various factors.

Conclusion. Most patients with mCRC in the third-line of treatment are recommended to receive trifluridine/tipiracil in combination with bevacizumab, regardless of the KRAS mutation status. Regorafenib or trifluridine/tipiracil monotherapy has lower efficacy, particularly when adverse factors are present, such as less than 18 months since the first diagnosis of metastasis, large tumor mass and liver metastases. If BRAF mutation or HER2 overexpression are present, it is advisable to take a more precise approach and use targeted therapy, such as anti-BRAF and MEK inhibitors combined with EGFR therapy, and a combination therapy of trastuzumab with pertuzumab. Immunotherapy can also be used in previously untreated patients with MSI tumors.