Only 20% of patients are suitable for targeted therapies Rapid diagnostic and tumor tissue-based workups are essential for all patients with an initial confirmation of mCRC. Delineating the precise stage of the disease is achieved by imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI), and positron emission tomography (FDG-PET). Alongside standard histology and immunohistochemistry on sections of formalin-fixated, paraffinembedded (FFPE) tumor tissue, determining molecular tumor subtypes is the established state of the art1. While distinct molecular subtypes of mCRC can be efficiently addressed with innovative drugs, this is actionable only for a minority of patients. Over 80% of mCRC patients cannot be offered any additional therapies2 based on molecular biology. While, in certain situations, surgical intervention on the primary tumor and/or colorectal liver metastases can be curative, the mainstay of therapy for the vast majority of patients with mCRC remains the systemic administration of cytotoxic agents. Among those, 5FU (5-fluorouracil) has been and continues to be the backbone of mCRC treatment strategies3 since its introduction in 1957. First-line treatments Doublets The addition of oxaliplatin and/or irinotecan to a fluoropyrimidine improves response rates and survival. Therapy regimens combining 5FU, leucovorin and oxaliplatin or irinotecan are referred to as ‘doublets’. Triplets The strategy of combining the three active cytotoxic agents 5FU, oxaliplatin and irinotecan (FOLFOXIRI) is referred to as a ‘triplet’ and has been explored in mCRC with the main purpose of improving tumor shrinkage, and thus allowing complete resection of metastases. Approximately 25% of colorectal cancer patients have metastatic disease at diagnosis, and 50–60% develop metastases during the course of their disease. Overall, treatment options in a clinical stage IV situation are limited. Current Standard of Care for patients with mCRC
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