J.Jpn. Surg. Soc.. 124(3): 268-275, 2023

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CURRENT STATUS AND FUTURE PERSPECTIVES OF PRECISION MEDICINE FOR COLORECTAL CANCER

In recent years, precision medicine for the treatment of colorectal cancer has developed remarkably. Patients undergoing drug therapy must be tested for RAS/BRAF gene mutations and microsatellite instability (MSI), and therapeutic drugs and treatment strategies are stratified. The efficacy of BRAF inhibitor combination therapy was shown for patients with the BRAF mutation, who have been considered to have an extremely poor prognosis. In addition, it should be noted that pembrolizumab became the first-line standard treatment for MSI-high unresectable colorectal cancer. Since July 2019, comprehensive cancer genome profiling (CGP) tests have been covered by insurance. The biggest challenge with CGP testing in colorectal cancer treatment is the small percentage of patients for whom usable therapeutic drugs can be found, and future research is expected to overcome this. Research on liquid biopsy targeting circulating tumor DNA in the blood is also progressing. CIRCULATE-Japan, a large-scale registry of resectable colorectal cancer cases, was launched in 2020, and clinical trials are underway to investigate the early detection of recurrence using liquid biopsy and stratification of adjuvant chemotherapy. Stratification of treatment and provision of optimal treatment for individual patients are directly linked to the improvement of prognosis, and further development of precision medicine is expected in the future.

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