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Biomarkers in Colorectal Cancer

S TAT E M E N T O F N E E D Despite improvements, colorectal cancer (CRC) continues to pose a heavy toll with an estimated over 1 million annual new cases of CRC and over half a million deaths worldwide. According to the American Cancer Society, in the US alone in 2008 there will be 148,810 patients newly diagnosed with CRC and 49,960 deaths. Current chemotherapeutic treatment options for patients with metastatic CRC consist of various combination and monotherapy regimens involving the cytotoxic agents 5-fluorouracil, irinotecan, oxaliplatin, and capecitabine, the anti-vascular endothelial growth factor receptor monoclonal antibody bevacizumab, and the anti-epidermal growth factor receptor monoclonal antibodies cetuximab and panitumumab. The choice of therapy involves consideration of multiple factors. Treatment planning for patients with CRC has evolved beyond distinct lines of therapy to a continuum of care. The goal is to improve patient survival and quality of life by maximizing patient exposure to all active treatment while minimizing treatment-related toxicity. The availability of several active treatment options has significantly improved the outcome for patients with metastatic CRC, but it has also increased the complexity of decision-making, patient and caregiver counseling, and overall treatment planning for clinical oncologists. While maximizing patient exposure to all active treatments has been shown to positively impact patients’ survival, many patients do not respond to treatment. In retrospect, these non-responders have been needlessly exposed to potentially toxic and costly treatments. To avoid these needless exposures, oncologists need tools to help match active treatment and individual patients. Advances are being made in developing molecular biomarkers that will help identify which patients are less likely or more likely to respond to treatment, or to developing certain treatment-related toxicities. New clinical data on biomarkers in CRC have been recently reported, but some of these results have not yet been reflected in revised versions of these important documents. Oncologists need to understand these new data and critically analyze these results, to help them determine if and how to best incorporate key findings into their clinical practice. Improved and expanded knowledge of new clinically relevant findings will help physicians S U P P L E M E N T T O ONCOLOGYTIMES