Oncology Unit, Oncology Department, ASST of Cremona, Hospital of Cremona, Viale Concordia 1, 26100, Cremona, Italy.
Oncology Unit, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, Italy.
Curr Treat Options Oncol. 2018 May 23;19(6):31. doi: 10.1007/s11864-018-0544-y.
Colorectal cancer does not represent a single anatomic entity and side of origin has a key impact on prognosis and response to different systemic therapies. Compared to tumours arising in left colon, right colorectal cancers rely on the activation of different molecular pathways (e.g. BRAF mutation and MSI status). From a clinical point of view, this results in a different response to anti-EGFR agents. Current guidelines suggest the use of cetuximab or panitumumab in RAS wild-type disease and left colon cancer especially for cytoreduction/conversion purposes, since the expected benefit in right colon cancer is absent or clinically modest. The prognostic role of microbiota in colorectal cancer disease deserves more clarification before being considered in common clinical practice. Screening policies could also be affected by these new acquisitions. At the moment, sidedness should be considered as a strong prognostic variable and a surrogate predictor of different activity of anti-EGFR agents in the metastatic setting. Its role in early stages of resected disease is still uncertain.
结直肠癌不是单一的解剖实体，起源部位对预后和对不同全身治疗的反应有重要影响。与左结肠癌相比，右半结肠癌依赖于不同的分子途径的激活（例如 BRAF 突变和 MSI 状态）。从临床角度来看，这导致对抗 EGFR 药物的反应不同。目前的指南建议在 RAS 野生型疾病和左结肠癌中使用西妥昔单抗或帕尼单抗，特别是用于细胞减少/转化目的，因为右结肠癌的预期获益不存在或临床获益较小。在考虑将其纳入常规临床实践之前，微生物组在结直肠癌疾病中的预后作用需要进一步阐明。筛查政策也可能受到这些新发现的影响。目前，侧别应被视为一种强烈的预后变量，也是转移性疾病中不同抗 EGFR 药物活性的替代预测指标。它在可切除疾病的早期阶段的作用仍不确定。
