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Role of Genomic Markers in Colorectal Cancer Treatment

Wendy L. Allen, Patrick G. Johnston

From the Drug Resistance Group, Centre for Cancer Research and Cell Biology, Queen's University Belfast, University Floor, Belfast City Hospital, United Kingdom

Address reprint requests to Patrick G. Johnston, MD, PhD, Department of Oncology, Queen's University Belfast, University Floor, Lisburn Road, Belfast Lisburn Road, Belfast, BT9 7AB, UK; e-mail: oncology{at}qub.ac.uk.

For the last four decades, fluorouracil (FU) has been the main treatment of choice in colorectal cancer (CRC) in both the advanced and adjuvant settings. In the advanced setting, FU monotherapy produces response rates of only 10% to 20%. Furthermore, in resected stage III CRC, FU monotherapy has increased overall survival by only 20%. The combination of FU with newer therapies such as oxaliplatin and irinotecan has significantly improved response rates to 40% to 50%. Despite these improvements, more than half of advanced CRC patients derive no benefit from treatment; this is due to either acquired or inherent drug resistance. This review aims to highlight the current prognostic and predictive markers that have been identified for CRC to date. The limited use of these predictive markers underscores the importance of and need for multiple marker testing in order to improve response rates and decrease toxicity. This review will also focus on high throughput methods to identify panels of predictive markers for CRC, which ultimately aim to tailor treatment according to an individual patient and tumor profile.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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