In recent years, a number of protein and genomic-based biomarkers have begun to refine the prognostic information available for colorectal cancer (CRC) and predict defined patient groups that are likely to benefit from systemic treatment or targeted therapies. Of these, KRAS represents the first biomarker integrated into clinical practice for CRC. Microarray-based gene expression profiling has been used to identify prognostic signatures and, to a lesser extent, predictive signatures in CRC. Despite these advances, a number of major challenges remain. This article, which is based on a lecture delivered as part of the 2013 Bob Pinedo Cancer Care Prize, reviews the impact of molecular biomarkers on the management of CRC, emphasizing changes that have occurred in recent years, and focuses on potential mechanisms of patient stratification and opportunities for novel therapeutic development based on enhanced biological understanding of colorectal cancer.
摘要
近年来，多种蛋白质类和基因组类生物标志物已开始为结直肠癌 (CRC) 提供更高质量的预后信息，并用于预测哪些患者群体更有可能受益于全身治疗或靶向治疗。其中，KRAS 是首个被纳入临床的 CRC 生物标志物。基于微阵列芯片的基因表达分析工具已被用以鉴定 CRC 的预后标志物，次之用于鉴定预测性标志物。尽管有了这些进展，目前仍存在若干重大挑战。本文基于一堂在 2013 年 Bob Pinedo 癌症治疗奖颁奖时发表的演讲，总结回顾了分子生物标志物对 CRC 治疗的影响，强调了近年来发生的一些变化，同时根据对结直肠癌生物机制的更深一步了解，重点分析了患者分层的潜在机制和新疗法的研发机遇。The Oncologist 2014;19:568–573