Liquid biopsy approaches and immunotherapy in colorectal cancer for precision medicine: Are we there yet?

Abstract

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths globally, with nearly half of patients detected in the advanced stages. This is due to the fact that symptoms associated with CRC often do not appear until the cancer has reached an advanced stage. This suggests that CRC is a cancer with a slow progression, making it curable and preventive if detected in its early stage. Therefore, there is an urgent clinical need to improve CRC early detection and personalize therapy for patients with this cancer. Recently, liquid biopsy as a non-invasive or nominally invasive approach has attracted considerable interest for its real-time disease monitoring capability through repeated sample analysis. Several studies in CRC have revealed the potential for liquid biopsy application in a real clinical setting using circulating RNA/miRNA, circulating tumor cells (CTCs), exosomes, etc. However, Liquid biopsy still remains a challenge since there are currently no promising results with high specificity and specificity that might be employed as optimal circulatory biomarkers. Therefore, in this review, we conferred the plausible role of less explored liquid biopsy components like mitochondrial DNA (mtDNA), organoid model of CTCs, and circulating cancer-associated fibroblasts (cCAFs); which may allow researchers to develop improved strategies to unravel unfulfilled clinical requirements in CRC patients. Moreover, we have also discussed immunotherapy approaches to improve the prognosis of MSI (Microsatellite Instability) CRC patients using neoantigens and immune cells in the tumor microenvironment (TME) as a liquid biopsy approach in detail.

Advances in Precision Medicine Approaches for Colorectal Cancer: From Molecular Profiling to Targeted Therapies

“…Liquid biopsies can detect and quantify ctDNA, providing valuable insights into the tumor's genetic heterogeneity and evolution over time. 196 This technology can help identify specific mutations, including those associated with resistance to targeted therapies, which enable more precise treatment decisions. The potential applications of liquid biopsies in colorectal cancer are vast.…”

“…These fragments carry genetic information about the tumor’s mutations, allowing for noninvasive and real-time assessment of the cancer’s genetic makeup. Liquid biopsies can detect and quantify ctDNA, providing valuable insights into the tumor’s genetic heterogeneity and evolution over time . This technology can help identify specific mutations, including those associated with resistance to targeted therapies, which enable more precise treatment decisions.…”