Compared with the progress achieved in breast cancer,
the use of prognostic and predictive parameters in colorectal
cancer is lagging behind. One of the reasons is
the limited information provided by ‘classic’ mutations
as markers for response to therapy. To bridge this gap,
prospective clinical trials need to be conducted to evaluate
the usefulness of gene expression profiling and candidate
markers, such as DNA repair proteins, onset of
the methylator phenotype, neo-angiogenetic pathways
related to inflammation, matrix metalloproteinases, tumor
suppressors and cell signaling pathways (e.g. Akt).
In parallel, the unrivalled sensitivity of molecular techniques
may be applied to diagnostic parameters, such as
cytokeratin 20 mRNA, for the detection of lymph node
metastases. This article reviews the current knowledge
on prognostic and predictive parameters in order to
highlight the close link between tumor biology and tumor
pharmacology. The increasing number of candidate
markers together with recently introduced therapeutic
options offer novel opportunities for a stepwise approach
to the ambitious goal of individualized therapy in
colorectal cancer.