What Is Known about Theragnostic Strategies in Colorectal Cancer

Abstract

Despite the paradigmatic shift occurred in recent years for defined molecular subtypes in the metastatic setting treatment, colorectal cancer (CRC) still remains an incurable disease in most of the cases. Therefore, there is an urgent need for new tools and biomarkers for both early tumor diagnosis and to improve personalized treatment. Thus, liquid biopsy has emerged as a minimally invasive tool that is capable of detecting genomic alterations from primary or metastatic tumors, allowing the prognostic stratification of patients, the detection of the minimal residual disease after surgical or systemic treatments, the monitoring of therapeutic response, and the development of resistance, establishing an opportunity for early intervention before imaging detection or worsening of clinical symptoms. On the other hand, preclinical and clinical evidence demonstrated the role of gut microbiota dysbiosis in promoting inflammatory responses and cancer initiation. Altered gut microbiota is associated with resistance to chemo drugs and immune checkpoint inhibitors, whereas the use of microbe-targeted therapies including antibiotics, pre-probiotics, and fecal microbiota transplantation can restore response to anticancer drugs, promote immune response, and therefore support current treatment strategies in CRC. In this review, we aim to summarize preclinical and clinical evidence for the utilization of liquid biopsy and gut microbiota in CRC.

Post-Induction Management in Patients With Left-Sided RAS and BRAF Wild-Type Metastatic Colorectal Cancer Treated With First-Line Anti-EGFR-Based Doublet Regimens: A Multicentre Study

“…In the PaNama trial, reinduction therapy was more active and effective in patients who had received FU/LV compared to those who received FU/LV+anti-EGFR (ORR = 34.7% vs. 8.9%, PFS = 6.3 vs. 3.8 months, respectively). On the other hand, preclinical and clinical evidence suggests a potential role of anti-EGFR reintroduction beyond the second-line, particularly in patients selected with liquid biopsy (28)(29)(30)(31).…”

The Effects of Mesenchymal Stem Cell on Colorectal Cancer

“…Restores the sensitivity of patients to anticancer drugs and enhances the immune response[132] trend of published articles on MSCs and tumor…”

Colorectal Cancer: From Pathophysiology to Novel Therapeutic Approaches

“…Indeed, a high consumption of alcohol or red meat may alter the composition of the gut microbiota—so-called dysbiosis—with a decrease in commensal bacterial species (i.e., butyrate-producing bacteria) and the growth of detrimental bacterial strains (i.e., pro-inflammatory opportunistic pathogens) [ 7 ]. Aside from a role in the initiation of CRC, dysbiosis seems also to be involved in the resistance to some chemotherapeutic agents, due to its ability to modulate the immune response, and is associated with shorter cancer-specific survival [ 6 , 8 ]. Therefore, probiotics, prebiotics, or antibiotics capable of restoring the normal equilibrium of gut microbiota (eubiosis) could open new scenarios for the prevention or treatment of CRC [ 6 , 8 ].…”

“…Aside from a role in the initiation of CRC, dysbiosis seems also to be involved in the resistance to some chemotherapeutic agents, due to its ability to modulate the immune response, and is associated with shorter cancer-specific survival [ 6 , 8 ]. Therefore, probiotics, prebiotics, or antibiotics capable of restoring the normal equilibrium of gut microbiota (eubiosis) could open new scenarios for the prevention or treatment of CRC [ 6 , 8 ].…”

“…Liquid biopsy might also be a promising tool for the identification of CRC patients at a high risk of progression [ 8 , 15 ]. This represents the isolation of cancer-derived components, such as circulating tumor cells (CTC), circulating tumor DNA (ctDNA), microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and proteins, from the peripheral blood or other body fluids [ 8 , 15 ].…”