April 18, 2024

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Is the genetic testing  for Colorectal cancer necessary?

Is the genetic testing  for Colorectal cancer necessary?



 

Is the genetic testing  for Colorectal cancer necessary?

The clinical practice guidelines for various malignant tumors issued by the National Comprehensive Cancer Network (NCCN) of the United States have been recognized and followed by clinicians around the world.

The guidelines recommend that patients with metastatic colorectal cancer undergo MMR protein expression/MSI detection, RAS and BRAF gene mutation detection, and HER2, RET, NTRK fusion detection.

 

Is the genetic testing  for Colorectal cancer necessary?

 

 

Detection of genes KRAS, NRAS, BRAF:

Unlike the CSCO guidelines that only guide cetuximab, for KRAS, NRAS, and BRAF-negative patients, the NCCN guidelines guide two drugs, cetuximab and panitumumab.

For BRAF V600E mutation-positive advanced/metastatic patients, the guideline update recommends that the regimen be used in patients who have previously received oxaliplatin chemotherapy.

Recommend BRAF inhibitor + EGFR inhibitor: BRAF inhibitor Encorafenib (canafenib) + EGFR inhibitor (cetuximab/panitumumab) treatment.

 

Detection of gene HER2:

Guided drugs: trastuzumab + pertuzumab, trastuzumab + lapatinib, DS8201 (RAS and BRAF negative)

 

Detection gene NTRK1/2/3:

Guiding drugs: larotrectinib, entrectinib

 

Detection gene RET:

Guiding drug: systemic treatment of advanced or metastatic colon cancer – follow-up treatment RET inhibitor Selpercatinib.

RET has just been added to the 2022.V2 version of the NCCN colon cancer guidelines, which is in line with the accelerated approval of Selpercatinib by the FDA on September 21, 2022, for localized RET gene fusions that have progressed after prior systemic therapy or have no other satisfactory alternative treatment options Relevant to adult patients with advanced or metastatic solid tumors.

Is the genetic testing  for Colorectal cancer necessary?

 

 

 

Detection of gene MSI/MMR:

Guiding drugs: nivolumab ± ipilimumab, pembrolizumab

In addition to guiding PD-1 antibody drug therapy, MSI detection indicates that patients with stage II colorectal cancer have a better prognosis but cannot benefit from 5-FU adjuvant therapy. For hereditary tumors, it can assist in the diagnosis of Lynch syndrome (80% of Lynch syndrome has MSI phenomenon).

 

 

 

 

 

 

References:
NCCN Guidelines Version 2.2022 Colon Cancer.
Is the genetic testing  for Colorectal cancer necessary?

(source:internet, reference only)


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