Immunotherapy
Checkpoint Inhibitors: Block proteins preventing immune system cancer attack, particularly effective for specific genetic features:
MSI-H and dMMR Tumors: High mutation burden makes them immune-visible. Approved treatments include pembrolizumab (Keytruda), nivolumab (Opdivo), and nivolumab plus ipilimumab (Yervoy) for advanced colorectal cancer. The combination significantly improves progression-free survival versus single agents.
Adoptive Cell Therapy: Extracts patient immune cells, enhances them in the lab, then reinfuses them to target and destroy cancer cells.
Targeted Therapy
Targeted therapies attack cancer cells by targeting specific genetic mutations or proteins while sparing healthy cells. Requires molecular testing to identify biomarkers.
KRAS Mutations: Previously “undruggable,” now treatable with:
- KRAS G12C Inhibitors: Adagrasib (Krazati) and sotorasib, often with panitumumab, shrink tumors and extend progression-free survival.
BRAF Mutations: Encorafenib (Braftovi) plus cetuximab approved for BRAF-V600E metastatic colorectal cancer.
HER2 Mutations: Tucatinib and trastuzumab combinations show promise for HER2-overexpressing colorectal cancers.
Anti-Angiogenesis Drugs: Bevacizumab (Avastin) and fruquintinib (Fruzaqla) cut tumor blood supply, often combined with chemotherapy.
Minimally Invasive and Advanced Surgical Techniques
Robotic and Laparoscopic Surgery: Use smaller incisions to reduce pain and recovery time. Robotic systems enable complex procedures with enhanced precision.
Cytoreductive Surgery (CRS) and HIPEC: Specialized procedure for peritoneal spread involving surgical tumor removal followed by heated chemotherapy wash of the abdominal cavity.
Liver-Directed Therapies: For liver metastases, hepatic arterial infusion chemotherapy (HAIC) delivers high-dose chemotherapy directly to the liver.