Predictive and prognostic biomarkers for targeted therapy in metastatic colorectal cancer

The use of targeted biologic agents in combination with chemotherapy has increased the overall survival (OS) of metastatic colorectal cancer (mCRC) to 23.5 months. With the assistance of Kirsten-ras (KRAS) mutational status, the subgroup population resistant to the inhibition of epidermal growth factor receptor (EGFR) by monoclonal antibodies (MoAbs) can be identified. However, only up to a third of the KRAS wild-type subpopulation respond to EGFR inhibition. Multiple factors, including relatively low response rates and high costs for targeted agents, are driving the search to identify further biomarkers within the EGFR/Ras/Raf/Mek/Erk and PTEN/PIP3/AKT signaling pathways. Vascular endothelial growth factor (VEGF) is a key player in tumor angiogenesis and the target for the MoAb bevacizumab, which is currently licensed for use in mCRC. Despite numerous studies, an equivalent predictive biomarker for bevacizumab has not been identified. Preclinical work indicates that inhibition of the insulin growth factor receptor (IGFR) pathway stops cellular transformation and tumor regression, thus identifying this pathway as a strong potential target for anticancer drug development and the identification of novel biomarkers. This review focuses on research relating to the roles of biomarkers within the EGF, VEGF, and IGF receptor pathways. The molecules KRAS, BRAF, NRAS, PTEN, PIP3, VEGF, IGF-1R, and IGF binding protein 3 are discussed. Currently, KRAS is the only biomarker used in clinical practice for mCRC. Pending the results of ongoing and future studies, additional biomarkers will be tested, tailoring our approach to targeted therapy in mCRC.