Landscape of Biomarkers and Pathologic Response in Rectal Cancer: Where We Stand?

Area of Science:

• Oncology
• Gastroenterology

Background:

• Colorectal cancer (CRC) is a prevalent global neoplasm.
• Multimodal treatment, including chemotherapy, radiotherapy, and surgery, is standard for locally advanced stages.
• Total neoadjuvant therapy (TNT) has enhanced pathological complete response (pCR) rates compared to traditional neoadjuvant therapy (NAT).

Purpose of the Study:

• To review robust prognostic biomarkers for clinical practice in colorectal cancer.
• To evaluate the advantages and disadvantages of various biomarkers.
• To emphasize the predictive value of biomarker combinations for treatment response.

Main Methods:

• Review of existing literature on prognostic biomarkers in colorectal cancer.
• Analysis of hematological, molecular, and imaging markers.
• Evaluation of combined biomarker approaches.

Main Results:

• TNT achieves higher pCR rates (up to 37%) than NAT (20-25%).
• Current biomarkers show contradictory results, limiting routine clinical use.
• Biomarker combinations show potential for improved predictive value.

Conclusions:

• Further research is needed to identify the optimal patient population for TNT.
• Robust prognostic biomarkers and their combinations are essential for predicting disease course and guiding CRC treatment.
• Standardization of biomarker use in clinical practice is necessary.