[Personalized pharmacotherapy of colorectal cancer]

Treatment of colorectal cancer has fundamentally evolved due to molecular characterization and biomarker-driven strategies.

To summarize key personalized treatment approaches in colorectal cancer with a focus on clinically relevant molecular subgroups.

Molecular biomarkers increasingly guide treatment decisions. Microsatellite instability-high (MSI-H)/deficient mismatch repair (dMMR) tumors show pronounced responses to immune checkpoint inhibitors and represent a distinct therapeutic entity. In the adjuvant setting, recent data identify for the first time a predictive biomarker for a targeted pharmacologic intervention: patients with alterations in the phosphoinositide 3‑kinase (PI3K) pathway significantly benefit from adjuvant aspirin therapy, emphasizing the importance of molecular testing even in early-stage disease. In metastatic colorectal cancer, molecular stratification is essential. For BRAF V600E-mutated tumors, the BREAKWATER study demonstrates that targeted therapy in first-line combination with chemotherapy significantly improves response rates and survival. Additional targets such as HER2 and emerging immunologic and cellular therapies continue to expand treatment options.

Colorectal cancer treatment is increasingly evolving into a precision oncology approach. Integration of molecular biomarkers enables tailored therapy decisions and opens new options, particularly in adjuvant and metastatic settings.