Colorectal cancer (CRC) is one of the leading causes of cancer death worldwide. Over the last decades, several studies have shown that tumor-related genomic alterations predict tumor prognosis, drug response and toxicity. These observations have led to the development of a number of precision therapies based on individual genomic profiles. As part of these approaches, pharmacogenomics analyses genomic alterations that may predict an efficient therapeutic response. Studying these mutations as biomarkers for predicting drug response is of a great interest to improve precision medicine. Here we conduct a comprehensive review of the main pharmacogenomics biomarkers and genomic alterations affecting enzyme activity, transporter capacity, channels and receptors, and therefore the new advances in CRC precision medicine to select the best therapeutic strategy in populations worldwide, with a focus on Latin America. mutations in the transforming growth factor-β (TGFβ), WNT-β-catenin, PI3K, EGFR and downstream MAPK pathways induces CRC 11,[13][14][15] .On the other hand, the development of CRC also occurs when chromosomal instability (CIN) occurs, progress due to defects in telomere stability, chromosomal segregation and mutations in TP53 gene 16 . The 15% of early-stage colorectal tumors present mismatch repair-deficient (MMRd) system, triggering hypermutation and microsatellite instability (MSI) 14 . According to Dienstmann et al., the epigenetic profile of tumors with CIN present mutations in APC, KRAS, TP53, SMAD4 and PIK3CA, promoting the formation of the non-hypermutated consensus molecular subtypes (CMSs): CMS2, CMS3 and CMS4 1 .Whereas tumors with MSI harbor mutations in the MSH6, RNF43, ATM, TGFBR2, BRAF and PTEN genes of the hypermutated molecular subtype CMS1 1 .
A consensus of molecular subtypesGene expression-based subtyping is widely accepted as a relevant source of disease stratification 17 . Nevertheless, the translational utility is hampered by divergent results that are probably related to differences in algorithms applied to sample preparation methods, gene expression platforms and racial/ethnic disparities 18,19 . Inspection of the published gene expression-based CRC classification revealed an absence of a clear methodological 'gold standard' 8,9,16,[20][21][22][23] . To facilitate clinical translation, the CRC Subtyping Consortium (CRCSC) was formed to assess the core subtype patterns among existing gene expressionbased CRC subtyping algorithms 18,24 .