The Role of Biomarkers in the Management of Colorectal Liver Metastases

Abstract

Surgical management combined with improved systemic therapies have extended 5-year overall survival beyond 50% among patients with colorectal liver metastases (CRLM). Furthermore, a multitude of liver-directed therapies has improved local disease control for patients with unresectable CRLM. Unfortunately, a significant portion of patients treated with curative-intent hepatectomy develops disease recurrence. Traditional markers fail to risk-stratify and prognosticate patients with CRLM appropriately. Over the last few decades, advances in molecular sequencing technology have greatly expanded our knowledge of the pathophysiology and tumor microenvironment characteristics of CRLM. These investigations have revealed biomarkers with the potential to better inform management decisions in patients with CRLM. Actionable biomarkers such as RAS and BRAF mutations, microsatellite instability/mismatch repair status, and tumor mutational burden have been incorporated into national and societal guidelines. Other biomarkers, including circulating tumor DNA and radiomic features, are under active investigation to evaluate their clinical utility. Given the plethora of therapeutic modalities and lack of evidence on timing and sequence, reliable biomarkers are needed to assist clinicians with the development of patient-tailored management plans. In this review, we discuss the current evidence regarding biomarkers for patients with CRLM.

The tumor burden score may be a discriminator in microwave ablation versus liver resection for hepatocellular carcinoma within the Milan criteria: a propensity score matching and inverse probability of treatment weighting study

“…To date, the best approach to the management of HCC within the Milan criteria, eligible for both microwave coagulation and liver resection, remains controversial. According to previous studies, tumor morphology has been validated as a strong predictor of recurrence and poorer survival outcomes (23,24). Sun et al reported that no marked difference was found in the 1-, 3-, and 5-year OS rates and the 1-year disease-free survival (DFS) rate between the MWA and resection groups.…”

Circulating Tumor DNA and Management of Colorectal Cancer

“…Many questions remain about the proper selection of patients and therapy so as to not overtreat patients at low risk of recurrence or undertreat those who are at a high recurrence risk. Biomarkers are of interest in many malignancies, including CRC, to offer prognostic information and help guide therapy [ 14 , 15 ]. For example, alfa-fetoprotein (AFP) has been used as a biomarker for hepatocellular carcinoma and is associated with aggressive tumor biology and high risk of tumor recurrence after potentially curative treatment such as liver transplantation [ 16 ].…”

Impact of Molecular Status on Metastasectomy of Colorectal Cancer Liver Metastases

“…9,10 In the era of genomics and targeted therapy, genetic mutation analysis is of great significance to guide systemic treatment and identify patients who can benefit from resection of CRLM. 5,11 RAS and BRAF mutations have been widely recognized to be associated with worse survival after resection of CRLM. Additionally, other molecular biomarkers such as TP53, SMAD4, APC, and PIK3CA were also reported to be prognostic factors for CRLM.…”