Dr. Mahipal on Molecular Markers in mCRC

Amit Mahipal, MBBS, senior associate consultant, Division of Medical Oncology, Department of Oncology, associate professor of oncology, Mayo Clinic, discusses emerging molecular markers in patients with metastatic colorectal cancer (mCRC).

In addition to microsatellite instability (MSI) and alterations in RAS and BRAF, investigators are actively looking into HER2 as a potential molecular marker in these patients, says Mahipal. There are several ongoing trials exploring the use of anti-HER2 therapies, especially after progression on first- and second-line treatment. Because single-agent HER2 blockade has shown limited activity, investigators are looking at dual combinations.

As more molecular markers emerge, it is becoming more important to do next-generation sequencing (NGS) in all patients with mCRC, says Mahipal. Recently, NTRK inhibitors have received FDA approval as well. In November 2018, the FDA granted an accelerated approval to larotrectinib (Vitrakvi) for the treatment of adult and pediatric patients with solid tumors that have an NTRK gene fusion. As such, Mahipal advises practitioners to perform NGS in all patients to reach that precision medicine approach in which targeted therapies can be paired with specific molecular aberrations.