Precision in Practice: Mastering Biomarker-Driven Management of Metastatic Colorectal Cancer

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This comprehensive document highlights the critical role of gastroenterologists (GIs) in advancing precision medicine for metastatic colorectal cancer (mCRC) through biomarker testing. Key biomarkers such as KRAS, NRAS, BRAF, and MSI guide personalized treatment planning and improve patient outcomes. Gastroenterologists, positioned at the outset of cancer diagnosis via colonoscopy and biopsy, can initiate reflex biomarker testing to avoid delays and advocate for comprehensive genomic profiling, particularly where such testing is inconsistent.<br /><br />The document stresses the importance of multidisciplinary collaboration among gastroenterologists, pathologists, oncologists, nurses, and advanced practice providers to optimize biomarker testing and patient management. Pathologists play a vital role in evaluating sample adequacy and triaging specimens for molecular testing, employing techniques like immunohistochemistry (IHC), PCR, and next-generation sequencing (NGS). Each testing method varies in sensitivity, cost, and tissue requirements.<br /><br />Oncologists utilize biomarker results to guide targeted therapies—such as anti-EGFR agents for RAS wild-type tumors or immunotherapy for MSI-high cancers—resulting in improved progression-free survival and response rates. Nurse navigators facilitate coordination of care, ensuring that pathology reports, staging scans, and genetic testing are completed timely, while also providing patient education on genetic risk and treatment implications.<br /><br />Barriers to widespread biomarker-guided therapy include limited infrastructure in smaller centers, variable provider knowledge, inconsistent institutional protocols, and insurance coverage challenges. The document emphasizes the need for gastroenterologists to lead in establishing testing protocols and advocate for comprehensive genomic profiling according to NCCN guidelines. Germline testing is recommended for all colorectal cancers, with somatic testing essential in metastatic cases.<br /><br />In summary, early biomarker testing initiated by gastroenterologists, supported by effective pathology evaluation and oncologic targeted therapy, combined with robust nurse navigator coordination, can transform mCRC patient care through precision oncology. Addressing systemic barriers and fostering multidisciplinary collaboration are key to optimizing outcomes.

Keywords

gastroenterologists

metastatic colorectal cancer

biomarker testing

KRAS

NRAS

BRAF

MSI

precision medicine

multidisciplinary collaboration

targeted therapies