Colorectal cancer (CRC) is a common malignancy and represents a global health burden. In developed nations, the prognosis for patients has improved in recent years due to a combination of earlier diagnosis, surgical resection of metastases, a broadening armamentarium of effective drugs and supportive care.
In the setting of metastatic disease, prognosis varies substantially between patients. Traditionally, clinical factors, such as disease bulk, performance status, biochemical parameters and comorbidities have given the treating oncologist insight into a given patient’s future, thus aiding treatment selection. While these factors remain as important as ever, novel molecular markers have emerged with the V600E mutation of the BRAF gene, present in approximately 5–10% of patients, being one of the most important. Patients with tumors harboring this BRAF mutation have a very poor prognosis when treated with the current range of approved drugs. Consequently, a distinct management approach is required. Intense research efforts resulting in rationally designed clinical trials are ongoing, with early reports providing hope that we are on track to making real progress. The importance of BRAF mutations are increasingly recognized with testing becoming more routine and recommended in the latest National Comprehensive Cancer Network clinical practice guidelines.
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