Guest Editors
Dr. Carlo Signorelli
Email: carlo.signorelli@asl.vt.it
Affiliation: Medical Oncology Unit, Santa Rosa Central Hospital, ASL Viterbo, Viterbo, Italy
Homepage:
Research Interests: colorectal cancer, gastrointestinal cancers, immunotherapy, refractory metastatic colorectal cancer, real-world studies
Summary
Even with major advances in treatment, refractory metastatic colorectal cancer (mCRC) is still one of the hardest areas in oncology. In everyday clinical practice, doctors often have to deal with patients who have already had multiple lines of therapy and complex biological heterogeneity. In this context, decisions are often made based on limited prospective evidence and highly personalised clinical situations. Even though survival has slowly gotten better, treatment after progression is still a grey area where there is more confusion than clarity. It is becoming increasingly clear that precision oncology should not cease upon the emergence of resistance.
The idea of "precision beyond progression" is at the heart of this Special Issue. It shows how important it is to combine real-world evidence (RWE) with dynamic, on-treatment markers that may better show how drugs are working. Instead of just seeing treatment-related events as bad effects, we suggest looking into their biological meaning more deeply. Haematologic toxicities, inflammatory alterations, exposure-response relationships, and initial radiologic dynamics may provide significant insights into pharmacodynamic activity and therapeutic efficacy. When systematically assessed in extensive real-world cohorts, these signals possess the capacity to enhance therapeutic sequencing, optimise patient selection, and facilitate more personalised dosing strategies in subsequent treatment lines.
We welcome original research, translational studies, multicenter observational analyses, and high-quality reviews that look into resistance mechanisms, anti-angiogenic strategies, multikinase inhibitors, combinations based on trifluridine and tipiracil, and new approaches based on biomarkers. This Special Issue's goal is to encourage a more practical, biologically informed, and patient-centered way of treating refractory mCRC by combining clinical trials with real-world experience.
Keywords
refractory metastatic colorectal cancer, real-world evidence, dynamic prognostic markers, treatment sequencing, precision oncology
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