Therapeutic Choices 7th Edition.torrent !!EXCLUSIVE!!

Therapeutic Choices 7th Edition.torrent !!EXCLUSIVE!!

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DCC, a widely used prognostic factor for CRC, typically carries a poor prognosis. Upon progression, metastatic CRC can develop a wide range of molecular alterations, many of which may be targets for therapeutic intervention. NGS is a useful tool in identifying the presence of these alterations in DCC. However, there is a very high degree of discordance between primary and metastatic CRCs for a number of the most common alterations, such as TP53, APC, PIK3CA, and SMAD4 [23, 24]. These results reflect the tumor heterogeneity seen in a progressive disease environment, and as such, they may contribute to the failure of therapeutic regimens to eradicate the tumor. Interestingly, the treatment-specific alterations are more prevalent between primary and metastatic CRCs than the identical alterations between primary CRCs and normal colon tissues, suggesting that treatment regimens preferentially target specific alterations rather than a general increase in genomic instability [23].

The therapeutic implications of the most frequently discordant alterations (TP53, APC, PIK3CA, and SMAD4) in each respective category are discussed. Our meta-analysis indicates that a subset of patients who fail initial therapy may benefit from sequencing of additional sites to identify new actionable genomic alterations not present in the initial analysis. Evidence-based recommendations are proposed.

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