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Cáncer colorrectal metastásico de primera línea: elección de biológico por lateralidad/subtipo
Pilar García Alfonso, Aitna Calvo Ferrándiz, Javier Soto Alsar, Laura Ortega Morán, Mónica Benavente de Lucas, Andrés J. Muñoz Martín
Prepublicado: 2026-01-26
Publicado: 2026-02-20
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El cáncer colorrectal (CCR) metastásico continúa siendo una enfermedad de pronóstico limitado, aunque los avances en quimioterapia combinada, terapias dirigidas e inmunoterapia han permitido mejorar de forma sustancial la supervivencia global en las últimas décadas. El tratamiento de primera línea se basa en la combinación de fluoropirimidinas con oxaliplatino o irinotecán y agentes biológicos dirigidos frente a VEGF o EGFR, cuya selección debe individualizarse según los objetivos terapéuticos, las características del paciente y el perfil tumoral. La determinación sistemática de biomarcadores, en particular RAS, BRAF y el estatus dMMR/MSI, así como la lateralidad del tumor primario, constituye un elemento clave en la toma de decisiones. En este contexto, los tumores de colon izquierdo RAS/BRAF wild-type se benefician preferentemente de terapias anti-EGFR, mientras que bevacizumab representa una opción eficaz en otros escenarios. La incorporación de estrategias de mantenimiento, de conversión quirúrgica y, más recientemente, de hiperselección molecular mediante ctDNA, refuerza el enfoque de medicina de precisión y permite optimizar la secuencia terapéutica en el CCR metastásico.
Palabras Clave: Terapias dirigidas. Lateralidad tumoral. Biomarcadores moleculares. Hiperselección molecular.
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