Colorectal Cancer: Targeted and Immunotherapies
Targeted and Immunotherapies for Colorectal Cancer
This section covers the following topics:
What is ?
Immunotherapies are cancer treatments that help the body’s immune system detect and attack cancer cells. Immune checkpoint inhibitors are a type of used to treat several types of cancer, including colorectal cancer. Some cancer cells can switch off the immune system. Immune checkpoint inhibitors are drugs that prevent this from happening. This allows the immune system to find, unmask and destroy cancer cells.
Which immunotherapies are used for colorectal cancer?
Immune checkpoint inhibitors are often used to treat advanced or colorectal cancer that are MSI-H or dMMR; usually after other treatments have been tried. The most common immune checkpoint inhibitors used for colorectal cancer are:
- Jemperli (dostarlimab)
- Keytruda (pembrolizumab)
- Opdivo (nivolumab)
- Yervoy (ipilimumab)
The drug, dostarlimab may be used for early ( 2 or 3) rectal cancer to shrink tumors before surgery. The use of dostarlimab in this setting is not yet approved, and is considered off-label. However, the National Comprehensive Cancer Network (NCCN) expert panel for colorectal cancer has added this indication to their treatment guidelines.
Researchers are studying new ways to use immunotherapies to treat colorectal cancer. Visit our Featured Research section for more information.
side effects
Like any medication, can come with side effects. Most are manageable, but some can be serious or even life threatening. You can learn more about on our Side Effects page.
What is ?
Targeted therapies are treatments designed to attack or kill cancer cells, while sparing normal cells as much as possible. These therapies are often designed to target abnormal proteins, receptors or genes that are found in high quantities in cancer cells or the surrounding tissue. Tumor testing can help doctors identify the patients most likely to benefit from a .
Which targered therapies are used for colorectal cancer?
Several targeted therapies are used to treat advanced or colorectal cancer. Common targeted therapies used in colorectal cancer include:
- Anti VEGF therapies block tumors from forming blood vessels. Anti VEGF drugs used to treat colorectal cancer include:
- Avastin (bevacizumab)
- Cyramza (ramucirumab)
- Fruzaqla (fruquintinib)
- Zaltrap (ziv-aflibercept)
- Anti EGFR therapies slow down tumor cell growth. Anti EGFR drugs used to treat colorectal cancer include:
- Erbitux (cetuximab)
- Vectibix (panitumumab)
- Anti-HER2 therapies are used for people with advanced colorectal cancer when tumor testing shows a called .
- Enhertu (trastuzumab deruxtecan)
- Herceptin (trastuzumab)
- Tukysa (tucatinib)
- Stivarga (regorafenib) blocks several different types of proteins in the body that tumors use to grow. Stivarga may be used to treat colorectal cancer that has come back after treatment with other drugs.
- Retevmo (selpercatinib) is a that is used to treat advanced cancers with a rare mutation known as a RET gene fusion. RET gene fusions are rare in colorectal cancer.
- Vitrakvi (larotrectinib) is approved for treatment of advanced cancers that have worsened with other treatments. It targets a genetic change called an NTRK fusion. This type of genetic change is rare in colon cancers.
Speak with your doctor if you have advanced colorectal cancer and you are not sure if you had testing, or if you don't understand your test results.
Researchers are studying new ways to use targeted therapies to treat colorectal cancer. Visit our Featured Research section for more information.
side effects
Like any medication, can come with side effects. Most are manageable, but some can be serious or even life threatening. You can learn more about on our Side Effects page.
In the News
Update : News from the FDA - Two new metastatic colorectal cancer treatments
The FDA recently approved two new treatments for metastatic colorectal cancer. (Posted 3/22/24) Este artículo está disponible en español.
Participate in Research
New Treatment in People with Triple Negative Breast Cancer or Advanced Solid Tumors
Study of a new drug called ONM-501 for people with triple negative breast cancer, advanced solid tumors or lymphomas
The Phoenix Trial: Cemiplimab for Patients with Localized dMMR Colon Cancer
This study will examine the effectiveness and safety of cemiplimab, a treatment given prior to surgery. Participants will undergo endoscopy...
The usual care after a person with stage 3 colon cancer has had surgery and chemotherapy is to begin active...
Treatment of HER2-positive Colorectal Cancer as First Line Treatment in the Metastatic Setting
This study is being done to decide if the drug Tukysa (Tucatinib) combined with other cancer drugs works better than...
Name of Drug |
Cancer Stage |
Indication |
Biomarker |
Type of Agent |
Jemperli (dostarlimab) |
Stage 2 or 3 rectal cancer |
Before surgery (neoadjuvant) to shrink tumor. The use of this drug in early-stage colorectal cancer is not FDA approved yet. It is included in the NCCN expert guidelines as an off-label treatment option based on very promising research results. |
Microsatellite Instability High (MSI-H) or Mismatch Repair Deficiency (dMMR or MMR-D) |
Immune checkpoint inhibitor |
Jemperli (dostarlimab) |
Metastatic or unresectable colorectal cancer |
For people who progressed after chemotherapy |
Microsatellite Instability High (MSI-H) or Mismatch Repair Deficiency (dMMR or MMR-D) |
Immune checkpoint inhibitor |
Keytruda (pembrolizumab) |
Metastatic or unresectable colorectal cancer |
For first-line treatment of metastatic or unresectable colorectal cancer |
Microsatellite Instability High (MSI-H) or Mismatch Repair Deficiency (dMMR or MMR-D) |
Immune checkpoint inhibitor |
Keytruda (pembrolizumab) |
Metastatic or unresectable solid tumors (including colorectal cancer) |
For treatment of solid tumors that have progressed after treatment and for which there are no other treatment options |
Microsatellite Instability High (MSI-H) or Mismatch Repair Deficiency (dMMR or MMR-D) |
Immune checkpoint inhibitor |
Keytruda (pembrolizumab) |
Metastatic or unresectable colorectal cancer |
For treatment of solid tumors that have progressed after treatment and for which there are no other treatment options |
Tumor Mutational Burden-High (TMB-H) |
Immune checkpoint inhibitor |
Keytruda (pembrolizumab) |
Metastatic or unresectable colorectal cancer |
For cancer that has progressed following treatment with a fluoropyrimidine, oxaliplatin, and irinoteca |
Microsatellite Instability High (MSI-H) or Mismatch Repair Deficiency (dMMR or MMR-D) |
Immune checkpoint inhibitor |
Opdivo |
Metastatic colorectal cancer |
As a single agent or in combination with Yervoy (ipilimumab) for cancer that has progressed following treatment with a fluoropyrimidine, oxaliplatin, and irinotecan |
Microsatellite Instability High (MSI-H) or Mismatch Repair Deficiency (dMMR or MMR-D) |
Immune checkpoint inhibitor |
Yervoy |
Metastatic colorectal cancer |
Combined with Opdivo (nivolumab) for cancer that has progressed following treatment with a fluoropyrimidine, oxaliplatin, and irinotecan |
Microsatellite Instability High (MSI-H) or Mismatch Repair Deficiency (dMMR or MMR-D) |
Immune checkpoint inhibitor |
Avastin |
Metastatic colorectal cancer |
Combined with intravenous 5-fluorouracil-based chemotherapy for first- or second-line treatment |
No biomarker required |
Targeted therapy that blocks the blood supply to tumors by targeting a protein called VEGF (Vascular endothelial growth factor) |
Avastin |
Metastatic colorectal cancer |
Combined with chemotherapy for second-line treatment in patients who have progressed on a first-line Avastin-containing regimen |
No biomarker required |
Targeted therapy that blocks the blood supply to tumors |
Cyramza |
Metastatic colorectal cancer |
Combined with FOLFIRI chemotherapy, for treatment after disease progression on, or after prior therapy with bevacizumab, oxaliplatin, and a fluoropyrimidine |
No biomarker required |
Targeted therapy that blocks the blood supply to tumors |
Fruzaqla |
Metastatic colorectal cancer |
Used as a single agent when cancer has progressed after treatment with chemotherapy and targeted therapy |
No biomarker required |
Targeted therapy that blocks the blood supply to tumors by targeting a protein called VEGF |
Erbitux |
Metastatic colorectal cancer |
Combined with FOLFIRI for first-line treatment, or combined with irinotecan for cancers that no longer respond to irinotecan-based chemotherapy or as a single agent in patients who have progressed after oxaliplatin- and irinotecan-based chemotherapy |
EGFR positive and KRAS mutation negative |
Targeted therapy that targets a receptor known as EGFR (epidermal growth factor receptor) |
Vectibix |
Metastatic colorectal cancer |
Combined with FOLFOX for first-line treatment |
Negative for KRAS and NRAS mutations |
Targeted therapy that targets a receptor known as EGFR |
Vectibix |
Metastatic colorectal cancer |
As a single therapy following disease progression after prior treatment with fluoropyrimidine, oxaliplatin, and irinotecan-containing chemotherapy |
Negative for KRAS and NRAS mutations |
Targeted therapy that targets a receptor known as EGFR |
Stivarga (regorafenib) |
Metastatic colorectal cancer |
For treatment of colorectal cancer that has progressed after treatment and for which there are no other treatment options |
No biomarker required |
Targeted therapy known as a multi-kinase inhibitor |
Krazati (adagrasib) |
Metastatic colorectal cancer |
In combination with cetuximab for locally advanced or metastatic colorectal cancer (CRC) that has progressed after treatment with chemotherapy |
KRASG12C mutation |
Targeted therapy against the KRASG12C protein |
Enhertu (fam-trastuzumab-deruxtecan-nxki) |
Metastatic or unresectable solid tumors |
For adult patients with unresectable or metastatic, HER2-positive solid tumors (including colorectal cancer) who have received prior systemic treatment and have no alternative treatment options |
HER2 overexpression (HER2-positive) |
Antibody-drug conjugate (chemotherapy attached to antibody targeting HER2 receptor) |
Herceptin (trastuzumab) and Tukysa (tucatinib) combination |
Metastatic or unresectable colorectal cancer |
For people who progressed after chemotherapy |
HER2-positive and RAS wild-type (no RAS tumor mutation) |
Targeted therapy |