الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Colorectal cancer is the third most common cancer in men after lung cancer and prostate cancer, and it is the third most common cancer in women after breast cancer and lung cancer. Colon is divided into right side and left side. Right side colon includes caecum, ascending colon and transverse colon, and it is derived from the midgut. Left side colon starts from splenic flexure till rectum, and it is derived from hindgut. Right and left colon cancer are now considered two different clinicopathological entities with different molecular profile, different treatment strategies and different disease outcome. Right-sided tumour is a negative predictive factor for the benefit of anti EGFR monoclonal antibodies in mCRC in first line settings. BRAF v600e mutant tumors have poor prognosis, and they are primarily resistant to anti EGFR monoclonal antibodies and donot respond well to conventional chemotherapy agents. Also, they are resistant to BRAF inhibitors due to the feedback stimulation to EGFR signalling pathway.
In our study, we concluded no difference in outcome between right sided and left sided tumors. Regarding response to chemotherapy, there was no difference in response to first line chemotherapy in metastatic disease. However, right sided tumors responded better to second line chemotherapy. We also concluded no benefit from adding Oxaliplatin to the adjuvant chemotherapy in stage II CRC. Regarding chemotherapy protocols, FOLFOX was the dominant regimen in the adjuvant chemotherapy and in first line chemotherapy in advanced CRC, while FOLIFIRI was the dominant regimen in second line chemotherapy for advanced CRC. The vast majority of our patients were treated with chemotherapy alone without targeted therapies.
Extended molecular profile testing is a corner stone in the management of CRC, especially in advanced disease, and it should be considered for all patients. In addition, combination of EGFR inhibitors and VEGF inhibitors with chemotherapy extended the survival of patients with advanced CRC, and we need to make it more available for our patients.
We recommend further studies to be done with more availability of genetic testing and targeted therapies to be familiar with the molecular profile and pattern of response in our populations.