Loading
The consensus molecular subtypes are four gene-expression groups of bowel cancer: immune (CMS1), canonical (CMS2), metabolic (CMS3), and mesenchymal (CMS4), with different prognoses.
The consensus molecular subtypes divide colorectal cancer into four gene-expression groups defined by Guinney and colleagues in Nature Medicine in 2015. CMS1 is the immune subtype, enriched for microsatellite instability and BRAF mutation; CMS2 is the canonical WNT and MYC subtype; CMS3 is the metabolic, KRAS-associated subtype; and CMS4 is the mesenchymal, TGF-beta and stroma-rich subtype with the worst prognosis. The classification is prognostic and partly predictive, with CMS2 appearing to gain most from anti-EGFR therapy, but it is not yet used routinely in the clinic. Readers meet it through RNA sequencing, the Wnt, epithelial-mesenchymal transition and mismatch repair pathways, and the idea of matching therapy to the type of scar-forming cell in a tumour.
Showing the technology this term belongs to: RNA sequencing & expression profiling.
It is the strongest evidence that the consensus subtypes could choose between the two first-line biologicals, and the clearest statement of why they have not: it is a retrospective analysis of a subset of one trial, on an assay nobody has validated for clinical use.
It is the caution attached to the sidedness rule: a tumour at the hepatic flexure and one at the caecum are both called right-sided and are not the same disease.
The analysis that put 'left-sided, RAS and BRAF wild-type' into every guideline as the anti-EGFR population, and made an anatomical fact into a treatment-selection biomarker.
It means a CMS4 call on a bulk sample partly measures how much stroma was in the block, which is both a caution for the classification and a pointer to the stroma as the thing to treat.
It made TGF-beta the central target of the microsatellite-stable half of the disease, which is the line that leads to Tauriello's immune-evasion work and to the TGF-beta plus checkpoint combinations in trials.
The CMS framework organises colorectal cancer biology and trial stratification; BRAF V600E tumours cluster in CMS1, and CMS4's shorter survival and stromal signalling are targets of ongoing research.
Shares CpG island methylator phenotype (CIMP), Serrated pathway, BRAF V600E-mutant colorectal cancer, Mismatch-repair deficient (MSI-high) colorectal cancer.
Shares The consensus molecular subtypes of colorectal cancer, Mismatch repair & microsatellite instability, Wnt / β-catenin, RNA sequencing & expression profiling.
Shares Impact of consensus molecular subtype on survival in patients with metastatic colorectal cancer: results from CALGB/SWOG 80405, Prognostic and predictive value of primary tumour side in patients with RAS wild-type metastatic colorectal cancer treated with chemotherapy and EGFR directed antibodies in six randomized trials, Colorectal cancer.
Shares Impact of consensus molecular subtype on survival in patients with metastatic colorectal cancer: results from CALGB/SWOG 80405, Prognostic and predictive value of primary tumour side in patients with RAS wild-type metastatic colorectal cancer treated with chemotherapy and EGFR directed antibodies in six randomized trials, Mismatch-repair deficient (MSI-high) colorectal cancer, Colorectal cancer.
Shares CpG island methylator phenotype (CIMP), Serrated pathway, Mismatch-repair deficient (MSI-high) colorectal cancer, Colorectal cancer.
Shares Stromal gene expression defines poor-prognosis subtypes in colorectal cancer, The consensus molecular subtypes of colorectal cancer, Colorectal cancer.
Shares Prognostic and predictive value of primary tumour side in patients with RAS wild-type metastatic colorectal cancer treated with chemotherapy and EGFR directed antibodies in six randomized trials, Sidedness (left vs right colon), Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, Colorectal cancer.
Shares Adenoma-carcinoma sequence, Wnt / β-catenin, Colorectal cancer.