The consensus molecular subtypes in translation

Colorectal cancer (CRC) is a major health care burden and one of the main causes of mortality. CRC is a heterogeneous disease, with patients presenting with different histopathological features, genetic mutations, course of the disease and response to treatment. The current clinicopathological characteristics combined with a few molecular features to guide treatment for CRC is insufficient in predicting prognosis and therapy response for the individual patient. This is leading to substantial over- and undertreatment in a large proportion of patients. Additional molecular tumor characteristics are needed to achieve a personalized approach with a treatment plan tailored for each patient.
The consensus molecular subtypes (CMSs) provide a stratification of CRC into molecularly highly distinct subtypes (CMS1-4). Although the CMSs were principally founded on the basis of differences in tumor biology, they also contain important clinical information as each subtype shows a different prognosis and distinct response to various treatment regimens.
In this thesis we explored the potential and therapeutic implications in clinical practice of the CMSs. We show the great potential of the CMSs to guide treatment allocation in future clinical practice. Although not completely ready for the clinic yet, once the findings are sufficiently validated in prospective clinical trials the CMS or related classification systems will have an important impact on improving and tailoring treatment strategies for the individual CRC patient. Therefore, the path towards clinical implementation should already be developed.