Multigene Testing for Prognostication and Therapeutic Actionability

High-throughput, cost-effective next-generation sequencing has enabled molecular profiling of patients with colorectal liver metastases to be performed in routine clinical practice. Somatic gene mutations, particularly driver mutations in RAS and BRAF, determine response to systemic therapy and survival after resection of colorectal liver metastases. Concurrent mutations in oncogenes and/or tumor suppressor genes in doublet or triplet combinations are increasingly recognized as stronger determinants of tumor biology than a single gene mutation. State-of-the-art care in colorectal liver metastases entails recognition of molecular subsets, interpretation of multigene panel results, and genomically informed therapies.