Emerging and targeted therapeutic strategies in colorectal cancer: molecular mechanisms and clinical perspectives.

Colorectal cancer (CRC) remains a leading cause of cancer-related morbidity and mortality worldwide, driven by complex genetic, epigenetic, and environmental factors. Despite advances in conventional treatments such as surgery, chemotherapy, and radiotherapy, therapeutic resistance and disease recurrence continue to limit long-term outcomes. This review provides a comprehensive overview of emerging and targeted therapeutic strategies in CRC, with emphasis on their molecular basis and clinical relevance. The key pathways involved in CRC pathogenesis, including the adenoma-carcinoma sequence, microsatellite instability, and CpG island methylator phenotype, are discussed to highlight their roles in disease progression and therapeutic targeting. Recent advances in targeted therapies, particularly those directed against vascular endothelial growth factor and epidermal growth factor receptor, along with the expanding role of immunotherapy, are critically examined. In addition, novel approaches such as gene- and RNA-based therapies, microbiome modulation, nanotechnology-driven drug delivery systems, and precision medicine strategies based on multi-omic profiling are explored. Despite these developments, the challenges including tumor heterogeneity, therapeutic resistance, and limitations in drug delivery and biomarker identification remain significant. Future perspectives emphasize the integration of molecular profiling and innovative therapeutic platforms to enable more personalized and effective treatment strategies. Collectively, these advances highlight a shift toward precision oncology for improved management of colorectal cancer.