Nouvelles Approches dans le diagnostic et le traitement du cancer colorectal : compréhension des mécanismes et innovations thérapeutiques

Abstract

Colorectal cancer is one of the leading causes of morbidity and mortality worldwide. Its pathophysiology is based on complex genetic and molecular alterations, as well as biochemical mechanisms closely involving immunity and inflammation. This thesis aims to analyze these mechanisms in order to better understand the interactions between the tumor, the immune system, and the intestinal microenvironment, and to explore the resulting therapeutic perspectives.The study highlights the crucial role of immune cells, such as T lymphocytes, macrophages, and dendritic cells, in tumor surveillance and progression. Additionally, biomarkers such as microRNAs, CTC, and ctDNA play an important role in the early detection and treatment of colorectal cancer. Immune escape strategies, particularly via the PD-1/PD-L1 and CTLA-4 pathways, are key targets for new therapeutic approaches. Furthermore, the influence of the gut microbiota appears to be decisive, modulating both the immune response and tolerance toward tumor cells. The impact of cytokines and inflammatory mediators, true regulators of cellular communication, is also highlighted as a key factor in tumor progression.Finally, recent therapeutic advances, particularly the use of monoclonal antibodies targeting immune checkpoints (anti-PD-1/PD-L1, anti-CTL4), open new perspectives for personalized management of colorectal cancer. These approaches, incorporating biochemical and immunological data, contribute to the development of precision medicine aimed at improving the prognosis and quality of life for patients.