The Changing Landscape of Colorectal Cancer: Early-Onset Disease, Immunotherapy, Microbiome and Precision Medicine

Colorectal cancer (CRC) is a biologically heterogeneous disease whose epidemiology and therapeutic landscape are evolving rapidly. The rising incidence of early-onset colorectal cancer (EOCRC) has intensified efforts to define the genetic, molecular, environmental, and epigenetic determinants that distinguish EOCRC from later-onset disease.Concurrently, advances in tumour immunology have revealed complex interactions between malignant cells and the immune microenvironment that influence disease progression and determine response or resistance to immunotherapy. The gut microbiome is also increasingly recognised as an important modulator of colorectal carcinogenesis, tumour immunity, treatment response, and toxicity. These biological factors intersect with substantial disparities in CRC presentation, access to treatment, and clinical outcomes across populations.Advances in molecular profiling and multi-omics technologies are enabling the identification of novel diagnostic, prognostic, and predictive biomarkers, and increasingly precise patient stratification. Together, these developments are driving precision oncology and supporting therapeutic and preventive strategies tailored to the molecular, immunological, and microbial characteristics of individual patients and tumours.This Research Topic brings together multidisciplinary research on the changing landscape of colorectal cancer, with particular emphasis on early-onset disease and the biological, genetic, immunological, microbial, environmental, and clinical factors that may contribute to its increasing incidence.The collection also highlights emerging approaches to CRC prevention, diagnosis, prognostication, and treatment, including immunotherapy, precision oncology, biomarker development, and microbiome-based research. By integrating insights from clinical medicine, molecular biology, epidemiology, and computational science, it aims to identify key knowledge gaps, stimulate cross-disciplinary collaboration, and support the translation of emerging discoveries into improved strategies for risk assessment, prevention, and personalised care.We welcome Original Research, Review, Systematic Review, and Meta-analysis articles, as well as translational studies, addressing themes including but not limited to:- Early-onset colorectal cancer: genetic and molecular determinants of disease- Tumour-immune interactions and mechanisms of response or resistance to immunotherapy- Microbiome-tumour interactions- Disparities in tumour biology, presentation, treatment, and outcomes- Novel diagnostic, prognostic, and predictive biomarkers- Precision oncology and emerging therapeutic and preventive strategiesTopic Editor Dr Vinodh Kannappan is an academic shareholder and Chief Technology Officer of Disulfican Ltd, a dormant academic spin-out company. Topic Editor Dr Oluwadunni E. Emiloju has received institutional research support from Coherus Oncology, Genentech and Merus; holds stock in Telix; has served in an advisory board/consulting role for Bristol Myers Squibb; and has participated in speaker bureaus for Revolution Medicines and AstraZeneca. All other Topic Editors declare no competing interests with regard to the Research Topic subject.Please note: manuscripts consisting solely of bioinformatics or computational analyses, or of predictions derived from public databases, are not suitable for publication in this journal unless they are accompanied by validation, either in an independent clinical or patient cohort, or biological validation in vitro or in vivo that is not based on public databases. Topic editors: Akinfemi Akingboye, Vinodh Kannappan, Ademola Adebanjo, Oluwadunni Emiloju Source: https://www.frontiersin.org/research-topics/84829/the-changing-landscape-of-colorectal-cancer-early-onset-disease-immunotherapy-microbiome-and-precision-medicine