Study to Investigate Outcome of Individualized Treatment in Patients With Metastatic Colorectal Cancer

Pre-screening: Inclusion Criteria:

• Has a histologically-proven locally advanced or metastatic adenocarcinoma from colonor rectum
• Has received or is receiving systemic treatment for mCRC
• Has non-resectable metastases and eligible to undergo a radiological-guided corebiopsy from at least one metastasis
• Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1
• Has measurable or evaluable disease (per RECIST v1.1)
• Is capable of giving signed informed consent, as described in Appendix 1, whichincludes compliance with the requirements and restrictions listed in the informedconsent form (ICF) and in this protocol

Exclusion Criteria:

• Has other clinically significant medical conditions which, in the opinion of thetreating physician, makes it undesirable for the patient to participate in the studyor which could jeopardize compliance with study requirements. MAIN STUDY: Inclusion Criteria:

1. Has a histologically-proven locally advanced or metastatic adenocarcinoma from colonor rectum (mCRC)
2. Has received at least two lines of SOC chemotherapy for mCRC Note: 1) For patients whodevelop a metastatic relapse < 6 months after completed total neo-adjuvant treatmentin conjunction with a metastasectomy, this treatment will be considered as one line (e.g. first-line) chemotherapy. 2) Patients with the gene RAS wild-type tumors shouldhave received or have been offered and refused prior treatment with antibodies againstepidermal growth factor receptor (EGFR) (e.g. in combination with prior lines ofchemotherapy) unless it was contraindicated due to underlying conditions or the tumorcontains molecular alterations suggested to provide primary resistance toEGFR-targeted therapy.
3. Has full combined pharmacogenomic profile (genomic and transcriptomic profile of thepatients tumor and ex vivo drug sensitivity testing of PDOs from the patient's owntumors cells) from which the MTB suggests a treatment with one of the defined targetedanti-cancer therapies provided this study
4. Has measurable or evaluable disease (per RECIST v1.1)
5. ECOG performance status 0 or 1
6. For orally administered drugs, the participant must be able to swallow and tolerateoral medication and must have no known malabsorption syndrome.
7. Because of the risks of drug treatment to a developing fetus, women of child-bearingpotential and men must agree to use adequate contraception in accordance with therespective SmPC and as listed in Appendix 4 for the duration of study participation,and up to 7 months following completion of study therapy. Male study patients, even ifsurgically sterilized, (i.e. post-vasectomy) must agree to one of the following:practice effective barrier contraception during the entire study treatment period andthrough 6 months after the last dose of study drug, or completely abstain from sexualintercourse.
8. Has acceptable organ function as defined below. However, as noted below (exclusioncriterion 16), drug-specific inclusion/exclusion criteria specified in the Appendix 16/respective SmPC for each agent will take precedence for this and all inclusioncriteria:
9. Absolute neutrophil count ≥ 1.5/nL (nL = nano Litre)
10. Hemoglobin > 10 g/dL
11. Platelets > 100/nL
12. Total bilirubin < 1.5 x institutional upper limit of normal (ULN)
13. Aspartate aminotransferase AST (SGOT) and alanine aminotransferase ALT(SGPT) < 2.5 x institutional upper limit of normal (ULN) (or < 5 x ULN in patients withknown hepatic metastases)
14. Calculated or measured creatinine clearance ≥ 50 mL/min/1.73 m2 Exclusion Criteria:
15. Has ongoing toxicity > CTCAE grade 2, other than peripheral neuropathy and alopecia,related to anti-tumor treatment that was completed within 4 weeks prior toregistration. Patients with ongoing peripheral neuropathy of ≥ CTCAE grade 3 will beexcluded.
16. Has received previous treatment with the selected study drug for the same malignancy.
17. Has a tumor with a genomic variant known to confer resistance to an anti-cancer agentavailable in this study, the patient will not be eligible to receive that agent butwill be eligible to receive other drugs available in this study if all inclusion andexclusion criteria are met for that drug.
18. Is receiving any other anti-cancer therapies (cytotoxic, biologic, radiation, orhormonal other than for replacement). Participants may be on warfarin, low molecularweight heparin or direct factor Xa inhibitors, unless such therapies are prohibited bydrug-specific exclusion criteria (please consult the corresponding SmPC and Appendix 16 for prohibited medication and contraindication/precautions).
19. Is pregnant or breastfeeding or refusing any type of required contraception methods.
20. Has known Central Nervous System (CNS) metastases.
21. Has preexisting cardiac conditions, including uncontrolled or symptomatic angina,uncontrolled atrial or ventricular arrhythmias, or symptomatic congestive heartfailure.
22. Has left ventricular ejection fraction (LVEF) known to be < 40%.
23. Has had a stroke (including TIA) or an acute myocardial infarction within 6 monthsbefore the first dose of study treatment.
24. Has had acute gastrointestinal bleeding within 1 month of start of treatment
25. Has other clinically significant medical conditions which, in the opinion of thetreating physician, makes it undesirable for the patient to participate in the studyor which could jeopardize compliance with study requirements.
26. Meets any of the assigned drug contraindications or other drug-specific exclusioncriteria as described in the respective SmPC and in Appendix 16