ALEXANDRIA, VA — The American Society of Clinical Oncology (ASCO) recently developed recommendations for the treatment of patients with metastatic colorectal cancer (mCRC).
To reach the conclusions, ASCO convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice. Meeting the systematic review inclusion criteria were five systematic reviews and 10 randomized controlled trials.
The recommendations published in the Journal of Clinical Oncology include that “doublet chemotherapy should be offered, or triplet therapy may be offered to patients with previously untreated, initially unresectable mCRC, on the basis of included studies of chemotherapy in combination with anti–vascular endothelial growth factor antibodies.”1
More specifically, the guideline stated:
- In the first-line setting, pembrolizumab is recommended for patients with mCRC and microsatellite instability-high or deficient mismatch repair tumors;
- chemotherapy and anti–epidermal growth factor receptor therapy is recommended for microsatellite stable or proficient mismatch repair left-sided treatment-naive RAS wild-type mCRC;
- chemotherapy and anti–vascular endothelial growth factor therapy is recommended for microsatellite stable or proficient mismatch repair RAS wild-type right-sided mCRC.
- Encorafenib plus cetuximab is recommended for patients with previously treated BRAF V600E–mutant mCRC that has progressed after at least one previous line of therapy.
In terms of procedures, cytoreductive surgery plus systemic chemotherapy might be recommended for selected patients with colorectal peritoneal metastases; however, the addition of hyperthermic intraperitoneal chemotherapy is not recommended, according to the panel.
The guideline added that stereotactic body radiation therapy may be recommended following systemic therapy for patients with oligometastases of the liver who are not considered candidates for resection.
On the other hand, the authors pointed out that selective internal radiation therapy is not routinely recommended for patients with unilobar or bilobar metastases of the liver. “Perioperative chemotherapy or surgery alone should be offered to patients with mCRC who are candidates for potentially curative resection of liver metastases,” the panel wrote.
The guideline also recommended multidisciplinary team management and shared decision-making.
“The 5-year relative overall survival (OS) for patients with metastatic colorectal cancer (mCRC) is approximately 15%,” according to the report. “Approximately 33% of patients with CRC will develop metastases either at presentation or follow-up. Evaluating treatment options is complex because of the heterogeneity of the patient population, including different molecular subtypes. “
The panel went on to note that, while treatment has included conventional fluorouracil (FU)–based chemotherapy, more recently, targeted therapies have been developed for specific molecular subtypes and primary tumor sidedness.
“This guideline provides a review of the evidence for areas of uncertainty in the treatment of mCRC, including indications for targeted therapy, and treatment options for oligometastatic and liver-limited disease,” the panel wrote.
- Morris VK, Kennedy EB, Baxter NN, Benson AB 3rd, et. Al. Treatment of Metastatic Colorectal Cancer: ASCO Guideline. J Clin Oncol. 2023 Jan 20;41(3):678-700. doi: 10.1200/JCO.22.01690. Epub 2022 Oct 17. PMID: 36252154; PMCID: PMC10506310.