Treatment of Metastatic Colorectal Cancer: ASCO Guideline

PURPOSE To develop recommendations for treatment of patients with metastatic colorectal cancer (mCRC). METHODS ASCO convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice. RESULTS Five systematic reviews and 10 randomized controlled trials met the systematic review inclusion criteria. RECOMMENDATIONS 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. 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. Cytoreductive surgery plus systemic chemotherapy may be recommended for selected patients with colorectal peritoneal metastases; however, the addition of hyperthermic intraperitoneal chemotherapy is not recommended. Stereotactic body radiation therapy may be recommended following systemic therapy for patients with oligometastases of the liver who are not considered candidates for resection. 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. Multidisciplinary team management and shared decision making are recommended. Qualifying statements with further details related to implementation of guideline recommendations are also included.

Automated summary

The purpose of this study is to develop treatment recommendations for patients with metastatic colorectal cancer (mCRC). An Expert Panel convened by ASCO conducted a systematic review of relevant studies and developed recommendations for clinical practice. Based on the inclusion criteria, five systematic reviews and ten randomized controlled trials were included in the analysis. The recommendations include offering doublet chemotherapy or triplet therapy to previously untreated mCRC patients who are initially unresectable, based on studies of chemotherapy combined with anti-vascular endothelial growth factor antibodies. Pembrolizumab is recommended for first-line treatment of mCRC patients with microsatellite instability-high or deficient mismatch repair tumors. Chemotherapy and anti-epidermal growth factor receptor therapy are recommended for microsatellite stable or proficient mismatch repair left-sided treatment-naive RAS wild-type mCRC, while chemotherapy and anti-vascular endothelial growth factor therapy are recommended for microsatellite stable or proficient mismatch repair RAS wild-type right-sided mCRC. Encorafenib plus cetuximab is recommended for previously treated BRAF V600E-mutant mCRC patients who have progressed after one previous line of therapy. Other recommendations are provided for patients with colorectal peritoneal metastases, liver metastases, and candidates for potentially curative resection of liver metastases. Multidisciplinary team management and shared decision making are also recommended.