CRC: treatment guidelines - PowerPoint Presentation

Slide1

CRC: treatment guidelines

Guidelines for the treatment of advanced colon and rectal cancers

1. NCCN Clinical Practice Guideline in Oncology. Rectal Cancer

, Version 1.2020;

2. NCCN Clinical Practice Guideline in Oncology. Colon Cancer

, Version 1.2020;

3

. Van

Cutsem

E, et al. Ann

Oncol

2016;27(8):

1386–422.

IntroductionThis slide deck summarises the recommended treatment pathways provided by

ESMO and NCCN for locally advanced or metastatic CRC, which includes

rectal and colon cancers1–3Please refer to the full guidelines for more information on:Diagnostic work-up and follow-upTreatment of early- and intermediate-stage diseaseDetails of specific treatment regimens1. NCCN Clinical Practice Guideline in Oncology. Rectal Cancer, Version 1.2020; 2. NCCN Clinical Practice Guideline in Oncology. Colon Cancer, Version 1.2020; 3. Van Cutsem E, et al. Ann Oncol

2016;27(8):1386–422.

CRC, colorectal cancer; ESMO, European Society for Medical Oncology; NCCN, National Comprehensive Cancer Network.

ESMO consensus guidelines

Summary of management guidelines for patients with metastatic colorectal cancer

1. Van Cutsem E, et al. Ann Oncol 2016;27(8):1386–422.

Zurich treatment algorithm

ChT, chemotherapy; EGFR, epidermal growth factor receptor; FP, fluoropyrimidine; mt, mutant; OMD, oligometastatic disease; VEGF, vascular endothelial growth factor; WT, wild-type.

1. Van Cutsem E, et al. Ann Oncol 2016;27(8):1386–422.

Systematic therapy choices for patients with unresectable metastatic disease

*If not previously given. Based on the Zurich treatment algorithm; excluding patients with OMD. Treatment decisions at each stage should consider patient suitability, tolerability, and prior exposure to targeted agents.ChT, chemotherapy;

EGFR, epidermal growth factor receptor; FC, 5-fluorouracil and cisplatin; FOLFIRI, folinic acid, fluorouracil, irinotecan; FOLFOXIRI, folinic acid, fluorouracil, oxaliplatin, irinotecan; FP, fluoropyrimidine; mt, mutant; OMD, oligometastatic disease; VEGF, vascular endothelial growth factor; VEGFR, vascular endothelial growth factor receptor; WT, wild-type.1. Van Cutsem E, et al. Ann Oncol 2016;27(8):1386–422.

Systematic therapy choices for patients with unresectable metastatic disease

*If not previously given. Based on the Zurich treatment algorithm; excluding patients with OMD. Treatment decisions at each stage should consider patient suitability, tolerability, and prior exposure to targeted agents. ChT, chemotherapy; EGFR, epidermal growth factor receptor; FC, 5-fluorouracil and cisplatin; FOLFIRI, folinic acid,

fluorouracil, irinotecan; FOLFOXIRI, folinic acid, fluorouracil, oxaliplatin, irinotecan; FP, fluoropyrimidine; mt, mutant; OMD, oligometastatic disease; VEGF, vascular endothelial growth factor; VEGFR, vascular endothelial growth factor receptor; WT, wild-type.1. Van Cutsem E, et al. Ann Oncol 2016;27(8):1386–422.

NCCN Clinical Practice Guidelines

Treatment considerations for advanced colon and rectal cancers

1. NCCN Clinical Practice Guideline in Oncology. Rectal Cancer, Version 1.2020; 2. NCCN Clinical Practice Guideline in Oncology. Colon Cancer, Version 1.2020.

Subsequent treatment considerations for advanced colon and rectal cancers1. NCCN Clinical Practice Guideline in Oncology. Rectal Cancer, Version 1.2020; 2. NCCN Clinical Practice Guideline in Oncology. Colon Cancer, Version 1.2020.

Please refer to the

NCCN treatment guidelines for full details of the decision-making pathway and treatment options at each stage.BRAF, B rapidly accelerated fibrosarcoma; dMMR, deficient mismatch repair; FP, fluoropyrimidine; KRAS, Kirsten rat sarcoma; MSI-H, high levels of microsatellite instability; NCCN, National Comprehensive Cancer Network; NRAS, neuroblastoma rat sarcoma; RAS, rat sarcoma.Treatment of advanced CRC should be considered as a continuum of care. Decision-making at each stage of therapy should account for patient suitability and tolerability, tumour biomarkers, and prior exposure to chemotherapies and/or targeted agentsConsider the patient’s prior treatments. Have they received a previous:Oxaliplatin-based chemotherapy?Irinotecan-based chemotherapy?Oxaliplatin

- and irinotecan-based regimen?FP without oxaliplatin/irinotecan?Consider the results of molecular testing. Is the patient’s tumour:- KRAS/NRAS/BRAF wild-type? - HER2-amplified, RAS wild-type?- BRAF

V600E-positive?

-

dMMR

/MSI-H

?

Initial systemic therapy:

Is

the patient

considered appropriate for intensive therapy?

Summary

SummaryESMO and NCCN guidelines aim to provide guidelines for the diagnosis, treatment and follow-up of CRC based on the

findings of evidence-based medicineBoth sets of guidelines provide specific treatment recommendations for patients with defined molecular markers (including RAS,

BRAF, MSI and HER2)Management of CRC can be considered a ‘continuum of care’, and treatment decisions at each stage should take into account the patient’s clinical status and treatment goals1. Van Cutsem E, et al. Ann Oncol 2016;27(8):1386–422.CRC, colorectal cancer; ESMO, European Society for Medical Oncology; HER2, human epidermal growth factor receptor 2; MSI, microsatellite instability; NCCN, National Comprehensive Cancer Network.