Abstract
Therapeutic options for metastatic CRC (mCRC) have changed significantly in recent years, greatly increasing the complexity of therapeutic decision-making. Although oncology guidelines have helped improve the care process, guidelines may also limit the flexibility to individualize in-clinic decision-making. This consensus paper addresses specific gaps in the current international guidelines to assist Taiwanese colon and rectal experts make specific therapeutic choices. Over 3 years and three meetings with selected experts on “real-world” Taiwanese practice patterns for mCRC, consensus was achieved. The experts also discussed specific questions during in-depth one-on-one consultation. Outcomes of the discussion were then correlated with published evidence by an independent medical writer. The final consensus includes clinically implementable recommendations to provide guidance in treating Taiwanese mCRC patients. The consensus includes criteria for defining fit and unfit intensive treatment patients, treatment goals, treatment considerations of molecular profiles, treatment consideration, and optimal treatment choices between different patient archetypes, including optimal treatment options based on RAS, BRAF, and microsatellite instability (MSI) status. This consensus paper is the second in the Taiwan Society of Colon and Rectal Surgeons (TSCRS) Consensus series to address unmet gaps in guideline recommendations in lieu of Taiwanese mCRC management. Meticulous discussions with experts, the multidisciplinary nature of the working group, and the final drafting of the consensus by independent medical professionals have contributed to the strong scientific value of this consensus.
Highlights
Epidemiology of mCRCColorectal cancer (CRC) represents 10% of global cancer incidence and 13% of all-cause deaths [1]
When cytoreduction is the goal, CT doublet plus anti-EGFR is recommended as 1L treatment for patients with RAS/BRAF wt mCRC, regardless of primary tumor location
When disease control is the goal, CT doublet plus anti-EGFR is recommended as 1L treatment for patients with left-sided, RAS/BRAF wt mCRC
Summary
Colorectal cancer (CRC) represents 10% of global cancer incidence and 13% of all-cause deaths [1] It is the second most common cancer in women and the third most common cancer in men. [1] ESMO and Pan-Asia ESMO guidelines further stratify treatment by different treatment goals, but NCCN guidelines do not. [3] Pan-Asia ESMO guidelines recommend doublet CT plus antiEGFR in all RAS WT left-sided patients; NCCN guidelines recommend both anti-EGFR and anti-VEGF in these patients. [4] Pan-Asia ESMO guidelines consider doublet CT plus antiEGFR in RAS WT right-sided patients when cytoreduction is the goal, but NCCN guidelines do not. [6] Pan-Asia ESMO guidelines and NCCN guidelines recommend immunotherapy for patients with dMMR/MSI- H mCRC at different levels of recommendation.
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