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Review
. 2021 Apr;23(4):827-839.
doi: 10.1007/s12094-020-02475-8. Epub 2020 Aug 13.

Controversies in the treatment of RAS wild-type metastatic colorectal cancer

R Vera  1 , M Salgado  2 , M J Safont  3 , J Gallego  4 , E González  5 , E Élez  6 , E Aranda  7
Affiliations
Review

Controversies in the treatment of RAS wild-type metastatic colorectal cancer

R Vera et al. Clin Transl Oncol. 2021 Apr.

Abstract

Objective: To provide guidance for the management of RAS wild-type (wt) metastatic colorectal cancer (mCRC) in daily practice.

Methods: Nominal group and Delphi techniques were used. A steering committee of seven experts analyzed the current management of RAS wt mCRC, through which they identified controversies, critically analyzed the available evidence, and formulated several guiding statements for clinicians. Subsequently, a group of 30 experts (the expert panel) was selected to test agreement with the statements, through two Delphi rounds. The following response categories were established in both rounds: 1 = totally agree, 2 = basically agree, 3 = basically disagree, 4 = totally disagree. Agreement was defined if ≥ 75% of answers were in categories 1 and 2 (consensus with the agreement) or 3 and 4 (consensus with the disagreement).

Results: Overall, 71 statements were proposed, which incorporated the following areas: (1) overarching principles; (2) tumor location; (3) triplets; (4) maintenance; (5) second-line and beyond treatments; (6) Rechallenge and liquid biopsy. After the two Delphi rounds, only six statements maintained a lack of clear consensus.

Conclusions: This document aims to describe the expert's attitude when dealing with several common clinical questions regarding patients with RAS wt mCRC.

Keywords: Delphi; Liquid biopsy; Maintenance; Metastatic colorectal cancer; Primary tumor sidedness; RAS wild-type; Rechallenge; Treatment patterns.

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Conflict of interest statement

EA has received honoraria for the advisory role from Amgen, Bayer, Celgene, Merck, Roche, Sanofi. JG has received honoraria for speaking from Lilly, Amgen; as a consultant or advisory role from BMS, Ipsen, Roche, Servier; for travel grants from Novartis, Amgen; and for research grants from Lilly, BMS. MS has received honoraria for speaking from LeoPharma, Rovi, Amgen, Celgene, Servier, Merck; as consultant or advisory role from Amgen, Celgene, Merck; for book chapters/Journals review from Servier, Kyowa Kirin, Sanofi; financial support for attending symposia from Roche, Servier and financial support for educational programs from Mylan, Kherm Pharma. MJS has received financial support for attending courses and congresses from Roche, Amgen, Merck, Sanofi and honoraria for speaking or as consultant or advisory role from Amgen, Merck, Servier, Bayer; RV reports personal fees from Amgen, during the conduct of the study; personal fees from Sanofi, personal fees from Merck, personal fees from BMS, personal fees from Servier, personal fees from MSD, personal fees from Bayer, personal fees from Roche, outside the submitted work. EG has received financial support for attending courses and congresses from Roche, Amgen, Merck, Sanofi, Servier, Bayer and for speaking and as consultant or advisory role from Roche, Amgen, Merck, Sanofi, Servier, Bayer.

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