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. 2023 Jan 20;41(3):678-700.
doi: 10.1200/JCO.22.01690. Epub 2022 Oct 17.

Treatment of Metastatic Colorectal Cancer: ASCO Guideline

Van K Morris  1 , Erin B Kennedy  2 , Nancy N Baxter  3 , Al B Benson 3rd  4 , Andrea Cercek  5 , May Cho  6 , Kristen K Ciombor  7 , Chiara Cremolini  8 , Anjee Davis  9 , Dustin A Deming  10 , Marwan G Fakih  11 , Sepideh Gholami  12 , Theodore S Hong  13 , Ishmael Jaiyesimi  14 , Kelsey Klute  15 , Christopher Lieu  16 , Hanna Sanoff  17 , John H Strickler  18 , Sarah White  19 , Jason A Willis  1 , Cathy Eng  7
Affiliations

Treatment of Metastatic Colorectal Cancer: ASCO Guideline

Van K Morris et al. J Clin Oncol. .

Abstract

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.Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.

PubMed Disclaimer

Conflict of interest statement

The Expert Panel was assembled in accordance with ASCO’s Conflict of Interest Policy Implementation for Clinical Practice Guidelines (“Policy,” found at https://www.asco.org/guideline-methodology). All members of the Expert Panel completed ASCO’s disclosure form, which requires disclosure of financial and other interests, including relationships with commercial entities that are reasonably likely to experience direct regulatory or commercial impact as a result of promulgation of the guideline. Categories for disclosure include employment; leadership; stock or other ownership; honoraria, consulting or advisory role; speaker’s bureau; research funding; patents, royalties, other intellectual property; expert testimony; travel, accommodations, expenses; and other relationships. In accordance with the Policy, the majority of the members of the Expert Panel did not disclose any relationships constituting a conflict under the Policy.

AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Disclosures provided by the authors are available with this article at DOI https://doi.org/10.1200/JCO.22.01690.

AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Treatment of Metastatic Colorectal Cancer: ASCO Guideline

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO’s conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/authors/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Van K. Morris

Consulting or Advisory Role: Incyte, Servier, Boehringer Ingelheim, Axiom Healthcare Strategies, BioMedical Insights, Bicara Therapeutics

Research Funding: Bristol Myers Squibb (Inst), EMD Serono (Inst), Immatics, Pfizer (Inst), BioNTech (Inst), Bicara Therapeutics (Inst)

Al B. Benson

Consulting or Advisory Role: Merck Sharp & Dohme, Array BioPharma, Bristol Myers Squibb, Samsung Bioepis, Pfizer, HalioDx, AbbVie, Janssen Oncology, Natera, Apexigen, Artemida Pharma, Xencor, Therabionic, Mirati Therapeutics, Boston Scientific, Hutchmed

Research Funding: Infinity Pharmaceuticals (Inst), Merck Sharp & Dohme (Inst), Taiho Pharmaceutical (Inst), Bristol Myers Squibb (Inst), Celgene (Inst), Rafael Pharmaceuticals (Inst), MedImmune (Inst), Xencor (Inst), Astellas Pharma (Inst), Amgen (Inst), SynCoreBio (Inst), Elevar Therapeutics (Inst), Tyme Inc (Inst), ST Pharm (Inst), ITM Solucin (Inst)

Andrea Cercek

Consulting or Advisory Role: Bayer, GlaxoSmithKline, Incyte, Merck, Janssen, Seattle Genetics

Research Funding: Seattle Genetics, Rgenix (Inst), GlaxoSmithKline

May Cho

Consulting or Advisory Role: Amgen, Eisai, Taiho Pharmaceutical, Astellas Pharma, Exelixis, Ipsen, Seattle Genetics, QED Therapeutics, AstraZeneca/MedImmune, Basilea, Genentech/Roche

Speakers’ Bureau: Taiho Pharmaceutical, Pfizer, Natera, Bristol Myers Squibb/Celgene, Helsinn Therapeutics, Daiichi Sankyo/Astra Zeneca

Research Funding: Bristol Myers Squibb (Inst), Seattle Genetics (Inst), AstraZeneca/MedImmune (Inst), Incyte (Inst), Immunocore (Inst)

Travel, Accommodations, Expenses: AstraZeneca/MedImmune

Kristen K. Ciombor

Consulting or Advisory Role: Merck, Pfizer, Lilly, Seattle Genetics, Replimune, Personalis

Research Funding: Pfizer (Inst), Boston Biomedical (Inst), MedImmune (Inst), Onyx (Inst), Bayer (Inst), Boehringer Ingelheim (Inst), Bristol Myers Squibb (Inst), Merck (Inst), Novartis (Inst), Incyte (Inst), Amgen (Inst), Sanofi (Inst), Bristol Myers Squibb (Inst), Array BioPharma (Inst), Daiichi Sankyo (Inst), Nucana (Inst), AbbVie (Inst), Merck (Inst), Pfizer/Calithera (Inst), Genentech (Inst)

Travel, Accommodations, Expenses: Array BioPharma

Chiara Cremolini

Honoraria: Roche, Amgen, Bayer, Servier, MSD, Merck, Pierre Fabre, Organon

Consulting or Advisory Role: Roche, Bayer, Amgen, MSD, Pierre Fabre, Nordic Pharma

Speakers’ Bureau: Servier, Merck, Pierre Fabre

Research Funding: Merck, Bayer, Roche, Servier

Anjee Davis

Honoraria: Daiichi Sankyo/UCB Japan (Inst), Komodo Health (Inst)

Travel, Accommodations, Expenses: Komodo Health (Inst)

Uncompensated Relationships: Taiho Oncology, Exact Sciences, Flatiron Health

Dustin A. Deming

Consulting or Advisory Role: Bayer, Promega, Array BioPharma, Lilly, Pfizer

Research Funding: Merck (Inst), Bristol Myers Squibb (Inst), Genentech (Inst), Revolution Medicines (Inst), Millennium (Inst), Bayer

Marwan G. Fakih

Honoraria: Amgen

Consulting or Advisory Role: Amgen, Taiho Pharmaceutical, Bayer, Pfizer, Seattle Genetics, GlaxoSmithKline, Incyte, Nouscom, Roche/Genentech, Mirati Therapeutics

Speakers’ Bureau: Guardant Health

Research Funding: Amgen (Inst), Verastem (Inst)

Sepideh Gholami

Consulting or Advisory Role: Signatera, QED Therapeutics, TRUSELTIQ

Speakers’ Bureau: Helsinn Therapeutics

Theodore S. Hong

Stock and Other Ownership Interests: PanTher Therapeutics

Consulting or Advisory Role: Merck, Synthetic Biologics, Novocure, Syndax, Boston Scientific

Research Funding: Taiho Pharmaceutical (Inst), AstraZeneca (Inst), IntraOp (Inst), Tesaro (Inst), Bristol Myers Squibb (Inst), Ipsen (Inst)

Kelsey Klute

Consulting or Advisory Role: Cancer Expert Now, Daiichi Sankyo/Lilly, Pfizer

Research Funding: AstraZeneca (Inst), FibroGen (Inst)

Christopher Lieu

Consulting or Advisory Role: Pfizer (Inst)

Research Funding: Merck (Inst)

Hanna Sanoff

Research Funding: AstraZeneca (Inst), Roche (Inst), Amgen (Inst), Bristol Myers Squibb (Inst), Pfizer (Inst), BioMed Valley Discoveries (Inst), Rgenix (Inst), Exelixis (Inst)

John H. Strickler

Consulting or Advisory Role: Bayer, Natera (Inst), Pfizer, Mereo Biopharma, AstraZeneca, Viatris, Seattle Genetics, Roche/Genentech (Inst), Inivata, Silverback Therapeutics, GlaxoSmithKline, Pionyr, AbbVie, Takeda, Zentalis

Research Funding: AbbVie (Inst), Roche/Genentech (Inst), Leap Therapeutics (Inst), Nektar (Inst), Amgen (Inst), Curegenix (Inst), A*STAR (Inst), Bayer (Inst), AstraZeneca/MedImmune (Inst), Sanofi (Inst), Daiichi Sankyo/Lilly, Silverback Therapeutics (Inst), Erasca Inc (Inst), Seattle Genetics (Inst)

Travel, Accommodations, Expenses: Guardant Health, Seattle Genetics

Sarah White

Honoraria: Varian Medical Systems

Consulting or Advisory Role: Cook Medical, Guerbet, AstraZeneca

Speakers’ Bureau: Penumbra

Research Funding: Focused Ultrasound Foundation (Inst), Guerbet (Inst), InSightec (Inst)

Travel, Accommodations, Expenses: Cook Medical

Open Payments Link: https://openpaymentsdata.cms.gov/physician/167903

Jason A. Willis

Honoraria: Cor2Ed

Cathy Eng

Consulting or Advisory Role: GlaxoSmithKline, Bayer Health, Natera, Janssen Oncology, HalioDx

Research Funding: Fruquitinib (Inst), Elevar Therapeutics (Inst)

Uncompensated Relationships: Pfizer (Inst), Merck (Inst)

No other potential conflicts of interest were reported.

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