Non-surgical treatment of colorectal cancer

Seek expert advice.

Colorectal carcinomas are relatively unresponsive to chemotherapy but liver metastases may occasionally be controlled by 5-fluorouracil (5 FU).

Test for RAS and BRAF V600E mutations in all people with metastatic colorectal cancer suitable for systemic anti-cancer treatment

Adjuvant chemotherapy in rectal cancer

• consider adjuvant chemotherapy for patients with high-risk stage II and all stage III rectal cancer to reduce the risk of local and systemic recurrence

Adjuvant chemotherapy for colon cancer

• consider adjuvant chemotherapy after surgery for patients with high-risk stage II colon cancer
• options for the adjuvant treatment of patients with stage III (Dukes' C) colon cancer following surgery for the condition:
  • capecitabine as monotherapy
  • oxaliplatin in combination with 5-fluorouracil and folinic acid

Chemotherapy for advanced and metastatic colorectal cancer

• when offering multiple chemotherapy drugs to patients with advanced and metastatic colorectal cancer, consider one of the following sequences of chemotherapy unless they are contraindicated:
  • FOLFOX (folinic acid plus fluorouracil plus oxaliplatin) as first-line treatment then single agent irinotecan as second-line treatment or
  • FOLFOX as first-line treatment then FOLFIRI (folinic acid plus fluorouracil plus irinotecan) as second-line treatment or
  • XELOX (capecitabine plus oxaliplatin) as first-line treatment then FOLFIRI (folinic acid plus fluorouracil plus irinotecan) as second-line treatment.

Biological therapy in metastatic colorectal cancer

• pembrolizumab is recommended as an option for untreated metastatic colorectal cancer with high microsatellite instability (MSI) or mismatch repair (MMR) deficiency in adults (3)

Reference:

• (1) National Institute for Health and Clinical Excellence (NICE) 2014. Colorectal cancer: the diagnosis and management of colorectal cancer
• (2) NICE (January 2020). Colorectal cancer.
• (3) NICE (June 2021). Pembrolizumab for untreated metastatic colorectal cancer with high microsatellite instability or mismatch repair deficiency