non-surgical treatment of colorectal cancer

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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)

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Last edited 06/2021 and last reviewed 06/2021

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