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🌱 來自: colorectal cancer

Metastatic Colon Cancer

ESMO guidelines of Metastatic Colon Cancer 󰒗

• Chemotherapy for advanced and metastatic disease
• Definitions:
  • FOLFOX:
    • Infusional Fluorouracil 5-FU/LV FULV +
      • AEs_5FU: 💩👄🤮🩸🤞🫀👁️🖐️🦶😇🐌
    • Oxaliplatin
  • FOLFIRI: Infusional 5-FU/LV + Irinotecan;
  • FOLFOXIRI: Infusional 5-FU/LV + OX + irinotecan;
  • CAPEOX: Capecitabine Diarrhea, HFS, (5FU pro, 3 steps to convert to 5FU, same aE) + OX
    • Xeloda 500mg/tab 1200mg/BSA
• 1st line: FOLFOX (JCO 2004;22:23) ± Bevacizumab (JCO 2008;26:2013); CAPEOX; FOLFIRI (JCO 2004;22:229) ± Bev (JCO 2007;25:4779); FOLFOXIRI ± Bev (TRIBE, NEJM 2014;371:1609)
• anti-VEGF: 血栓出血蛋白尿、術後傷口高血壓
• For pts w/ L-sided CRC & wt RAS/BRAF: FOLFOX or FOLFIRI ± cetuximab/panitumumab (CRYSTAL, NEJM 2009;360:1408; PRIME, JCO 2010;28:4697)
  • R-sided CRC: C,A,T
  • cetuximab vs bevacizumab:
    • FIRE-3 28.7 month
    • CALGB-SWOG 80405 30 month
    • PARADIGM 37.9 vs 34.3
• If pts not appropriate for intense Rx: Infusional 5-FU/LV; Cape
• 2nd line:
  • FOLFIRI or irinotecan for pts who received prior FOLFOX;
  • FOLFOX/CAPEOX for pts w/ prior FOLFIRI;
    • GERCOR
  • FOLFOX/CAPEOX, or FOLFIRI for prior 5-FU/LV or Cape;
  • all regimens ±
    • Bev/ziv-aflibercept/ramucirumab
      • Bev 11.2 vs 9.8: ML18147
      • ziv-aflib 4mg/kg 13.5 vs 12.6: VELOUR agranulocytosis
      • ramu 13.6 vs 11.7: RAISE
    • (note that Bev is → preferred over ziv-aflibercept/ramucirumab because of tox &/or cost);
  • irinotecan-based regimens ±;
  • cetuximab/panitumumab if not previously used
    • phase III, continued use of bevacizumab plus standard second-line chemotherapy in patients with metastatic colorectal cancer progressing after standard first-line bevacizumab-based treatment.
  • BRiTE BRiTE observational cohort study

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• 3rd line: Irinotecan ± panitumumab/cetuximab (BOND, NEJM 2004;351:337) or single-agent panitumumab/cetuximab, or single-agent regorafenib or TAS-102; overall benefits of regorafenib or TAS-102 are modest w/ significant s/e
  • CORRECT 160mg/day for three week in 28d cycle ♻︎
  • RECOURSE 35/BSA 1-5 8-15 in 28d cycle ♻︎
• 1st line for MSI-H/dMMR: Pembrolizumab ([[KEY line for MSI-JM 2020;383:2207) or nivolumab ± ipilimumab (CHECKMATE 142, Lancet Oncol 2017;18:1182)
• Later line for BRAF V600E mut: encorafenib + cetuximab/panitumumab (BEACON, NEJM 2019;381:1632); addition of binimetinib did not improve OS or ORR
• Later line for HER2 amplified & RAS/BRAF wildtype: Trastuzumab + pertuzumab; trastuzumab + lapatinib; trastuzumab deruxtecan
• For FOLFOX, OX should be discontinued after first 3 mos of Rx till progression to reduce risk of severe neurotoxicity. Can be resumed at ↣ or after progression (OPTIMOX1, JCO 2006;24:394)
• Do not use concurrent anti-EGFR + anti-VEGF Rx (CAIRO2, NEJM 2009;360:563)
• Do not use anti-EGFR Rx in RAS/BRAF mut or any R sided CRC (JCO 2016;34(suppl, abstr 3504, 3505, 3506; JAMA Oncol 2017;3:211)
• For pts progressing on anti-EGFR, use of anti-EGFR is → not rec in subsequent lines

UpToDate Links 󰒖

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• 2024-07-14: TOS 2024 ASCO
• Evolution of treatment in mCRC in 2024