What are the NCCN guidelines on targeted therapy to treat colon cancer?

Updated: Apr 15, 2020
  • Author: Tomislav Dragovich, MD, PhD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Answer

For BRAF V600E–mutated colorectal cancer unresponsive to previous oxaliplatin-based therapy without irinotecan, National Comprehensive Cancer Network (NCCN) guidelines include any of the following options for subsequent therapy [93] :

  • Irinotecan plus vemurafenib plus cetuximab or panitumumab (EGFR antibody)
  • Dabrafenib (BRAF inhibitor) plus trametinib (MEK inhibitor) plus cetuximab or panitumumab 
  • Encorafenib (BRAF inhibitor) plus binimetinib (MEK inhibitor) plus cetuximab or panitumumab.

​As a subsequent treatment option in patients with metastatic colorectal cancer who have neurotrophic receptor tyrosine kinase (NTRK) gene fusions.

  • Larotrectinib was added as a  The FDA also granted tissue-agnostic approval for use of the drug in patients with  NTRK gene fusions.
  • Combination immunotherapy options for dMMR/MSI-high advanced colorectal cancer are now included. In the first-line setting, nivolumab or pembrolizumab, or a combination of nivolumab and ipilimumab, are listed as category 2B recommendations for patients with dMMR/MSI-high disease who are not appropriate for treatment with cytotoxic combinations.
  • Modified FOLFOXIRI (fluorouracil, leucovorin, oxaliplatin, irinotecan) plus panitumumab or cetuximab is recommended for patients with unresectable metastatic colorectal cancer with synchronous liver and/or lung metastases alone,  KRAS/NRAS/BRAF wild-type, and left-sided tumors.

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