Controversies in the treatment of RAS wild-type metastatic colorectal cancer

Abstract

Objective To provide guidance for the management of RAS wild-type (wt) metastatic colorectal cancer (mCRC) in daily practice. Methods Nominal group and Delphi techniques were used. A steering committee of seven experts analyzed the current management of RAS wt mCRC, through which they identified controversies, critically analyzed the available evidence, and formulated several guiding statements for clinicians. Subsequently, a group of 30 experts (the expert panel) was selected to test agreement with the statements, through two Delphi rounds. The following response categories were established in both rounds: 1 = totally agree, 2 = basically agree, 3 = basically disagree, 4 = totally disagree. Agreement was defined if ≥ 75% of answers were in categories 1 and 2 (consensus with the agreement) or 3 and 4 (consensus with the disagreement). Results Overall, 71 statements were proposed, which incorporated the following areas: (1) overarching principles; (2) tumor location; (3) triplets; (4) maintenance; (5) second-line and beyond treatments; (6) Rechallenge and liquid biopsy. After the two Delphi rounds, only six statements maintained a lack of clear consensus. Conclusions This document aims to describe the expert’s attitude when dealing with several common clinical questions regarding patients with RAS wt mCRC.

Guidance documents for colorectal and anal cancer treatment: A systematic quality and reporting assessment

“…After filtering through reviews of titles and abstracts, 63 records were appraised for eligibility. Finally, 59 guidelines were included (45 CPGs [30–88] and 14 CSs [42, 44–46, 49, 56–58, 67, 75, 80, 83, 86, 88]) for the final full‐text appraisal (Table 1). Seven CPGs and no CSs (11.9%) were in French [37–40], Slovenian [77], Norwegian [68] and Croatian [82]; a total of 52/59 (88.1%) documents were in English.…”

Real-World Data Analysis of Second-Line Antiangiogenic Targeted Treatments Following Anti-Epidermal Growth Factor Receptor Monoclonal Antibodies and First-Line FOLFOX for Patients with Metastatic Colorectal Cancer

“…Although there is consensus that second-line antiangiogenic drugs in combination with chemotherapy should be considered for patients with RAS wild-type CRC who have previously received first-line anti-EGFR therapy [ 5 , 11 ], there is very little evidence from clinical trials to guide clinicians on the most appropriate second- and third-line treatment sequences for these patients [ 11 ]. In Japan, bevacizumab became available for use in combination with various chemotherapy regimens for patients with CRC in April 2007, followed by ramucirumab (in May 2016) and aflibercept beta (in March 2017) for combination with second-line FOLFIRI (leucovorin + 5-fluorouracil [5-FU] + irinotecan) [ 5 , 6 ].…”