Treatment of Patients with Late-Stage Colorectal Cancer Resource-Stratified Guideline

Note: On October 17, 2022, ASCO published a maximal-setting guideline, Treatment of Patients with Metastatic Colorectal Cancer. Refer to this guideline for maximal-setting guidance regarding doublet v triplet chemotherapy, cytoreductive surgery with or without HIPEC, liver-directed therapies, and for specific recommendations for patients with MSI-H, MSS, dMMR, pMMR, RAS wild-type, or BRAF V600E-mutant metastatic colorectal cancer. 

Published online March 9, 2020, doi: 10.1200/JGO.19.00367

E. Gabriela Chiorean, Govind Nandakumar, Temidayo Fadelu, Sarah Temin, Ashley Efrain Alarcon-Rozas, Suyapa Bejarano, Adina-Emilia Croitoru, Surbhi Grover, Pritesh V. Lohar, Andrew Odhiambo, Se Hoon Park, Erika Ruiz Garcia, Catherine Teh, Azmina Rose, Bassem Zaki, and Mary D. Chamberlin

Purpose

To provide expert guidance to clinicians and policymakers in resource-constrained settings on the management of patients with late-stage colorectal cancer.

Methods

ASCO convened a multidisciplinary, multinational Expert Panel that reviewed existing guidelines, conducted a modified ADAPTE process, and used a formal consensus process with additional experts for two rounds of formal ratings.

Results

Existing sets of guidelines from four guideline developers were identified and reviewed; adapted recommendations from five guidelines form the evidence base and provided evidence to inform the formal consensus process, which resulted in agreement of ≥ 75% on all recommendations.

Recommendations

Common elements of symptom management include addressing clinically acute situations. Diagnosis should involve the primary tumor and, in some cases, endoscopy, and staging should involve digital rectal exam and/or imaging, depending on resources available. Most patients receive treatment with chemotherapy, where chemotherapy is available. If, after a period of chemotherapy, patients become candidates for surgical resection with curative intent of both primary tumor and liver or lung metastatic lesions on the basis of evaluation in multidisciplinary tumor boards, the guidelines recommend patients undergo surgery in centers of expertise if possible. On-treatment surveillance includes a combination of taking medical history, performing physical examinations, blood work, and imaging; specifics, including frequency, depend on resource-based setting.

© 2020 American Society of Clinical Oncology, all rights reserved. For licensing opportunities, contact licensing@asco.org.

Guideline Disclaimer

The clinical practice guidelines and other guidance published herein are provided by the American Society of Clinical Oncology, Inc. ("ASCO") to assist practitioners in clinical decision making. The information therein should not be relied upon as being complete or accurate, nor should it be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. With the rapid development of scientific knowledge, new evidence may emerge between the time information is developed and when it is published or read. The information is not continually updated and may not reflect the most recent evidence. The information addresses only the topics specifically identified therein and is not applicable to other interventions, diseases, or stages of diseases. This information does not mandate any particular course of medical care. Further, the information is not intended to substitute for the independent professional judgment of the treating physician, as the information does not account for individual variation among patients. Recommendations reflect high, moderate or low confidence that the recommendation reflects the net effect of a given course of action. The use of words like "must," "must not," "should," and "should not" indicate that a course of action is recommended or not recommended for either most or many patients, but there is latitude for the treating physician to select other courses of action in individual cases. In all cases, the selected course of action should be considered by the treating physician in the context of treating the individual patient. Use of the information is voluntary. ASCO provides this information on an "as is" basis, and makes no warranty, express or implied, regarding the information. ASCO specifically disclaims any warranties of merchantability or fitness for a particular use or purpose. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this information or for any errors or omissions.