NCCN updates guidelines for metastatic colorectal cancer

  • Messersmith WA
  • J Natl Compr Canc Netw
  • 1 May 2019

  • curated by Emily Willingham, PhD
  • Univadis Clinical Summaries
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Takeaway

  • In this guidelines update for managing metastatic colorectal cancer ([m]CRC), the National Comprehensive Cancer Network (NCCN) adds major updates for BRAF-mutated advance cancers, approval of larotrectinib for broad tissue types, and more information regarding Lynch syndrome testing.

Why this matters

  • These changes have been made in the last year for managing one of the most common cancers worldwide, with limited 5-year survival with mCRC. 

Key updates

  • 4 consensus molecular subtypes (CMS 1 through 4) are characterized, associated with OS differences. 
  • Treatment options based on BRAF/MEK and NTRK fusion targets (e.g., tissue-agnostic approval for the NTRK inhibitor larotrectinib) have been added.
  • Guidelines note that BRAF positivity does not rule out Lynch syndrome.
  • Regarding Lynch syndrome, germline testing, mismatch repair (MMR) immunohistochemistry recommended with family history of cancer.
  • mFOLFOXIRI + panitumumab added for unresectable stage IV mCRC, only for KRAS/NRAS/BRAF wild-type, left-sided tumors.
  • Nivolumab±ipilimumab or pembrolizumab okayed for second-, third-line treatment of dMMR/microsatellite instability-H CRC.
  • New second-line combination treatment options for BRAF-mutated CRC:
    • Dabrafenib + trametinib + cetuximab or panitumumab.
    • Encorafenib + binimetinib + cetuximab or panitumumab.