Frequent updates to the NCCN guidelines reflect new practice information in a timely manner, thus alerting clinicians to important information. The new NCCN guidelines are now posted for colon cancer (www.nccn.org), and are available to viewers after free registration at the site. Highlights of the changes include the following:
- Bevacizumab, cetuximab, panitumumab, or irinotecan should not be used in the adjuvant setting for stage II or III patients outside the setting of a clinical trial
- Testing for mismatch repair proteins (MMR) should be considered for all patients < 50 years of age who have been diagnosed with stage III colon cancer
- Bevacizumab may be safely given at a rate of 0.5 mg/kg/minute (5 mg/kg over 10 minutes and 7.5 mg/kg over 15 minutes
- Bolus 5-FU/leucovorin (de Gramont) regimen removed from the options for chemotherapy regimens and irinotecan dosing regimen changed from 4 weeks on and 2 weeks off to 2 weeks on and 1 week off
- FOLFOX is superior to fluoropyrimidine therapy alone for stage III patients
- Patients with a known V600E BRAF mutations should not be treated with anti-EGFR monoclonal antibodies
The recommendation regarding the BRAF mutations reflects new data on additional biomarkers which could help clinicians tailor therapy for patients with metastatic CRC (mCRC). Although identification of the mutated form of KRAS helped to eliminate inappropriate candidates for epidermal growth factor (EGFR) inhibitor therapy, (occurring in approximately 40% of patients with mCRC), the new biomarkers may demonstrate that more patients with the disease may not respond to therapy with these agents. These additional biomarkers include the BRAF, EGFR amplification, and expression of PTEN.1 At this point in time, more information is known about BRAF, and the NCCN changes reflect this in their current guidelines.
There are several other changes noted in the current iteration of the guidelines. A full summary of the guideline changes can be viewed in the practice guidelines on the NCCN website.
NCCN (2009). National Comprehensive Cancer Center Practice Guidelines in Oncology – v.1.2010: Colon Cancer. Retrieved December 21, 2009 from www.nccn.org.
1. Laurent-Puig, P., Cayre, A., Manceau, G. et al. Analysis of PTEN, BRAF, and EGFR status in determining benefit from cetuximab therapy for metastatic colon cancer. J Clin Oncol. 2009 Dec 10; 27(35):5924-30. Epub 2009 Nov 2.