Colon Cancer

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Colon Cancer

last line agents

Regorafenib trifluridine - tipiracil

STAGE IV/Metastatic - all metastatic colorectal cancers should be geonotyped for RAS, BRAFV600, MSI/ MMR, HER2

5FU/LV capecitabine + bevacizumab cetuximab/panitumumab for KRAS WT, left side tumor nivolumab/pembrolizumab for dMMR/MSI-h only nivolumab + ipilmumab for dMMR/MSI-H only trastuzumab + (pertuzumab or lapatinib) or fam-trastuzumab deruxtecan for HER2+, RAS, BRAF WTG

If improved functional status -> use "fit for therapy" if no improve functional status -> supportive care

FOLFOX +/- bevacizumab (VEGF) CAPEOX +/- bevacizumab FOLFIRI +/- bevacizumab FOLFOX + (cetuximab/panitumumab)[EGFR] for KRAS WT (Nivolumab [PD1] + ipilimumab [CTLA4]) or pembrolizumab [PD1] for dMMR/MSI-H only

Switch from OX to IRI/ IRI to OX

Stage I, II, III

neoadjuvant therapy

surgery

Adjuvant therapy - begins 4-8 weeks after surgery for 3-6 months

FOLFIRI

Bolus 5FU + IV leucovorin + IV irinotecan + CIV 5FU for 46-48h

5FU/LV OR capecitabine

Stage III

5FU/LV

CAPEOX x3-6 months OR FOLFOX x6 months

CAPEOX x3 months OR FOLFOX x6 months

CAPEOX

capecitabine + oxaliplatin

FOLFOX

Bolus 5FU + IV leucovorin + oxaliplatin + CIV 5FU for 46-48h x 14 days

can be outpatient