Subsequent therapy
Subsequent therapy
if NOT fit for therapy
if fit for therapy
Poor status
HIGH RISK
LOW RISK

Colon Cancer

Stage I, II, III

neoadjuvant therapy

surgery

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

FOLFOX

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

can be outpatient

CAPEOX

capecitabine + oxaliplatin

Stage III

CAPEOX x3 months
OR
FOLFOX x6 months

CAPEOX x3-6 months
OR
FOLFOX x6 months

5FU/LV

5FU/LV
OR
capecitabine

FOLFIRI

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

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

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

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

last line agents

Regorafenib
trifluridine - tipiracil