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
