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1、Clinical Practice Guidelines in Oncology (NCCN Guidelines)Colon CancerVersion 2.2016ContinueNCCN.orgVersion 2.2016, 11/24/15 National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written
2、permission of NCCN.NCCN Guidelines for Patients available at www.nccn.org/NCCN Guidelines Index Colon Cancer Table of Contents DiscussionVersion 2.2016, 11/24/15 National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in
3、any form without the express written permission of NCCN.NCCN Guidelines Version 2.2016 Panel Members Colon CancerAl B. Benson, III, MD/Chair Robert H. Lurie Comprehensive Cancer Center of Northwestern UniversityAlan P. Venook, MD/Vice-Chair UCSF Helen Diller Family Comprehensive Cancer CenterTanios
4、Bekaii-Saab, MD The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research InstituteEmily Chan, MD, PhD Vanderbilt-Ingram Cancer CenterYi-Jen Chen, MD, PhD City of Hope Comprehensive Cancer CenterHarry S. Cooper, MD Fox Chase Cancer Center Paul F. Engstrom, MD
5、Fox Chase Cancer CenterPeter C. Enzinger, MD Dana-Farber/Brigham and Womens Cancer CenterMoon J. Fenton, MD, PhD St. Jude Childrens Research Hospital/ University of Tenessee Health Science CenterCharles S. Fuchs, MD, MPH Dana-Farber/Brigham and Womens Cancer Center Jean L. Grem, MD Fred sub-bullet 5
6、 modified: Consider preoperative marking of small lesion(s).Updates in Version 1.2016 of the NCCN Guidelines for Colon Cancer from Version 3.2015 include:Printed by Maria Chen on 11/30/2015 10:35:13 PM. For personal use only. Not approved for distribution. Copyright 2015 National Comprehensive Cance
7、r Network, Inc., All Rights RVersion 2.2016, 11/24/15 National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN.UPDATESNCCN Guidelines Index Colon Cancer Table of C
8、ontents DiscussionNCCN Guidelines Version 2.2016 Updates Colon CancerCOL-C 1 of 9 The regimen of trifluridine + tipiracil was added as a subsequent therapy option for patients with disease progression after oxaliplatin- and irinotecan-based chemotherapy. (also applies for COL-C 2 of 9 and COL-C 3 of
9、 9) COL-C 5 of 9 Footnote 11 modified: There are no data to suggest activity of FOLFIRI-ziv-aflibercept or FOLFIRI-ramucirumab in a patient who has progressed on FOLFIRI-bevacizumab, or vice versa. Ziv-aflibercept and ramucirumab have only shown activity when given in conjunction with FOLFIRI in FOL
10、FIRI-nave patients. Footnote 12 modified: Bevacizumab is the preferred anti-angiogenic agent based on toxicity and/or cost. COL-C 6 of 9 Footnote “*” added: Oxaliplatin may be given either over 2 hours, or may be infused over a shorter time at a rate of 1 mg/m2/minute. Leucovorin infusion should mat
11、ch infusion time of oxaliplatin. Cercek A, Park V, Yaeger RD, et al. Oxaliplatin can be safely infused at a rate of 1mg/m2/min. J Clin Oncol 33, 2015 (suppl; abstr e14665). (also applies for COL-F 2 of 2) COL-C 8 of 9 The following regimen added: Trifluoride + tipiracil 35 mg/m2 (up to a maximum dos
12、e of 80 mg per dose (based on the trifuluridine component) PO twice daily days 1-5 and 8-12. Repeat every 28 days Footnote “” added: It is common practice to start at a lower dose of regorafenib (80 or 120 mg) and escalate, as tolerated. COL-C 9 of 9 Reference added: Mayer RJ, Van Cutsem E, Falcone
13、A, et al. Randomized Trial of TAS-102 for Refractory Metastatic Colorectal Cancer (RECOURSE). N Engl J Med 2015; 372:1909-19. COL-D Bullet 3 modified: If radiation therapy is to be used, conformal external beam radiation should be routinely used and intensity-modulated radiation therapy (IMRT) shoul
14、d be reserved only for unique clinical situations including such as re-irradiation of previously treated patients with recurrent disease or unique anatomical situations. COL-E Bullet 4; sub-bullet 2 modified: MMR or MSI testing should also be considered performed for all patients with stage II disea
15、se, because stage II MSI-H patients may have a good prognosis and do not benefit from 5-FU adjuvant therapy. COL-F 1 of 2 Bullet 5 modified: Bevacizumab, cetuximab, panitumumab, irinotecan, ziv-aflibercept, ramucirumab, or regorafenib should not be used in the adjuvant setting for patients with stag
16、e II or III colon cancer outside the setting of a clinical trial.Updates in Version 1.2016 of the NCCN Guidelines for Colon Cancer from Version 3.2015 include:Printed by Maria Chen on 11/30/2015 10:35:13 PM. For personal use only. Not approved for distribution. Copyright 2015 National Comprehensive Cancer Network, Inc., All Rights RN
