Adaptation of international guidelines for metastatic colorectal cancer: an asian consensus

Ann-Lii Cheng; Jin Li; Ashok K Vaid; Brigette Buig Yue Ma; Catherine Teh; Joong B Ahn; Maximino Bello; Chaiyut Charoentum; Li-Tzong Chen; Gilberto de Lima Lopes Jr; Gwo F Ho; Hwai L Kong; Ka O Lam; Tian S Liu; Young S Park; Virote Sriuranpong; Aru W Sudoyo; Jaw-Yuan Wang; Jun Zhang; Su Z Zhang; Fortunato Ciardiello; Clause-Henning Köhne; Michael Shaw; Tae Won Kim

doi:10.1016/j.clcc.2014.06.004

Adaptation of international guidelines for metastatic colorectal cancer: an asian consensus

Clin Colorectal Cancer. 2014 Sep;13(3):145-55. doi: 10.1016/j.clcc.2014.06.004. Epub 2014 Jun 26.

Authors

Ann-Lii Cheng¹, Jin Li², Ashok K Vaid³, Brigette Buig Yue Ma⁴, Catherine Teh⁵, Joong B Ahn⁶, Maximino Bello⁷, Chaiyut Charoentum⁸, Li-Tzong Chen⁹, Gilberto de Lima Lopes Jr¹⁰, Gwo F Ho¹¹, Hwai L Kong¹², Ka O Lam¹³, Tian S Liu¹⁴, Young S Park¹⁵, Virote Sriuranpong¹⁶, Aru W Sudoyo¹⁷, Jaw-Yuan Wang¹⁸, Jun Zhang¹⁹, Su Z Zhang²⁰, Fortunato Ciardiello²¹, Clause-Henning Köhne²², Michael Shaw²³, Tae Won Kim²⁴

Affiliations

¹ Departments of Oncology and Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
² Department of Medical Oncology, Fudan University Cancer Hospital, and Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
³ Medical Oncology and Haematology, Medanta Cancer institute, Gurgaon, India.
⁴ Sir Y.K. Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong.
⁵ Liver Care Center, Makati Medical Center, Manila, Philippines.
⁶ Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
⁷ Cancer Institute, St Luke's Medical Center, Quezon City, Philippines.
⁸ Chiang Mai University, Maharaj Nakorn Chiang Mai Hospital, Medical Oncology Unit, Department of Medicine, Faculty of Medicine, Maung Chiang Mai district, Thailand.
⁹ National Institute of Cancer Research, National Health Research Institutes, Tainan, and Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹⁰ HCor Onco, São Paulo, and Oncoclinicas do Brasil, Belo Horizonte, Minas Gerais, Brazil, and Johns Hopkins University School of Medicine, Baltimore, MD.
¹¹ Faculty of Medicine University of Malaya, Kuala Lumpur, Malaysia.
¹² H.L. Kong Medical Oncology Centre Pte Ltd, The Paragon Medical, Singapore.
¹³ Department of Clinical Oncology, L.K.S. Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
¹⁴ Department of Medical Oncology, Zhong Shan Hospital, Fu Dan University, Shanghai, China.
¹⁵ Division of Hematology/Oncology, Samsung Medical Center, Seoul, South Korea.
¹⁶ Medical Oncology Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University and The King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
¹⁷ Division of Hematology-Medical Oncology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
¹⁸ Division of Gastrointestinal and General Surgery and Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan R.O.C.
¹⁹ Department of General Surgery, Rui Jin Hospital, Shanghai Jiaotong University Medical School, Shanghai, China.
²⁰ Cancer Institute Zhejiang University, Zhejiang, China.
²¹ Oncologia Medica, Dipartimento Medico-Chirurgico di Internistica Clinica e Sperimentale "F. Magrassi e A. Lanzara," Seconda Università degli Studi di Napoli, Napoli, Italy.
²² Onkologischen Zentrum am Klinikum Oldenburg, Oldenburg, Germany.
²³ MScript Ltd, East Sussex, United Kingdom.
²⁴ Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. Electronic address: twkimmd@amc.seoul.kr.

PMID: 25209093
DOI: 10.1016/j.clcc.2014.06.004

Abstract

Colorectal cancer (CRC) is among the most common cancers worldwide, but marked epidemiological differences exist between Asian and non-Asian populations. Hence, a consensus meeting was held in Hong Kong in December 2012 to develop Asia-specific guidelines for the management of metastatic CRC (mCRC). A multidisciplinary expert panel, consisting of 23 participants from 10 Asian and 2 European countries, discussed current guidelines for colon or rectal cancer and developed recommendations for adapting these guidelines to Asian clinical practice. Participants agreed that mCRC management in Asia largely follows international guidelines, but they proposed a number of recommendations based on regional 'real-world' experience. In general, participants agreed that 5-fluorouracil (5-FU) infusion regimens in doublets can be substituted with UFT (capecitabine, tegafur-uracil) and S1 (tegafur, 5-chloro-2,4-dihydroxypyridine and oxonic acid), and that the monoclonal antibodies cetuximab and panitumumab are recommended for KRAS wild type tumors. For KRAS mutant tumors, bevacizumab is the preferred biological therapy. FOLFOX (folinic acid, 5-FU, and oxaliplatin) is preferred for initial therapy in Asian patients. The management of mCRC is evolving, and it must be emphasized that the recommendations presented here reflect current treatment practices and thus might change as more data become available.

Keywords: Asia; Chemotherapy; Epidermal growth factor receptor (EGFR)-specific monoclonal antibody; KRAS; Targeted therapy.

Publication types

Consensus Development Conference
Research Support, Non-U.S. Gov't

MeSH terms

Antibodies, Monoclonal / administration & dosage
Antibodies, Monoclonal, Humanized / administration & dosage
Antineoplastic Combined Chemotherapy Protocols / administration & dosage
Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
Asia
Bevacizumab
Camptothecin / administration & dosage
Camptothecin / analogs & derivatives
Capecitabine
Cetuximab
Colonic Neoplasms / genetics
Colonic Neoplasms / pathology
Colonic Neoplasms / therapy*
Combined Modality Therapy
Deoxycytidine / analogs & derivatives
Deoxycytidine / therapeutic use
Drug Combinations
ErbB Receptors / antagonists & inhibitors
Fluorouracil / administration & dosage
Fluorouracil / analogs & derivatives
Fluorouracil / therapeutic use
Guideline Adherence
Humans
Leucovorin / administration & dosage
Liver Neoplasms / genetics
Liver Neoplasms / secondary
Liver Neoplasms / therapy*
Lung Neoplasms / genetics
Lung Neoplasms / secondary
Lung Neoplasms / therapy*
Magnetic Resonance Imaging
Metastasectomy
Neoplasm Staging
Organoplatinum Compounds / administration & dosage
Oxaloacetates
Oxonic Acid / administration & dosage
Panitumumab
Practice Guidelines as Topic*
Proto-Oncogene Proteins / genetics
Proto-Oncogene Proteins p21(ras)
Rectal Neoplasms / genetics
Rectal Neoplasms / pathology
Rectal Neoplasms / therapy*
Tegafur / administration & dosage
Tomography, X-Ray Computed
ras Proteins / genetics

Substances

Antibodies, Monoclonal
Antibodies, Monoclonal, Humanized
Drug Combinations
KRAS protein, human
Organoplatinum Compounds
Oxaloacetates
Proto-Oncogene Proteins
Deoxycytidine
S 1 (combination)
Tegafur
Bevacizumab
Oxonic Acid
Capecitabine
Panitumumab
ErbB Receptors
Proto-Oncogene Proteins p21(ras)
ras Proteins
Cetuximab
Leucovorin
Fluorouracil
Camptothecin

Supplementary concepts

Folfox protocol
IFL protocol
XELOX