nccn临床实践指南：结肠癌

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 permission of NCCN®.NCCN Guidelines for Patients® available at www.nccn.org/patientsguide.medlive.cnNCCN 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 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 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 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 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 Cancer Network, Inc., All Rights Reserved.guide.medlive.cnVersion 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 Contents 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) 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 FOLFIRI-naïve 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 match 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 dose 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 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) should 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 disease, 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 stage 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 Reserved.guide.medlive.cnN