ESMO consensus guidelines for the management of patients with metastatic colorectal cancer
Open accessAbstract
Colorectal cancer (CRC) is one of the most common malignancies in Western countries. Over the last 20 years, and the last decade in particular, the clinical outcome for patients with metastatic CRC (mCRC) has improved greatly due not only to an increase in the number of patients being referred for and undergoing surgical resection of their localised metastatic disease but also to a more strategic approach to the delivery of systemic therapy and an expansion in the use of ablative techniques. This reflects the increase in the number of patients that are being managed within a multidisciplinary team environment and specialist cancer centres, and the emergence over the same time period not only of improved imaging techniques but also prognostic and predictive molecular markers. Treatment decisions for patients with mCRC must be evidence-based. Thus, these ESMO consensus guidelines have been developed based on the current available evidence to provide a series of evidence-based recommendations to assist in the treatment and management of patients with mCRC in this rapidly evolving treatment setting.
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Patients with colorectal cancer whose tumors harbor a KRAS mutation, including KRAS G12C, do not benefit from anti-EGFR-based therapies and are not eligible for them.
“Patients with CRC who have tumors harboring a KRAS mutation (including KRAS G12C) do not benefit and thus are not eligible for anti-epidermal growth factor receptor-based therapies8,9.”
From Divarasib plus cetuximab in KRAS G12C-positive colorectal cancer: a phase 1b trial (2024) · cites this paper as [9]
The RAS testing section (p. 4) says patients with metastatic colorectal cancer whose tumors have activating KRAS codon 12/13 mutations do not benefit from EGFR antibodies; this includes the codon-12 mutation G12C. It also says cetuximab and panitumumab should be considered only for RAS-wild-type metastatic colorectal cancer (p. 5). The citing sentence omits the metastatic-disease qualifier and therefore states the conclusion for a broader CRC population than the guideline addresses. (LLM, conf=0.86)
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- Authors
- Van Cutsem, E., Cervantes, A., Adam, R., Sobrero, A., Van Krieken, J. H., Aderka, D., Aranda Aguilar, E., Bardelli, A., Benson, A., Bodoky, G., Ciardiello, F., D'Hoore, A., Diaz-Rubio, E., Douillard, J.-Y., Ducreux, M., Falcone, A., Grothey, A., Gruenberger, T., Haustermans, K., Heinemann, V., Hoff, P., Köhne, C.-H., Labianca, R., Laurent-Puig, P., Ma, B., Maughan, T., Muro, K., Normanno, N., Österlund, P., Oyen, W. J. G., Papamichael, D., Pentheroudakis, G., Pfeiffer, P., Price, T. J., Punt, C., Ricke, J., Roth, A., Salazar, R., Scheithauer, W., Schmoll, H. J., Tabernero, J., Taïeb, J., Tejpar, S., Wasan, H., Yoshino, T., Zaanan, A., & Arnold, D.
- Affiliations
- Universitat de València (ES)
- Hôpital Paul-Brousse (FR)
- Ospedale Policlinico San Martino (IT)
- Tel Aviv University (IL)
- University of Turin (IT)
- Northwestern Medicine (US)
- Unified Szent István and Szent László Hospital (HU)
- University of Campania "Luigi Vanvitelli" (IT)
- Institut de Cancérologie de l'Ouest (FR)
- Université Paris-Saclay (FR)
- University of Pisa (IT)
- Mayo Clinic (US)
- Krankenanstalt Rudolfstiftung der Stadt Wien (AT)
- KU Leuven (BE)
- Ludwig-Maximilians-Universität München (DE)
- Universidade de São Paulo (BR)
- Klinikum Oldenburg (DE)
- Ospedale Papa Giovanni XXIII (IT)
- Chinese University of Hong Kong (HK)
- University of Oxford (GB)
- Aichi Cancer Center (JP)
- Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale" (IT)
- Institute of Cancer Research (GB)
- Bank of Cyprus Oncology Center (CY)
- University of Ioannina (GR)
- Odense University Hospital (DK)
- Queen Elizabeth Hospital (AU)
- Amsterdam UMC Location University of Amsterdam (NL)
- University Hospital Magdeburg (DE)
- University Hospital of Geneva (CH)
- Institut Català d'Oncologia (ES)
- Comprehensive Cancer Center Vienna (AT)
- Martin Luther University Halle-Wittenberg (DE)
- Vall d'Hebron Hospital Universitari (ES)
- Universitair Ziekenhuis Leuven (BE)
- Imperial College Healthcare NHS Trust (GB)
- National Cancer Center Hospital East (JP)
- Hôpital Européen Georges-Pompidou (FR)
- ORCID
- Cervantes, A.
- Adam, R.
- Sobrero, A.
- Bardelli, A.
- Benson, A.
- Bodoky, G.
- Ciardiello, F.
- Douillard, J.-Y.
- Ducreux, M.
- Falcone, A.
- Grothey, A.
- Gruenberger, T.
- Haustermans, K.
- Heinemann, V.
- Hoff, P.
- Labianca, R.
- Ma, B.
- Maughan, T.
- Muro, K.
- Normanno, N.
- Oyen, W.J.G.
- Papamichael, D.
- Pentheroudakis, G.
- Pfeiffer, P.
- Price, T.J.
- Punt, C.
- Ricke, J.
- Salazar, R.
- Schmoll, H.J.
- Tabernero, J.
- Tejpar, S.
- Wasan, H.
- Yoshino, T.
- Zaanan, A.
- Arnold, D.
- Venue
- Annals of Oncology
- Publisher
- Elsevier BV
- Published
- 2016-08
- Volume
- 27
- Issue
- 8
- Pages
- 1386-1422
- ISSN
- 0923-7534 (ISSN-L)
- OpenAlex
- W2470575266
- Cited by
- 3,421
- References
- 309
- Citations by year
- 2026: 199 · 2025: 236 · 2024: 297 · 2023: 364 · 2022: 481 · 2021: 518 · 2020: 444 · 2019: 365 · 2018: 279 · 2017: 189 · 2016: 39 · 2014: 1 · 2013: 1
- FWCI
- 155.89
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Annals of Oncology (publishedVersion)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
- Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
- Lirias (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
- Funders
- Cancer Research UK (13363)
- National Institute for Health and Care Research (11/100/50)
- Topics
- Health Sciences › Medicine › Oncology › Colorectal Cancer Treatments and Studies
- Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
- Health Sciences › Medicine › Surgery › Intraperitoneal and Appendiceal Malignancies
- Keywords
- metastatic colorectal cancer, colorectal cancer, surgical resection of metastases, systemic therapy, multidisciplinary management, treatment decision-making, evidence-based recommendations
- MeSH terms
- Humans, Neoplasm Metastasis, Prognosis, Biomarkers, Tumor, Colorectal Neoplasms, Guidelines as Topic, Molecular Targeted Therapy
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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