Treatment of Metastatic Colorectal Cancer: ASCO Guideline
Open accessAbstract
PURPOSE: To develop recommendations for treatment of patients with metastatic colorectal cancer (mCRC). METHODS: ASCO convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice. RESULTS: Five systematic reviews and 10 randomized controlled trials met the systematic review inclusion criteria. RECOMMENDATIONS: Doublet chemotherapy should be offered, or triplet therapy may be offered to patients with previously untreated, initially unresectable mCRC, on the basis of included studies of chemotherapy in combination with anti–vascular endothelial growth factor antibodies. In the first-line setting, pembrolizumab is recommended for patients with mCRC and microsatellite instability-high or deficient mismatch repair tumors; chemotherapy and anti–epidermal growth factor receptor therapy is recommended for microsatellite stable or proficient mismatch repair left-sided treatment-naive RAS wild-type mCRC; chemotherapy and anti–vascular endothelial growth factor therapy is recommended for microsatellite stable or proficient mismatch repair RAS wild-type right-sided mCRC. Encorafenib plus cetuximab is recommended for patients with previously treated BRAF V600E–mutant mCRC that has progressed after at least one previous line of therapy. Cytoreductive surgery plus systemic chemotherapy may be recommended for selected patients with colorectal peritoneal metastases; however, the addition of hyperthermic intraperitoneal chemotherapy is not recommended. Stereotactic body radiation therapy may be recommended following systemic therapy for patients with oligometastases of the liver who are not considered candidates for resection. Selective internal radiation therapy is not routinely recommended for patients with unilobar or bilobar metastases of the liver. Perioperative chemotherapy or surgery alone should be offered to patients with mCRC who are candidates for potentially curative resection of liver metastases. Multidisciplinary team management and shared decision making are recommended. Qualifying statements with further details related to implementation of guideline recommendations are also included. Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines .
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An increasing number of new biomarker-driven chemotherapy-free targeted therapy regimens for defined molecular mCRC subtypes have been shown to be effective and are approved or are close to being approved and can be included in different lines of treatment.
“An increasing number of new biomarker-driven chemotherapy-free targeted therapy regimens for defined molecular mCRC subtypes have been shown to be effective and are approved or are close to being approved and can be included in different lines of treatment.8 24”
From Current and emerging concepts for systemic treatment of metastatic colorectal cancer (2025) · cites this paper as [24]
Anti-PD1 blockade with pembrolizumab is the new standard of care for patients with dMMR/MSI-H mCRC.
“Consequently, anti-PD1 blockade with pembrolizumab became the new standard of care for patients with dMMR/MSI-H mCRC.8 23 102”
From Current and emerging concepts for systemic treatment of metastatic colorectal cancer (2025) · cites this paper as [102]
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FOLFOX/bevacizumab +/- irinotecan in advanced colorectal cancer (CHARTA): Long term outcome
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Flagged first, then by citations
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André, T., Elez, E., Lenz, H.-J., Jensen, L. H., Touchefeu, Y., Van Cutsem, E., Garcia-Carbonero, R., Tougeron, D., Mendez, G. A., Schenker, M., et al. (2025) · The Lancet · doi:10.1016/s0140-6736(24)02848-4 · Cited by 256 · see citing works
Encorafenib, Cetuximab, and mFOLFOX6 in <i>BRAF</i> -Mutated Colorectal Cancer
Elez, E., Yoshino, T., Shen, L., Lonardi, S., Van Cutsem, E., Eng, C., Kim, T. W., Wasan, H. S., Desai, J., Ciardiello, F., et al. (2025) · New England Journal of Medicine · doi:10.1056/nejmoa2501912 · Cited by 166 · see citing works
Self-citationGPT-4 for Information Retrieval and Comparison of Medical Oncology Guidelines
Ferber, D., Wiest, I. C., Wölflein, G., Ebert, M. P., Beutel, G., Eckardt, J.-N., Truhn, D., Springfeld, C., Jäger, D., & Kather, J. N. (2024) · NEJM AI · doi:10.1056/aics2300235 · Cited by 92 · see citing works
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Steup, C., Kennel, K. B., Neurath, M. F., Fichtner-Feigl, S., & Greten, F. R. (2025) · Gut · doi:10.1136/gutjnl-2025-335412 · Cited by 39 · see citing works
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Anti-EGFR Therapy in Metastatic Colorectal Cancer: Identifying, Tracking, and Overcoming Resistance
Leite, L. F., Noronha, M. M., de Menezes, J. S. A., da Conceição, L. D., Almeida, L. F. C., Cappellaro, A. P., Belotto, M., Biachi de Castria, T., Peixoto, R. D., & Megid, T. B. C. (2025) · Cancers · doi:10.3390/cancers17172804 · Cited by 32 · see citing works
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Gavrilas, L., Sava, O., Balacescu, L., Miron, S., Miere, D., Balacescu, O., & Cruceriu, D. (2025) · Biochemical Pharmacology · doi:10.1016/j.bcp.2025.117386 · Cited by 1 · see citing works
- Authors
- Morris, V. K., Kennedy, E. B., Baxter, N. N., Benson, A. B., Cercek, A., Cho, M., Ciombor, K. K., Cremolini, C., Davis, A., Deming, D. A., Fakih, M. G., Gholami, S., Hong, T. S., Jaiyesimi, I., Klute, K., Lieu, C., Sanoff, H., Strickler, J. H., White, S., Willis, J. A., & Eng, C.
- Affiliations
- The University of Texas MD Anderson Cancer Center (US)
- American Society of Clinical Oncology (US)
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University (US)
- Memorial Sloan Kettering Cancer Center (US)
- University of California, Irvine (US)
- Vanderbilt-Ingram Cancer Center (US)
- University of Pisa (IT)
- Fight Colorectal Cancer, Springfield, MO
- University of Wisconsin–Madison (US)
- City Of Hope National Medical Center (US)
- UC Davis Health (US)
- Massachusetts General Hospital (US)
- University of Nebraska at Omaha (US)
- CU Medicine, Denver, CO
- University of North Carolina at Chapel Hill (US)
- University Medical Center, Durham, NC
- Medical College of Wisconsin (US)
- ORCID
- Morris, Van K.
- Kennedy, Erin B.
- Baxter, Nancy N.
- Benson, Al B.
- Cercek, Andrea
- Cho, May
- Ciombor, Kristen K.
- Cremolini, Chiara
- Deming, Dustin A.
- Fakih, Marwan G.
- Gholami, Sepideh
- Hong, Theodore S.
- Jaiyesimi, Ishmael
- Klute, Kelsey
- Lieu, Christopher
- Sanoff, Hanna
- Strickler, John H.
- White, Sarah
- Willis, Jason A.
- Eng, Cathy
- Venue
- Journal of Clinical Oncology
- Published
- 2023-01-20
- Volume
- 41
- Issue
- 3
- Pages
- 678-700
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- PMC
- PMC10506310
- OpenAlex
- W4306660133
- Cited by
- 682
- References
- 84
- Citations by year
- 2026: 196 · 2025: 214 · 2024: 178 · 2023: 93 · 2022: 1
- FWCI
- 50.82
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Cold Spring Harbor Laboratory Institutional Repository (Cold Spring Harbor Laboratory) (submittedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- Funders
- Amgen
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- AstraZeneca
- GlaxoSmithKline
- Sanofi
- FibroGen
- Focused Ultrasound Foundation
- Cook Medical
- Exelixis
- Revolution Medicines
- Silverback Therapeutics
- Natera
- Mereo BioPharma
- Genentech
- National Cancer Institute (P50CA221707, K12CA088084)
- Daiichi Sankyo Europe
- 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, first-line therapy, anti-VEGF therapy, pembrolizumab, microsatellite instability, DNA mismatch repair, anti-EGFR therapy, BRAF V600E mutation, cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, stereotactic body radiotherapy, radioembolization, liver metastasis, oligometastatic disease, perioperative chemotherapy, multidisciplinary team management, shared decision-making
- MeSH terms
- Cetuximab, Antineoplastic Combined Chemotherapy Protocols, Colonic Neoplasms, Humans, Rectal Neoplasms, Colorectal Neoplasms, Endothelial Growth Factors, Practice Guidelines as Topic
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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