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

Cheng AL1, Li J2, Vaid AK3, Ma BB4, Teh C5, Ahn JB6, Bello M7, Charoentum C8, Chen LT9, de Lima Lopes G Jr10, Ho GF11, Kong HL12, Lam KO13, Liu TS14,Park YS15, Sriuranpong V16, Sudoyo AW17, Wang JY18, Zhang J19, Zhang SZ20, Ciardiello F21, Köhne CH22, Shaw M23, Kim TW24.

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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.