Adaptation Of International Guidelines For Metastatic Colorectal Cancer: An Asian Consensus

Abstract

Background 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). Methods A multidisciplinary expert panel, consisting of 23 participants from ten Asian and two European countries, discussed current guidelines for colon or rectal cancer and developed recommendations for adapting these guidelines to Asian clinical practice. Results 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 capecitabine, tegafur-uracil (UFT) 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 tumor types. For KRAS mutant tumor types, bevacizumab is the preferred biological therapy. FOLFOX (folinic acid, 5-FU and oxaliplatin) is preferred for initial therapy in Asian patients. Conclusion The management of mCRC is evolving, and it must be emphasized that the recommendations presented here reflect current treatment practices and thus may change as more data become available.