Colorectal cancer, BRAF-mutated

Section editor
	Neeta K. Venepalli, MD, MBA University of Illinois at Chicago Chicago, IL

Note: the page has regimens specific to BRAF-mutated colon cancer.

• See the main colon cancer page for general regimens.

4 regimens on this page 5 variants on this page

Guidelines

ESMO

• 2016: Van Cutsem et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. PubMed

Older

• 2013: Labianca et al. Early Colon Cancer: ESMO Clinical Practice Guidelines PubMed
• 2013: Balmaña et al. Familial risk-colorectal cancer: ESMO Clinical Practice Guidelines. PubMed

Japanese Society for Cancer of the Colon and Rectum

• 2016: Watanabe et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer PubMed

NCCN

• NCCN Guidelines - Colon Cancer

SIOG

• 2014: Papamichael et al. Treatment of colorectal cancer in older patients: International Society of Geriatric Oncology (SIOG) consensus recommendations 2013

Advanced or metastatic disease, second or third-line therapy

Encorafenib, Binimetinib, and Cetuximab

Study	Evidence	Comparator	Comparative Efficacy
Kopetz et al. 2019 (BEACON)	Phase III	1. Cetuximab & Irinotecan 2. Cetuximab & FOLFIRI	Seems to have superior OS

Chemotherapy

• Encorafenib (Braftovi) 300 mg PO once per day on days 1 through 28
• Binimetinib (Mektovi) 45mg PO twice per day on days 1 through 28
• Cetuximab (Erbitux) 400 mg/m² IV over 120 minutes on day 1
• Cetuximab (Erbitux) 250 mg/m² IV over 60 minutes on days 8, 15, 22

28-day cycle, continued indefinitely

References

1. BEACON: Kopetz S, Grothey A, Yaeger R, Van Cutsem E, Desai J, Yoshino T, Wasan H, Ciardiello F, Loupakis F, Hong YS, Steeghs N, Guren TK, Arkenau HT, Garcia-Alfonso P, Pfeiffer P, Orlov S, Lonardi S, Elez E, Kim TW, Schellens JHM, Guo C, Krishnan A, Dekervel J, Morris V, Calvo Ferrandiz A, Tarpgaard LS, Braun M, Gollerkeri A, Keir C, Maharry K, Pickard M, Christy-Bittel J, Anderson L, Sandor V, Tabernero J. Encorafenib, Binimetinib, and Cetuximab in BRAF V600E–Mutated Colorectal Cancer. N Engl J Med. 2019 Oct 24;381(17):1632-1643. doi: 10.1056/NEJMoa1908075. Epub 2019 Sep 30. link to original article contains verified protocol PubMed

Vemurafenib, Irinotecan, and Cetuximab

Study	Evidence	Comparator	Comparative Efficacy
Kopetz et al. 2017 (SWOG 1406)	Phase II	Cetuximab & Irinotecan	Seems to have superior PFS

Chemotherapy

• Vemurafenib (Zelboraf) 960 mg PO twice per day on days 1 through 14
• Irinotecan (Camptosar) 180mg/m² IV on day 1
• Cetuximab (Erbitux) 500 mg/m² IV on day 1

14-day cycle, continued indefinitely

References

1. SWOG 1406: Kopetz S, McDonough S, Morris V, Lenz HJ, Magliocco A, Atreya C, Diaz L, Allegra C, Lieu C, Wang S, Eckhardt SG, Semrad T, Kaberle K, Guthrie K, Hochster H. Randomized phase II study of irinotecan and cetuximab with or without vemurafenib in BRAF-mutant metastatic colorectal cancer (SWOG1406). DOI: 10.1200/JCO.2017.35.4_suppl.520 Journal of Clinical Oncology 35, no. 4_suppl (February 01, 2017) 520-520. Published online March 21, 2017.link to original article