Colon cancer, RAS wild-type
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Section editor transclusions Note: the page has adjuvant regimens specific to RAS wild-type colon cancer. Also note that most of the regimens were evaluated on patients tested for KRAS mutations only, and that the definition of wild-type has evolved over time. See individual regimen biomarker eligibility criteria for more details.
- See the main colon cancer page for general regimens.
2 regimens on this page
2 variants on this page
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Guidelines
ESMO
- 2013: Early Colon Cancer: ESMO Clinical Practice Guidelines PubMed
- 2013: Familial risk-colorectal cancer: ESMO Clinical Practice Guidelines. PubMed
Japanese Society for Cancer of the Colon and Rectum
- 2016: Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer PubMed
NCCN
Adjuvant therapy
mFOLFOX6
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mFOLFOX6: modified FOLinic acid, Fluorouracil, OXaliplatin
Regimen
| Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
|---|---|---|---|---|
| Alberts et al. 2012 (N0147) | 2004-2009 | Phase 3 (C) | mFOLFOX6 & Cetuximab | Might have superior DFS DFS36: 74.6% vs 71.5% (HR 0.83, 95% CI 0.67-1.02) |
Preceding treatment
- Surgery, within 10 weeks
Chemotherapy
- Fluorouracil (5-FU) 400 mg/m2 IV bolus once on day 1, then 2400 mg/m2 IV continuous infusion over 46 to 48 hours, given second (total dose per cycle: 2800 mg/m2)
- Folinic acid (Leucovorin) 400 mg/m2 IV over 2 hours once on day 1, given first, with oxaliplatin
- Oxaliplatin (Eloxatin) 85 mg/m2 IV over 2 hours once on day 1, given first, with folinic acid
14-day cycle for 12 cycles
References
- N0147: Alberts SR, Sargent DJ, Nair S, Mahoney MR, Mooney M, Thibodeau SN, Smyrk TC, Sinicrope FA, Chan E, Gill S, Kahlenberg MS, Shields AF, Quesenberry JT, Webb TA, Farr GH Jr, Pockaj BA, Grothey A, Goldberg RM. Effect of oxaliplatin, fluorouracil, and leucovorin with or without cetuximab on survival among patients with resected stage III colon cancer: a randomized trial. JAMA. 2012 Apr 4;307(13):1383-93. link to original article contains verified protocol link to PMC article PubMed NCT00079274
mFOLFOX6 & Cetuximab
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mFOLFOX6 & Cetuximab: modified FOLinic acid, Fluorouracil, OXaliplatin, Cetuximab
Regimen
| Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
|---|---|---|---|---|
| Alberts et al. 2012 (N0147) | 2004-2009 | Phase 3 (E-esc) | mFOLFOX6 | Might have inferior DFS |
Some guidelines do not recommend using cetuximab as adjuvant therapy outside of a clinical trial.
Preceding treatment
- Surgery, within 10 weeks
Chemotherapy
- Fluorouracil (5-FU) 400 mg/m2 IV bolus once on day 1, then 2400 mg/m2 IV continuous infusion over 46 to 48 hours (total dose per cycle: 2800 mg/m2)
- Folinic acid (Leucovorin) 400 mg/m2 IV over 2 hours once on day 1
- Oxaliplatin (Eloxatin) 85 mg/m2 IV over 2 hours once on day 1
Targeted therapy
- Cetuximab (Erbitux) as follows:
- Cycle 1: 400 mg/m2 IV over 2 hours once on day 1, then 250 mg/m2 IV over 60 minutes once on day 8
- Cycles 2 to 12: 250 mg/m2 IV over 2 hours once per day on days 1 & 8
14-day cycle for 12 cycles
References
- N0147: Alberts SR, Sargent DJ, Nair S, Mahoney MR, Mooney M, Thibodeau SN, Smyrk TC, Sinicrope FA, Chan E, Gill S, Kahlenberg MS, Shields AF, Quesenberry JT, Webb TA, Farr GH Jr, Pockaj BA, Grothey A, Goldberg RM. Effect of oxaliplatin, fluorouracil, and leucovorin with or without cetuximab on survival among patients with resected stage III colon cancer: a randomized trial. JAMA. 2012 Apr 4;307(13):1383-93. link to original article contains verified protocol link to PMC article PubMed NCT00079274