Controversies in the treatment of RAS wild-type metastatic colorectal cancer
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RESEARCH ARTICLE
Controversies in the treatment of RAS wild‑type metastatic colorectal cancer R. Vera1 · M. Salgado2 · M. J. Safont3 · J. Gallego4 · E. González5 · E. Élez6 · E. Aranda7 Received: 19 June 2020 / Accepted: 3 August 2020 © The Author(s) 2020
Abstract Objective To provide guidance for the management of RAS wild-type (wt) metastatic colorectal cancer (mCRC) in daily practice. Methods Nominal group and Delphi techniques were used. A steering committee of seven experts analyzed the current management of RAS wt mCRC, through which they identified controversies, critically analyzed the available evidence, and formulated several guiding statements for clinicians. Subsequently, a group of 30 experts (the expert panel) was selected to test agreement with the statements, through two Delphi rounds. The following response categories were established in both rounds: 1 = totally agree, 2 = basically agree, 3 = basically disagree, 4 = totally disagree. Agreement was defined if ≥ 75% of answers were in categories 1 and 2 (consensus with the agreement) or 3 and 4 (consensus with the disagreement). Results Overall, 71 statements were proposed, which incorporated the following areas: (1) overarching principles; (2) tumor location; (3) triplets; (4) maintenance; (5) second-line and beyond treatments; (6) Rechallenge and liquid biopsy. After the two Delphi rounds, only six statements maintained a lack of clear consensus. Conclusions This document aims to describe the expert’s attitude when dealing with several common clinical questions regarding patients with RAS wt mCRC. Keywords Metastatic colorectal cancer · RAS wild-type · Treatment patterns · Primary tumor sidedness · Maintenance · Liquid biopsy · Rechallenge · Delphi
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12094-020-02475-8) contains supplementary material, which is available to authorized users. * E. Aranda [email protected] 1
Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
2
Medical Oncology Department, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
3
Medical Oncology Department, Hospital General Universitario de Valencia, Valencia, Spain
4
Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain
5
Medical Oncology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
6
Vall d’Hebron Institute of Oncology, Barcelona, Spain
7
Medical Oncology Department, Maimonides Institute of Biomedical Research (IMIBIC), Hospital Reina Sofía, University of Córdoba, Av. Menendez Pidal, s/n, 14004 Córdoba, Spain
Introduction Colorectal cancer (CRC) is the fourth most commonly diagnosed malignancy and the second-leading cause of global cancer-related deaths [1]. Approximately 20–25% of patients exhibit metastatic disease (mCRC) at disease onset and 50% of patients will eventually develop metastases [2]. The prognosis of mCRC has dramatically improved in recent decades, due to a range of factors, incl
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