Editing Colon cancer (section)

== '''Adjuvant CTX''' ==

** Candidates:
*** Node-positive (stage III)
*** Node-negative (stage II) but high-risk
**** Consider adjuvant (poorly-differentiated, lymphovascular invasion, inadequate margins, T4 lesion, inadequate number of lymph nodes harvested, perforated or obstructed, MSI microsatellite instability)
**** However even in this group, the benefits are minimal
** Regimen:

*** Most commonly FOLFOX (folinic acid, 5-FU and oxaliplatin) for 6 months
*** Fluoropyrimidine alone can be used for more frail patients
*** Sometimes FOLFIRI is also used (folinic acid, 5-FU and irinotecan
*** Trials ongoing 3 months vs 6 months

'''Other systemic options'''

** EGFR inhibitors

*** Cetuximab or panitumumab
*** Indicated with metastatic disease and wild-type KRAS/NRAS and BRAF wild-type
*** If BRAF is mutated, EGFR inhibitors can be combined with a BRAF inhibitor (encorafenib)

** Immune checkpoint inhibitors

*** Given for patients with stage IV CRC and dMMR (MSI-H)
*** Nivolumab plus ipilimumab usually given instead of traditional chemotherapy for those patients

** HER2-targeted therapy

*** Used as second-line therapy for patients with HER2 overexpression

** VEGF inhibitors

*** Bevacizumab (Avastin)
*** Small benefit when added to cytotoxic chemotherapy in some situations
*** Risk of perforation