Summary Recommendations

Group

KRAS wild-type

Recommendationa

KRAS mutant

Recommendationa

1

FOLFIRI + Cet

+++

FOLFOX/XELOX + Bev

+++

FOLFOX + Pan/Cet

+++

FOLFOXIRI

++(+)b

FOLFOX/XELOX + Bev

++(+)

FOLFIRI/XELIRI + Bev

++(+)c

FOLFOXIRI

++(+)b

FOLFOX/XELOX

+

FOLFIRI/XELIRI + Bev

++(+)c

FOLFIRI/XELIRI

+

FOLFOX/XELOX

+

IRIS

+

FOLFIRI/XELIRI

+

IRIS

+

2

FOLFIRI + Cet

+++

FOLFOX/XELOX + Bev

+++

FOLFOX + Pan

+++

FOLFIRI/XELIRI + Bev

++(+)c

FOLFOX/XELOX + Bev

+++

FOLFOX/XELOX

++

FOLFIRI/XELIRI + Bev

++(+)c

FOLFIRI/XELIRI

++

FOLFOXIRI

+(+)b

FOLFOXIRI

++b

FOLFOX + Cet

+(+)

IRIS

+

FOLFOX/XELOX

+

FOLFIRI/XELIRI

+

IRIS

+

3

FUFOL/Cape (mono)

+++

FUFOL/Cape (mono)

+++

FUFOL/Cape + Bev

+++

FUFOL/Cape + Bev

+++

XELOX/FOLFOX

++

XELOX/FOLFOX

++

FOLFIRI/XELIRI

++

FOLFIRI/XELIRI

++

IRIS

+

IRIS

+

Cet/Pan (mono)

(+)

Watchful Waiting

+ Selected pts.d

Watchful Waiting

+ Selected pts.d

Triplets (Bev)

+ Option for spec.

Triplets (+/Bev or Cet/Pan)

+ Option for spec.

Situationse

Situationse

aConsented recommendation, however decision might be modified based on individual objective and subjective parameters.

bFOLFOXIRI: Only two (small) phase III trials with contradictory results.

cNo randomized data for FOL(XEL)IRI + Bev.

dOption in case of low tumour burden, asymptomatic, indolent disease: Close control until definitive progression (not until symptoms).

ePatients who are Group 3 but deserve (and tolerate) more intensive treatment due to specific reasons.

XELIRI, capecitabine + irinotecan; IRIS, irinotecan + S1.