Clinical practice guidelines in oncology

Al B. Benson, J. Pablo Arnoletti, Tanios Bekaii-Saab, Emily Chan, Yi Jen Chen, Michael A. Choti, Harry S. Cooper, Raza A. Dilawari, Paul F. Engstrom, Peter C. Enzinger, James W. Fleshman, Charles S. Fuchs, Jean L Grem, James A. Knol, Lucille A. Leong, Edward Lin, Kilian Salerno May, Mary F. Mulcahy, Kate Murphy, Eric Rohren & 9 others David P. Ryan, Leonard Saltz, Sunil Sharma, David Shibata, John M. Skibber, William Small, Constantinos T. Sofocleous, Alan P. Venook, Christopher Willett

Research output: Contribution to journalReview article

8 Citations (Scopus)

Abstract

The panel believes that a multidisciplinary approach is necessary for managing colorectal cancer. The panel endorses the concept that treating patients in a clinical trial has priority over standard or accepted therapy. The recommended surgical procedure for resectable colon cancer is an en bloc resection and adequate lymphadenectomy. Adequate pathologic assessment of the resected lymph nodes is important, with a goal of evaluating at least 12 nodes. Adjuvant therapy with FOLFOX (category 1, preferred), FLOX (category 1), CapeOx (category 1), 5-FU/LV (category 2A), or capecitabine (category 2A) is recommended by the panel for patients with stage III disease. Adjuvant therapy for patients with high-risk stage II disease is also an option; the panel recommends 5-FU/LV with or without oxaliplatin (FOLFOX or FLOX) or capecitabine with or without oxaliplatin (category 2A for all treatment options). Patients with metastatic disease in the liver or lung should be considered for surgical resection if they are candidates for surgery and if all original sites of disease are amenable to resection (R0) and/or ablation. Preoperative chemotherapy can be considered as initial therapy in patients with synchronous or metachronous resectable metastatic disease. When a response to chemotherapy would likely convert a patient from an unresectable to a resectable state (i.e., conversion therapy), this therapy should be initiated. Adjuvant chemotherapy should be considered after resection of liver or lung metastases. The recommended posttreatment surveillance program includes serial CEA determinations and periodic chest, abdominal, and pelvic CT scans, colonoscopic evaluations, and a survivorship plan to manage long-term side effects of treatment, facilitate disease prevention, and promote a healthy lifestyle. Recommendations for patients with disseminated metastatic disease represent a continuum of care in which lines of treatment are blurred rather than discrete. Principles to consider at initiation of therapy include preplanned strategies for altering therapy for patients in both the presence and absence of disease progression, including plans for adjusting therapy for patients who experience certain toxicities. Recommended initial therapy options for advanced or metastatic disease depend on whether the patient is appropriate for intensive therapy. The more-intensive initial therapy options include FOLFOX, FOLFIRI, CapeOx, and FOLFOXIRI (category 2B). Addition of a biologic agent (e.g., bevacizumab, cetuximab, panitumumab) is either recommended or listed as an option in combination with some of these regimens, depending on available data. Chemotherapy options for patients with progressive disease depend on the choice of initial therapy.

Original languageEnglish (US)
Pages (from-to)1238-1289
Number of pages52
JournalJNCCN Journal of the National Comprehensive Cancer Network
Volume9
Issue number11
StatePublished - Nov 1 2011

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Practice Guidelines
oxaliplatin
Therapeutics
Drug Therapy
Fluorouracil
Continuity of Patient Care
Biological Factors
Adjuvant Chemotherapy
Lymph Node Excision
Colonic Neoplasms
Lung Diseases
Disease Progression
Liver Diseases
Colorectal Neoplasms
Thorax

Keywords

  • 5-fluorouracil
  • Adenocarcinoma
  • Adjuvant chemotherapy
  • Bevacizumab
  • Capecitabine
  • Cetuximab
  • Colonic neoplasms
  • Colorectal surgery
  • Irinotecan
  • Liver resection
  • Metastatic colorectal cancer
  • NCCN clinical practice guidelines
  • NCCN guidelines
  • Neoadjuvant therapy
  • Neoplasm recurrence
  • Neoplasm staging
  • Oxaliplatin
  • Panitumumab

ASJC Scopus subject areas

  • Oncology

Cite this

Benson, A. B., Arnoletti, J. P., Bekaii-Saab, T., Chan, E., Chen, Y. J., Choti, M. A., ... Willett, C. (2011). Clinical practice guidelines in oncology. JNCCN Journal of the National Comprehensive Cancer Network, 9(11), 1238-1289.

Clinical practice guidelines in oncology. / Benson, Al B.; Arnoletti, J. Pablo; Bekaii-Saab, Tanios; Chan, Emily; Chen, Yi Jen; Choti, Michael A.; Cooper, Harry S.; Dilawari, Raza A.; Engstrom, Paul F.; Enzinger, Peter C.; Fleshman, James W.; Fuchs, Charles S.; Grem, Jean L; Knol, James A.; Leong, Lucille A.; Lin, Edward; May, Kilian Salerno; Mulcahy, Mary F.; Murphy, Kate; Rohren, Eric; Ryan, David P.; Saltz, Leonard; Sharma, Sunil; Shibata, David; Skibber, John M.; Small, William; Sofocleous, Constantinos T.; Venook, Alan P.; Willett, Christopher.

In: JNCCN Journal of the National Comprehensive Cancer Network, Vol. 9, No. 11, 01.11.2011, p. 1238-1289.

Research output: Contribution to journalReview article

Benson, AB, Arnoletti, JP, Bekaii-Saab, T, Chan, E, Chen, YJ, Choti, MA, Cooper, HS, Dilawari, RA, Engstrom, PF, Enzinger, PC, Fleshman, JW, Fuchs, CS, Grem, JL, Knol, JA, Leong, LA, Lin, E, May, KS, Mulcahy, MF, Murphy, K, Rohren, E, Ryan, DP, Saltz, L, Sharma, S, Shibata, D, Skibber, JM, Small, W, Sofocleous, CT, Venook, AP & Willett, C 2011, 'Clinical practice guidelines in oncology', JNCCN Journal of the National Comprehensive Cancer Network, vol. 9, no. 11, pp. 1238-1289.
Benson AB, Arnoletti JP, Bekaii-Saab T, Chan E, Chen YJ, Choti MA et al. Clinical practice guidelines in oncology. JNCCN Journal of the National Comprehensive Cancer Network. 2011 Nov 1;9(11):1238-1289.
Benson, Al B. ; Arnoletti, J. Pablo ; Bekaii-Saab, Tanios ; Chan, Emily ; Chen, Yi Jen ; Choti, Michael A. ; Cooper, Harry S. ; Dilawari, Raza A. ; Engstrom, Paul F. ; Enzinger, Peter C. ; Fleshman, James W. ; Fuchs, Charles S. ; Grem, Jean L ; Knol, James A. ; Leong, Lucille A. ; Lin, Edward ; May, Kilian Salerno ; Mulcahy, Mary F. ; Murphy, Kate ; Rohren, Eric ; Ryan, David P. ; Saltz, Leonard ; Sharma, Sunil ; Shibata, David ; Skibber, John M. ; Small, William ; Sofocleous, Constantinos T. ; Venook, Alan P. ; Willett, Christopher. / Clinical practice guidelines in oncology. In: JNCCN Journal of the National Comprehensive Cancer Network. 2011 ; Vol. 9, No. 11. pp. 1238-1289.
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AU - Benson, Al B.

AU - Arnoletti, J. Pablo

AU - Bekaii-Saab, Tanios

AU - Chan, Emily

AU - Chen, Yi Jen

AU - Choti, Michael A.

AU - Cooper, Harry S.

AU - Dilawari, Raza A.

AU - Engstrom, Paul F.

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AU - Fuchs, Charles S.

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AU - Small, William

AU - Sofocleous, Constantinos T.

AU - Venook, Alan P.

AU - Willett, Christopher

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AB - The panel believes that a multidisciplinary approach is necessary for managing colorectal cancer. The panel endorses the concept that treating patients in a clinical trial has priority over standard or accepted therapy. The recommended surgical procedure for resectable colon cancer is an en bloc resection and adequate lymphadenectomy. Adequate pathologic assessment of the resected lymph nodes is important, with a goal of evaluating at least 12 nodes. Adjuvant therapy with FOLFOX (category 1, preferred), FLOX (category 1), CapeOx (category 1), 5-FU/LV (category 2A), or capecitabine (category 2A) is recommended by the panel for patients with stage III disease. Adjuvant therapy for patients with high-risk stage II disease is also an option; the panel recommends 5-FU/LV with or without oxaliplatin (FOLFOX or FLOX) or capecitabine with or without oxaliplatin (category 2A for all treatment options). Patients with metastatic disease in the liver or lung should be considered for surgical resection if they are candidates for surgery and if all original sites of disease are amenable to resection (R0) and/or ablation. Preoperative chemotherapy can be considered as initial therapy in patients with synchronous or metachronous resectable metastatic disease. When a response to chemotherapy would likely convert a patient from an unresectable to a resectable state (i.e., conversion therapy), this therapy should be initiated. Adjuvant chemotherapy should be considered after resection of liver or lung metastases. The recommended posttreatment surveillance program includes serial CEA determinations and periodic chest, abdominal, and pelvic CT scans, colonoscopic evaluations, and a survivorship plan to manage long-term side effects of treatment, facilitate disease prevention, and promote a healthy lifestyle. Recommendations for patients with disseminated metastatic disease represent a continuum of care in which lines of treatment are blurred rather than discrete. Principles to consider at initiation of therapy include preplanned strategies for altering therapy for patients in both the presence and absence of disease progression, including plans for adjusting therapy for patients who experience certain toxicities. Recommended initial therapy options for advanced or metastatic disease depend on whether the patient is appropriate for intensive therapy. The more-intensive initial therapy options include FOLFOX, FOLFIRI, CapeOx, and FOLFOXIRI (category 2B). Addition of a biologic agent (e.g., bevacizumab, cetuximab, panitumumab) is either recommended or listed as an option in combination with some of these regimens, depending on available data. Chemotherapy options for patients with progressive disease depend on the choice of initial therapy.

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KW - Adenocarcinoma

KW - Adjuvant chemotherapy

KW - Bevacizumab

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KW - Colorectal surgery

KW - Irinotecan

KW - Liver resection

KW - Metastatic colorectal cancer

KW - NCCN clinical practice guidelines

KW - NCCN guidelines

KW - Neoadjuvant therapy

KW - Neoplasm recurrence

KW - Neoplasm staging

KW - Oxaliplatin

KW - Panitumumab

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