National Comprehensive Cancer Network

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NCCN Updates Guidelines for Colorectal Cancer

NCCN announces new updates to the NCCN Guidelines for Colon and Rectal Cancers. The updates include recommendations to the pre-treatment work-up and use of anti-cancer agents in patients with metastatic colorectal cancer depending on the status of the tumor’s KRAS gene. The changes are based on recent studies demonstrating that the tumor KRAS gene status is highly predictive of outcome with certain therapies.

November 03, 2008

FORT WASHINGTON, PA — The National Comprehensive Cancer Network (NCCN) announces important updates to the NCCN Guidelines on Colon and Rectal Cancers. These changes reflect leading developments in the treatment of patients with colon and rectal cancers and represent the standard of care in oncology in both community and academic settings.

New to the NCCN Guidelines is the recommendation that a determination of the KRAS gene status of either the primary tumor or a site of metastasis should be part of the pre-treatment work-up for all patients diagnosed with metastatic colorectal cancer.

Another important update to the NCCN Guidelines is that the epidermal growth factor receptor (EGFR) inhibitors, cetuximab (Erbitux®, Bristol-Myers Squibb Company/ImClone Systems Incorporated) and panitumumab (Vectibix®, Amgen), either as single agents, or, in the case of cetuximab, in combination with other agents, are now recommended only for patients with tumors characterized by the wild-type KRAS gene.

These modifications to the NCCN Colon and Rectal Cancer Guidelines are based on results of a number of recent studies demonstrating that the tumor KRAS gene status is highly predictive of outcome with anti-EGFR therapies. In these studies, statistically significant benefits of EGFR inhibitor therapy were restricted to patients with tumors characterized by the wild-type KRAS gene. Since anti-EGFR therapies were ineffective for patients with tumors characterized by known KRAS gene mutations, the NCCN panel concluded that the potential toxicity and expense of anti-EGFR therapies are not justified in this group of patients.

NCCN Clinical Practice Guidelines in Oncology™ are developed and updated through an evidence-based process with explicit review of the scientific evidence by multidisciplinary panels of expert physicians from NCCN Member Institutions. The most recent version of this and all the NCCN Guidelines are available free of charge at

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 27 leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives. For more information, visit

The NCCN Member Institutions are:

  • Fred & Pamela Buffett Cancer Center
  • Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
  • City of Hope Comprehensive Cancer Center
  • Dana-Farber/Brigham and Women's Cancer Center | Massachusetts General Hospital Cancer Center
  • Duke Cancer Institute
  • Fox Chase Cancer Center
  • Huntsman Cancer Institute at the University of Utah
  • Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
  • The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
  • Robert H. Lurie Comprehensive Cancer Center of Northwestern University
  • Mayo Clinic Cancer Center
  • Memorial Sloan Kettering Cancer Center
  • Moffitt Cancer Center
  • The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
  • Roswell Park Cancer Institute
  • Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
  • St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
  • Stanford Cancer Institute
  • University of Alabama at Birmingham Comprehensive Cancer Center
  • UC San Diego Moores Cancer Center
  • UCSF Helen Diller Family Comprehensive Cancer Center
  • University of Colorado Cancer Center
  • University of Michigan Comprehensive Cancer Center
  • The University of Texas MD Anderson Cancer Center
  • University of Wisconsin Carbone Cancer Center
  • Vanderbilt-Ingram Cancer Center
  • Yale Cancer Center/Smilow Cancer Hospital