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NCCN Adds Survivorship Section to Colon and Rectal Cancer Guidelines

NCCN announces new modifications to the NCCN Guidelines for Colon and Rectal Cancers. Important additions include a new survivorship section, new indications for cetuximab as it relates to KRAS gene testing, and recommendations on how to re-evaluate patients initially presenting with unresectable disease. Colorectal cancer remains the third most frequently diagnosed cancer in men and women in the United States.

February 18, 2009

FORT WASHINGTON, PA — The National Comprehensive Cancer Network (NCCN) announces the addition of a survivorship section to the NCCN Clinical Practice Guidelines in Oncology™ for Colon and Rectal Cancers, as well as other important updates. These changes reflect leading developments in the treatment of patients with colon and rectal cancer and represent the standard of clinical policy in oncology in both community and academic settings.

A significant addition to the NCCN Guidelines is a new section dedicated to survivorship that provides recommendations for long-term follow-up care of patients treated for colorectal cancer. Specific information is provided about managing possible long-term side effects of treatment, routine screening and monitoring, healthy lifestyle and wellness counseling, and making the transition back into the care of a primary care physician. This section was added to help oncologists support their patients with the complex issues they face after treatment.

The NCCN Guidelines continue to incorporate new research about the widely publicized KRAS gene test. In November 2008, NCCN announced modifications to the
Guidelines for Colon and Rectal Cancers that included the recommendation for KRAS testing for all patients with a diagnosis of metastatic colorectal cancer based upon a number of studies demonstrating that the tumor KRAS gene status is highly predictive of outcome with anti-EGFR agents, such as cetuximab (Erbitux®, Bristol-Myers Squibb Company/ImClone Systems Incorporated) and panitumumab (Vectibix®, Amgen). Furthermore, the NCCN Guidelines recommend against the use of these agents for patients with tumors characterized by specific KRAS gene mutations. 

The updated NCCN Guidelines reflect other new data regarding the use of cetuximab in the treatment of patients with metastatic colorectal cancer, and now include it in combination with specific chemotherapy drugs as a first-line therapy option.

Also new to the NCCN Guidelines for Colon and Rectal Cancers are recommendations for the re-evaluation of patients with initially unresectable metastatic colorectal disease to determine if they would be suitable for resection following chemotherapy. Although resection of metastatic colorectal cancer is the only potentially curative treatment for the disease, the majority of patients do not initially meet the necessary criteria for this procedure. The NCCN Guideline Panel noted research suggesting that preoperative chemotherapy has the potential to convert some patients who are initially classified as having unresectable disease to a resectable status. The new section in the NCCN Guidelines provides direction on re-evaluation of these patients.

Colorectal cancer is the third most frequently diagnosed cancer in men and women in the United States. However, mortality from colon cancer has decreased slightly over the past 30 years, possibly because of earlier diagnosis through screening and better treatment modalities.

NCCN Clinical Practice Guidelines in Oncology™ are developed and updated through an evidence-based process with explicit review of the scientific evidence integrated with expert judgment by multidisciplinary panels of 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 Comprehensive Cancer Center
  • 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 Rogel 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