NCCN Guidelines for Patients® Version Updates: Colon Cancer

Following are the major updates that were included in the NCCN Guidelines for Patients®: Colon Cancer, Version 1.2014:

  • Part 3 – Treatment planning
    • Page 21
      • Molecular testing is discussed on this page. Tests to assess genes that control KRAS or NRAS proteins are recommended for Stage IV colon cancers.
  • Part 5 – Treatment guide: first-time treatment
    • Page 38
      • This page discusses treatment for stages I (T2), II, and III colon cancers. A stent followed by surgery was removed as primary treatment option for tumors that block the gut.
    • Page 42
      • On this page, the treatment options for stage IV colon cancers that can be treated with surgery are listed.
      • For Option 1, drug treatment after surgery (3rd treatment) is now listed as "FOLFOX or CapeOX."
      • Cetuximab and panitumumab should only be used if both KRAS and NRAS genes are normal.
    • Page 44
      • On this page, the treatment options for Stage IV colon cancers that can't be treated with surgery are listed.
      • "FOLFOXIRI + bevacizumab" has been added as an option.
      • Cetuximab and panitumumab should only be used if both KRAS and NRAS genes are normal.
  • Part 6 – Treatment guide: recurrent treatment
    • Page 50
      • This page discusses treatment options for colon cancer that returns and can be treated with surgery. For Option 2, neoadjuvant treatment regimens have been clarified to be FOLFOX or CapeOx, FLOX, Capecitabine, or 5-FU/LV.
    • Page 52
      • This page discusses treatment options for colon cancer that returns and can't be treated with surgery. If you had adjuvant FOLFOX or CapeOX within the past 12 months, there are new drug regimens. These regimens include FOLFIRI ± ziv-aflibercept, Irinotecan ± bevacizumab, Irinotecan ± ziv-aflibercept, and for normal KRAS/NRAS genes, Irinotecan + panitumumab and Irinotecan + cetuximab.
  • Part 7 – Treatment guide: chemotherapy pathways
    • Pages 55-66
      • This is a new chapter detailing which drugs should be used for advanced colon cancers.
      • Cetuximab and panitumumab should only be used if both KRAS and NRAS genes are normal.
      • Regorafenib is sometimes an option depending on prior treatment.