Clinical and Translational Oncology

, Volume 12, Issue 11, pp 729–734 | Cite as

SEOM clinical guidelines for the treatment of advanced colorectal cancer

  • Rocío García-Carbonero
  • M. Auxiliadora Gómez España
  • Enrique Casado Sáenz
  • Vicente Alonso Orduña
  • Andrés Cervantes Ruipérez
  • Javier Gallego Plazas
  • Pilar García Alfonso
  • Ignacio Juez Martel
  • Encarnación González Flores
  • María Lomas Garrido
  • Dolores Isla Casado
Clinical Guides in Oncology


Colorectal cancer is the first cause of cancer diagnosis in Spain. Over half of the patients are diagnosed with or will eventually develop distant metastasis. The current manuscript aims to provide synthetic practical guidelines for the therapeutic approaches in advanced disease. Available systemic therapeutic options, and integration and sequencing of chemotherapy with surgical procedures are discussed. Extent of disease, treatment objective, tumor kras mutation status, as well as patient’s functional and comorbid conditions shall be considered to properly design the most adequate therapeutic strategy.


Colorectal cancer Practice guidelines Chemotherapy Surgery 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Greene F, Page D, Fleming I et al (2002) AJCC cancer staging manual. Springer Verlag, New YorkCrossRefGoogle Scholar
  2. 2.
    Van Cutsem E, Nordlinger B, Adam R et al (2006) Towards a pan-European consensus on the treatment of patients with colorectal liver metastases. Eur J Cancer 42:2212–2221CrossRefPubMedGoogle Scholar
  3. 3.
    Choti MA, Sitzmann JV, Tiburi MF et al (2002) Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg 235:759–766CrossRefPubMedGoogle Scholar
  4. 4.
    Charnsangavej C, Clary B, Fong Y et al (2006) Selection of patients for resection of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol 13:1261–1268CrossRefPubMedGoogle Scholar
  5. 5.
    Abdalla EK, Vauthey JN, Ellis LM et al (2004) Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 39:818–827CrossRefGoogle Scholar
  6. 6.
    Nordlinger B, Sorbye H, Glimelius B et al (2008) Perioperative chemotherapy with FOLFOX 4 and surgery versus surgery alone for resectable liver metastasis from colorectal cancer (EORTC Intergroup Trial 40983): a randomized control trial. Lancet 371:1007–1016CrossRefPubMedGoogle Scholar
  7. 7.
    de Gramont A, Figer A, Seymour M et al (2000) Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 18:2938–2947PubMedGoogle Scholar
  8. 8.
    Rothenberg ML, Oza AM, Bigelow RH et al (2003) Superiority of oxaliplatin and fluorouracilleucovorin compared with either therapy alone in patients with progressive colorectal cancer after irinotecan and fluorouracil-leucovorin: interim results of a phase III trial. J Clin Oncol 21:2059–2069CrossRefPubMedGoogle Scholar
  9. 9.
    Douillard JY, Cunningham D, Roth AD et al (2000) Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet 355:1041–1047CrossRefPubMedGoogle Scholar
  10. 10.
    Koopman M, Antonini NF, Douma J et al (2007) Sequential versus combination chemotherapy with capecitabine, irinotecan, and oxaliplatin in advanced colorectal cancer (CAIRO): a phase III randomised controlled trial. Lancet 214;370 (9582):135–142CrossRefGoogle Scholar
  11. 11.
    Seymour MT, Maughan TS, Ledermann JA et al; FOCUS Trial Investigators; National Cancer Research Institute Colorectal Clinical Studies Group (2007) Different strategies of sequential and combination chemotherapy for patients with poor prognosis advanced colorectal cancer (MRC FOCUS): a randomised controlled trial. Lancet 14;370(9582):143–152CrossRefGoogle Scholar
  12. 12.
    Cunningham D, Sirohi B, Pluzanska A et al (2009) Two different first-line 5-fluorouracil regimens with or without oxaliplatin in patients with metastatic colorectal cancer. Ann Oncol 20:244–250. Epub 2008 Oct 14CrossRefPubMedGoogle Scholar
  13. 13.
    Tournigand C, Andre T, Achille E et al (2004) FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol 22:229–237CrossRefPubMedGoogle Scholar
  14. 14.
    Van Cutsem E, Hoff PM, Harper P et al (2004) Oral capecitabine vs intravenous 5-fluorouracil and leucovorin: integrated efficacy data and novel analyses from two large, randomised, phase III trials. Br J Cancer 90:1190–1197CrossRefPubMedGoogle Scholar
  15. 15.
    Falcone A, Ricci S, Brunetti I et al (2007) Phase III trial of infusional fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) compared with infusional fluorouracil, leucovorin, and irinotecan (FOLFIRI) as first-line treatment for metastatic colorectal cancer: the Gruppo Oncologico Nord Ovest. J Clin Oncol 25:1670–1676CrossRefPubMedGoogle Scholar
  16. 16.
    Hurwitz H, Fehrenbacher L, Novotny W et al (2004) Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 350:2335–2342CrossRefPubMedGoogle Scholar
  17. 17.
    Van Cutsem E, Lang I, D’haens G et al (2008) KRAS status and efficacy in the first-line treatment of patients with metastatic colorectal cancer (mCRC) treated with FOLFIRI with or without cetuximab: the CRYSTAL experience. J Clin Oncol 26:5sCrossRefGoogle Scholar
  18. 18.
    Bokemeyer C, Bondarenko I, Hartmann JT et al (2008) KRAS status and efficacy of first-line treatment of patients with metastatic colorectal cancer (mCRC) with FOLFOX with or without cetuximab: the OPUS experience. J Clin Oncol 26:178sCrossRefGoogle Scholar
  19. 19.
    Douillard JY, Siena S, Cassidy J, et al (2010) Randomized, Phase III Trial of Panitumumab With Infusional Fluorouracil, Leucovorin, and Oxaliplatin (FOLFOX4) Versus FOLFOX4 Alone As First-Line Treatment in Patients With Previously Untreated Metastatic Colorectal Cancer: The PRIME Study. J Clin Oncol 4. [Epub ahead of print] PubMed PMID:20921465Google Scholar
  20. 20.
    Jonker DJ, O’Callaghan CJ, Karapetis CS et al (2007) Cetuximab for the treatment of colorectal cancer. N Engl J Med 357:2040–2048CrossRefPubMedGoogle Scholar
  21. 21.
    Peeters M, Price TJ, Cervantes A, et al (2010) Randomized Phase III Study of Panitumumab With Fluorouracil, Leucovorin, and Irinotecan (FOLFIRI) Compared With FOLFIRI Alone As Second-Line Treatment in Patients With Metastatic Colorectal Cancer. J Clin Oncol 4. [Epub ahead of print] PubMed PMID: 20921462.Google Scholar
  22. 22.
    Giantonio BJ, Catalano PJ, Meropol NJ et al (2007) Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: results from the Eastern Cooperative Oncology Group Study E3200. J Clin Oncol 25:1539–1544CrossRefPubMedGoogle Scholar
  23. 23.
    Kabbinavar FF, Schulz J, McCleod M et al (2005) Addition of bevacizumab to bolus fluorouracil and leucovorin in first-line metastatic colorectal cancer: results of a randomized phase II trial. J Clin Oncol 23:3697–3705CrossRefPubMedGoogle Scholar
  24. 24.
    Cunningham D, Humblet Y, Siena S et al (2004) Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. N Engl J Med 351:337–345CrossRefPubMedGoogle Scholar
  25. 25.
    Van Cutsem E, Peeters M, Siena S et al (2007) Open-label phase III trial of panitumumab plus best supportive care compared with best supportive care alone in patients with chemotherapy-refractory metastatic colorectal cancer. J Clin Oncol 25:1658–1664CrossRefPubMedGoogle Scholar
  26. 26.
    Esquivel J, Sticca R, Sugarbaker P et al (2007) Cytorreducive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Society of Surgical Oncology. Ann Surg Oncol 14:128–133Google Scholar

Copyright information

© Feseo 2010

Authors and Affiliations

  • Rocío García-Carbonero
    • 1
    • 2
  • M. Auxiliadora Gómez España
    • 3
  • Enrique Casado Sáenz
    • 4
  • Vicente Alonso Orduña
    • 5
  • Andrés Cervantes Ruipérez
    • 6
  • Javier Gallego Plazas
    • 7
  • Pilar García Alfonso
    • 8
  • Ignacio Juez Martel
    • 9
  • Encarnación González Flores
    • 10
  • María Lomas Garrido
    • 11
  • Dolores Isla Casado
    • 12
  1. 1.Oncology DepartmentHospital Universitario Virgen del Rocío Instituto de Biomedicina de Sevilla (IBIS)SevillaSpain
  2. 2.Servicio de Oncología MédicaHospital Universitario Virgen del RocíoSevillaSpain
  3. 3.Servicio de Oncología MédicaHospital Universitario Reina SofíaCórdobaSpain
  4. 4.Servicio de Oncología MédicaHospital Infanta Sofía San Sebastián de los ReyesMadridSpain
  5. 5.Servicio de Oncología MédicaHospital Universitario Miguel ServetZaragozaSpain
  6. 6.Servicio de Oncología MédicaHospital Clínico UniversitarioValenciaSpain
  7. 7.Servicio de Oncología MédicaHospital General Universitario de ElcheElche, AlicanteSpain
  8. 8.Servicio de Oncología MédicaHospital General U. Gregorio MarañónMadridSpain
  9. 9.Servicio de Oncología MédicaHospital de FuenlabradaFuenlabrada, MadridSpain
  10. 10.Servicio de Oncología MédicaHospital Universitario Virgen de las NievesGranadaSpain
  11. 11.Servicio de Oncología MédicaHospital Médico QuirúrgicoJaénSpain
  12. 12.Servicio de Oncología MédicaHospital Clínico Universitario Lozano BlesaZaragozaSpain

Personalised recommendations