title: Adaptation of international guidelines for metastatic colorectal cancer: an asian consensus.
abstract: Colorectal cancer (CRC) is among the most common cancers worldwide, but marked epidemiological differences exist between Asian and non-Asian populations. Hence, a consensus meeting was held in Hong Kong in December 2012 to develop Asia-specific guidelines for the management of metastatic CRC (mCRC). A multidisciplinary expert panel, consisting of 23 participants from 10 Asian and 2 European countries, discussed current guidelines for colon or rectal cancer and developed recommendations for adapting these guidelines to Asian clinical practice. Participants agreed that mCRC management in Asia largely follows international guidelines, but they proposed a number of recommendations based on regional 'real-world' experience. In general, participants agreed that 5-fluorouracil (5-FU) infusion regimens in doublets can be substituted with UFT (capecitabine, tegafur-uracil) and S1 (tegafur, 5-chloro-2,4-dihydroxypyridine and oxonic acid), and that the monoclonal antibodies cetuximab and panitumumab are recommended for KRAS wild type tumors. For KRAS mutant tumors, bevacizumab is the preferred biological therapy. FOLFOX (folinic acid, 5-FU, and oxaliplatin) is preferred for initial therapy in Asian patients. The management of mCRC is evolving, and it must be emphasized that the recommendations presented here reflect current treatment practices and thus might change as more data become available.
authors.affiliation: Departments of Oncology and Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Ann-Lii
authors.initials: AL
authors.lastname: Cheng
authors.affiliation: Department of Medical Oncology, Fudan University Cancer Hospital, and Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Li
authors.affiliation: Medical Oncology and Haematology, Medanta Cancer institute, Gurgaon, India.
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Vaid
authors.affiliation: Sir Y.K. Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Brigette Buig Yue
authors.initials: BB
authors.lastname: Ma
authors.affiliation: Liver Care Center, Makati Medical Center, Manila, Philippines.
authors.forename: Catherine
authors.initials: C
authors.lastname: Teh
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Joong B
authors.initials: JB
authors.lastname: Ahn
authors.affiliation: Cancer Institute, St Luke's Medical Center, Quezon City, Philippines.
authors.forename: Maximino
authors.initials: M
authors.lastname: Bello
authors.affiliation: Chiang Mai University, Maharaj Nakorn Chiang Mai Hospital, Medical Oncology Unit, Department of Medicine, Faculty of Medicine, Maung Chiang Mai district, Thailand.
authors.forename: Chaiyut
authors.initials: C
authors.lastname: Charoentum
authors.affiliation: National Institute of Cancer Research, National Health Research Institutes, Tainan, and Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Li-Tzong
authors.initials: LT
authors.lastname: Chen
authors.affiliation: HCor Onco, São Paulo, and Oncoclinicas do Brasil, Belo Horizonte, Minas Gerais, Brazil, and Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Gilberto
authors.initials: G
authors.lastname: de Lima Lopes
authors.affiliation: Faculty of Medicine University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Gwo F
authors.initials: GF
authors.lastname: Ho
authors.affiliation: H.L. Kong Medical Oncology Centre Pte Ltd, The Paragon Medical, Singapore.
authors.forename: Hwai L
authors.initials: HL
authors.lastname: Kong
authors.affiliation: Department of Clinical Oncology, L.K.S. Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors.forename: Ka O
authors.initials: KO
authors.lastname: Lam
authors.affiliation: Department of Medical Oncology, Zhong Shan Hospital, Fu Dan University, Shanghai, China.
authors.forename: Tian S
authors.initials: TS
authors.lastname: Liu
authors.affiliation: Division of Hematology/Oncology, Samsung Medical Center, Seoul, South Korea.
authors.forename: Young S
authors.initials: YS
authors.lastname: Park
authors.affiliation: Medical Oncology Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University and The King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Virote
authors.initials: V
authors.lastname: Sriuranpong
authors.affiliation: Division of Hematology-Medical Oncology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
authors.forename: Aru W
authors.initials: AW
authors.lastname: Sudoyo
authors.affiliation: Division of Gastrointestinal and General Surgery and Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan R.O.C.
authors.forename: Jaw-Yuan
authors.initials: JY
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Rui Jin Hospital, Shanghai Jiaotong University Medical School, Shanghai, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Cancer Institute Zhejiang University, Zhejiang, China.
authors.forename: Su Z
authors.initials: SZ
authors.lastname: Zhang
authors.affiliation: Oncologia Medica, Dipartimento Medico-Chirurgico di Internistica Clinica e Sperimentale "F. Magrassi e A. Lanzara," Seconda Università degli Studi di Napoli, Napoli, Italy.
authors.forename: Fortunato
authors.initials: F
authors.lastname: Ciardiello
authors.affiliation: Onkologischen Zentrum am Klinikum Oldenburg, Oldenburg, Germany.
authors.forename: Clause-Henning
authors.initials: CH
authors.lastname: Köhne
authors.affiliation: MScript Ltd, East Sussex, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Shaw
authors.affiliation: Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. Electronic address: twkimmd@amc.seoul.kr.
authors.forename: Tae Won
authors.initials: TW
authors.lastname: Kim
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001208:Asia; D000068258:Bevacizumab; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D000069287:Capecitabine; D000068818:Cetuximab; D003110:Colonic Neoplasms / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D004338:Drug Combinations; D066246:ErbB Receptors / Q000037:antagonists & inhibitors; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D019983:Guideline Adherence; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000235:genetics / Q000556:secondary / Q000628:therapy*; D008175:Lung Neoplasms / Q000235:genetics / Q000556:secondary / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D059146:Metastasectomy; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D010071:Oxaloacetates; D010094:Oxonic Acid / Q000008:administration & dosage; D000077544:Panitumumab; D017410:Practice Guidelines as Topic; D011518:Proto-Oncogene Proteins / Q000235:genetics; D016283:Proto-Oncogene Proteins p21(ras); D012004:Rectal Neoplasms / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D005641:Tegafur / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed; D018631:ras Proteins / Q000235:genetics
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D004338:Drug Combinations; C117307:KRAS protein, human; D009944:Organoplatinum Compounds; D010071:Oxaloacetates; D011518:Proto-Oncogene Proteins; D003841:Deoxycytidine; C079198:S 1 (combination); D005641:Tegafur; D000068258:Bevacizumab; D010094:Oxonic Acid; D000069287:Capecitabine; D000077544:Panitumumab; D066246:ErbB Receptors; D016283:Proto-Oncogene Proteins p21(ras); D018631:ras Proteins; D000068818:Cetuximab; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin
keywords: Asia; Chemotherapy; Epidermal growth factor receptor (EGFR)-specific monoclonal antibody; KRAS; Targeted therapy