First-Line Treatment of Metastatic Colon Cancer with pMMR/MSS Status and KRAS, NRAS, BRAF Wild-Type Profile
This protocol applies to metastatic colon adenocarcinoma where the tumor is proficient mismatch repair (pMMR) and microsatellite stable (MSS), with no activating mutations detected in KRAS, NRAS, or BRAF. This specific molecular profile determines which combination treatment strategies are appropriate at initial therapy.
Clinical Scenario
Metastatic colon adenocarcinoma with the following confirmed biomarker status:
pMMR
MSS
KRAS wild-type
NRAS wild-type
BRAF wild-type
Treatment Approach (Partial Overview)
Initial systemic therapy involves combination chemotherapy regimens, with certain options incorporating targeted agents — including choices specific to patients with left-sided primary tumors. The complete regimen options, selection criteria, and sequencing guidance are in the full protocol.
References
- pMMR/MSS
- KRAS WT/NRAS WT/BRAF WT
- CAPEOX (Capecitabine/Oxaliplatin) ± Bevacizumab
- CAPEOX + (Cetuximab or Panitumumab) (left-sided tumors only)
- FOLFIRI (Leucovorin/Fluorouracil/Irinotecan) ± Bevacizumab
- FOLFIRI + (Cetuximab or Panitumumab) (left-sided tumors only)
- FOLFIRINOX (Leucovorin/Fluorouracil/Irinotecan/Oxaliplatin) ± Bevacizumab
- FOLFOX (Leucovorin/Fluorouracil/Oxaliplatin) ± Bevacizumab
- FOLFOX + (Cetuximab or Panitumumab) (left-sided tumors only)
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