Treatment of Metastatic Colon Cancer: pMMR/MSS, KRAS Wild-Type, NRAS Wild-Type, BRAF Wild-Type
Clinical Scenario
This protocol addresses patients with proficient mismatch repair (pMMR) / microsatellite stable (MSS) metastatic colon adenocarcinoma confirmed negative for KRAS, NRAS, and BRAF mutations. All three markers must be wild-type to define this molecular subgroup and determine the eligible treatment pathway.
Molecular Profile
pMMR/MSS status combined with KRAS wild-type, NRAS wild-type, and BRAF wild-type identifies a distinct subset of metastatic colon adenocarcinoma. This combination of negative biomarkers is required for the treatment strategy described in this protocol.
Treatment Approach (Partial Overview)
Subsequent-line management in this setting involves chemotherapy backbone combinations paired with targeted agents — with the specific regimen determined by what therapy was used previously. The complete selection criteria, options, and sequencing are in the full protocol.
References
- pMMR/MSS
- KRAS WT/NRAS WT/BRAF WT
- FOLFIRI + (Cetuximab or Panitumumab)
- FOLFIRI ± (Bevacizumab [preferred] or Ziv-aflibercept or Ramucirumab)
- Irinotecan + (Cetuximab or Panitumumab)
- Irinotecan ± (Bevacizumab [preferred] or Ziv-aflibercept or Ramucirumab)
- CAPEOX ± Bevacizumab
- CAPEOX + (Cetuximab or Panitumumab)
- FOLFOX ± Bevacizumab
- FOLFOX + (Cetuximab or Panitumumab)
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