Treatment

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Document Overview

Design and created by Guideline Central in participation with the American Society of Clinical Oncology.

Treatment of Metastatic Colorectal Cancer

American Society of Clinical Oncology

Publication Date: Oct 16, 2022

Page Last Updated: May 5, 2026

Grading Table

Recommendation Grading

Type		Benefit/harm		Evidence Quality		Strength of Recommendation
EB	Evidence-based	B	Benefits outweigh harms	H	High	Strong
CB/ FC	Consensus-based/ Formal Consensus	H	Harms outweigh benefits	M	Moderate	Moderate
IC	Informal consensus	B / H	Relative balance of benefits and harms	I	Intermediate	Weak
		U	Benefits/harms ratio uncertain	L	Low
				VL	Very Low
				Ins	Insufficient

Recommendation Rating Definitions

Quality of Evidence

Term	Definitions
H = High	We are very confident that the true effect lies close to that of the estimate of the effect
M = Moderate	We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
L = Low	Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
VL = Very low	We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

Strength of Recommendation

Term	Definitions
S = Strong	In recommendations for an intervention, the desirable effects of an intervention outweigh its undesirable effects. In recommendations against an intervention, the undesirable effects of an intervention outweigh its desirable effects. All or almost all informed people would make the recommended choice for or against an intervention.
C = Conditional/ W = Weak	In recommendations for an intervention, the desirable effects probably outweigh the undesirable effects, but appreciable uncertainty exists. In recommendations against an intervention, the undesirable effects probably outweigh the desirable effects, but appreciable uncertainty exists. Most informed people would choose the recommended course of action, but a substantial number would not.

Brozek JL, Akl EA, Compalati E, et al: Grading quality of evidence and strength of recommendations in clinical practice guidelines part 3 of 3. The GRADE approach to developing recommendations. Allergy 66:588-95, 2011

Document Overview

Document Title: Treatment of Metastatic Colorectal Cancer

Authoring Society: American Society of Clinical Oncology

Document Publication Date: Oct 16, 2022

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: ascopubs.org/doi/full/10.1200/JCO.22.01690

Source Citation: Morris VK, Kennedy EB, Baxter NN, et al. Treatment of metastatic colorectal cancer: ASCO guideline. J Clin Oncol. 2022 Oct 17. doi: 10.1200/JCO.22.01690

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: To develop recommendations for treatment of patients with metastatic colorectal cancer (mCRC).

Scope: Treatment

Diseases/Conditions (MeSH)

D015179 - Colorectal Neoplasms

D009362 - Neoplasm Metastasis

D003110 - Colonic Neoplasms

Keywords: Anti-EGFR therapy, BRAF V600E-mutant, Encorafenib, FOLFIRI, FOLFOX, FOLFOXIRI, Stereotactic body radiation therapy, Targeted Therapy, cetuximab, chemotherapy, colorectal cancer, colorectal peritoneal metastases, cyotoxic chemotherapy, cytoreductive surgery, deficient mismatch repair, fluorouracil, folinic acid, hyperthermic intraperitoneal chemotherapy, immunotherapy, irinotecan, liver metastases, mCRC, metastases, microsatellite instability-high, microsatellite stable, oxaliplatin, pembrolizumab, proficient DNA mismatch repair

Target Patient Population: patients with metastatic colorectal cancer

Target Provider Population: Medical oncologists and other health care professionals who treat patients with metastatic colorectal cancer

Inclusion Criteria: Male, Female, Adult, Older Adult

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant, Radiology Technologist

Recommendation Development Processes & Methodology

PICO Questions

For patients with previously untreated, initially unresectable mCRC who are candidates for chemotherapy plus bevacizumab, is doublet (folinic acid, FU, and oxaliplatin [FOLFOX], or folinic acid, FU, and irinotecan [FOLFIRI]) or triplet (folinic acid, FU, oxaliplatin, and irinotecan [FOLFOXIRI]) cytotoxic chemotherapy recommended?
In the first-line setting, are outcomes for patients with microsatellite instability-high (MSI-H) or deficient mismatch repair (dMMR) mCRC improved with pembrolizumab immunotherapy versus chemotherapy with or without bevacizumab or cetuximab?
Is pembrolizumab recommended as later-line therapy for patients with microsatellite stable (MSS) or proficient mismatch repair (pMMR) mCRC and high tumor mutational burden (TMB ≥ 10 mutations/Mb)?
For patients with treatment-naive RAS wild-type mCRC, are anti–epidermal growth factor receptor (EGFR) antibodies (ie, panitumumab and cetuximab) recommended for patients with right-sided or left-sided primary tumors?
For patients with previously treated BRAF V600E–mutant mCRC, does treatment with encorafenib plus cetuximab result in better outcomes compared with chemotherapy plus targeted therapy?
For patients with colorectal peritoneal metastases, are outcomes improved with cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) plus chemotherapy, compared with chemotherapy alone?
For patients with unresectable liver-limited mCRC, are liver-directed therapies stereotactic body radiation therapy (SBRT) and selective internal radiation therapy (SIRT) recommended?
For patients with mCRC and potentially curable oligometastatic liver metastases, is perioperative chemotherapy recommended?

Supplemental Methodology Resources: Data Supplement Summary of Recommendations Table Methodology Manual

Number of Source Documents: 96

Literature Search End Date: Sunday, June 19, 2022

Includes peer/external review process?: Yes

Includes public comment process?: Yes

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: No

Treatment of Metastatic Colorectal Cancer

Treatment

Recommendation 1.1

Recommendation 1.2

Recommendation 2.1

Recommendation 3.1

Recommendation 4.1

Recommendation 5.1

Recommendation 5.2

Recommendation 6.1

Recommendation 6.2

Recommendation 7.1

Video

Grading Table

Recommendation Grading

Recommendation Rating Definitions

Quality of Evidence

Strength of Recommendation

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology