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Cytoreduction (shrinkage)
MOLECULAR PROFILE
Adaptado de Van Cutsem. ESMO guideline. Annals of Oncology 0: 1–37, 2016.
CLINICAL CONDITION OF THE PATIENT
Unfit (but may be suitable)
Fit
Unfit
FP ± bevacizumab;
reduced dose doublet;
anti-EGFR
BSC
GOAL
MT
BRAF
MT
RAS
WT
RAS
Triplet +
bevacizumab
Combination +
bevacizumab
Doublet +
anti-EGFR
NED
Clearly
resectable
metastases
Surgery alone;
surgery with
perioperative/
postoperative
CT
Re-evaluation/assessment of response Q2M
GOAL
Cytoreduction (shrinkage)
Continue
Progressive
disease
Disease control
Continue;
maintenance;
or pause
Second-line
Surgery
Disease control (control progression)
MOLECULAR PROFILE
MT
BRAF
MT
RAS
WT
RAS
Unusual,
see text
CT +
bevacizumab
CT + biological
agent
Re-evaluation/assessment of response Q2−3M
Continue;
maintenance;
or pause
Progressive
disease
Second-line
LOCALIZACIÓN
Selección de tratamiento en CCRm
SECUENCIA
TERAPÉUTICA