Differences in Metastatic Colorectal Cancer Treatment Guidelines Between China and United States
Colorectal cancer is the fourth most common cancer in China. As more individuals in China adopt Westernized diets and sedentary lifestyles, they are put at higher risk for developing colon cancer. Therefore, it is important to increase early-screening and learn more about effective colorectal cancer treatment (Chin J Cancer Res, 2019). This article will focus on metastatic colorectal cancer and speak to how the treatment guidelines differ between China and the United States.
The National Comprehensive Cancer Network (NCCN) publishes guidelines for the United States and the guidelines used in China are published by Chinese Society of Clinical Oncology (CSCO). To determine the treatment plan in metastatic colorectal cancer, biomarker testing is recommended to identify mutations present in the cancer. Both guidelines recommend testing microsatellite instability high/deficient mismatch repair (MSI-H/dMMR), KRAS/NRAS and BRAF genes (NCCN, 2020; CSCO, 2020). Besides mutations detected in colorectal cancer, the location of the cancer is important to the treatment decision as well. For instance, it is found that chemotherapy with cetuximab (Erbitux) has improved the overall survival more significantly than bevacizumab (Avastin) in left-sided colorectal cancer. However, in right-sided colorectal cancer, bevacizumab has better survival outcomes (JAMA Oncol, 2017).
Both U.S. NCCN and China CSCO guidelines recommend chemotherapy with or without a targeted therapy as the first choice. The preferred chemotherapy regimens include: CAPEOX (capecitabine plus oxaliplatin), FOLFOX (leucovorin, fluorouracil plus oxaliplatin), and FOLFIRI (leucovorin, fluorouracil plus irinotecan). FOLFOX/FOLFIRI with or without cetuximab is recommended in both countries to treat left-sided colorectal cancer patients with no KRAS/NRAS mutation, and CAPEOX/FOLFOX/FOLFIRI with or without bevacizumab in all patients (NCCN, 2020; CSCO, 2020). Another targeted therapy recommended in the United States as the first line in left-sided colorectal cancer is panitumumab (Vectibix) (NCCN, 2020). This drug has not been approved in China as of September 2020 (National Medical Products Administration, 2020).
Immunotherapy is recommended in patients with dMMR/MSI-H colorectal cancer. Options recommended by U.S.NCCN guidelines include Opdivo® (nivolumab), Keytruda® (pembrolizumab), and Yervoy® (ipilimumab) (NCCN, 2020). Both Opdivo® and Keytruda® have been on the market in China since 2018. As of September 2020, Yervoy® has yet to be approved in China (National Medical Products Administration, 2020). In Chinese CSCO guidelines, immunotherapy is listed as a possible consideration for metastatic dMMR/MSI-H colorectal cancer according to the patient's willingness and severity of cancer. However, no specific immunotherapy drug options were mentioned in CSCO guidelines (CSCO, 2020).
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