Fit for treatment Confirmed mCRC Request RAS Yes Liver only disease?

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Presentation transcript:

Exeter and Torbay Algorithm for systemic treatment of metastatic Colorectal Cancer March 2015 Fit for treatment Confirmed mCRC Request RAS Yes Liver only disease? Neo-adjuvant treatment (NICE TA176) RAS status Wild-type Mutant Fit for Irinotecan? Fit for Irinotecan? Yes No Yes No 1st Irinotecan + FP + Cetuximab Capecitabine Irinotecan + FP Capecitabine 2nd Oxaliplatin + FP + Bevacizumab Oxaliplatin + FP + Bevacizumab Oxaliplatin + FP + Bevacizumab Oxaliplatin + FP + Bevacizumab 3rd Mitomycin + FP Cetuximab or Panitumumab Mitomycin + FP ?Irinotecan + FP if fit