Interpretation of Updated NCCN Clinical Guidelines for Rectal Cancer (2024.V1/V2)

doi:10.12114/j.issn.1007-9572.2024.0323

Abstract

Abstract:

The incidence of colorectal cancer ranks second among cancers in China and colorectal cancer is also one of the most common malignant tumors in the digestive system. With the development of medical research and technology, the diagnostic and therapeutic strategies of colorectal cancer are continuously evolving. The National Comprehensive Cancer Network (NCCN) is closely following the forefront and released the 2024 V1/V2 versions of the NCCN Clinical Practice Guidelines for Rectal Cancer on January 29 and April 4, 2024 respectively. The two revisions of the guidelines mainly focus on the latest research progress in molecular detection, immunotherapy, targeted therapy, neoadjuvant therapy and disease surveillance. This article analyzed the key updates of the 2024 V1/V2 NCCN guidelines, aiming to provide a more accurate reference for clinical rectal cancer diagnosis and treatment practice.

Key words: Rectal neoplasms, Mutation testing, Treatment strategy, Surveillance, NCCN, Guidelines interpretation

摘要：

结直肠癌是消化系统中常见的恶性肿瘤之一，其发病率位居中国癌症发病率第二位。随着医学研究的深入和科技的进步，其诊疗策略也在不断演化。美国国家综合癌症网络（NCCN）紧跟科研前沿，分别于2024-01-29和2024-04-04发布了2024年V1/V2版《NCCN直肠癌临床实践指南》，这两次修订主要聚焦于分子学检测、免疫治疗、靶向治疗、新辅助治疗及疾病监测等方面的最新进展。本文通过分析2024年V1/V2版NCCN指南的更新要点，旨在为临床直肠癌的诊断与治疗实践提供更精确的参考依据。

关键词: 直肠肿瘤, 基因突变检测, 治疗策略, 监测, 美国国家综合癌症网络, 指南解读

CLC Number:

R 735.37

CAO Qinhan,ZHUO Xiao,XIA Yuhan, et al. Interpretation of Updated NCCN Clinical Guidelines for Rectal Cancer (2024.V1/V2)[J]. Chinese General Practice, 2025, 28(17): 2070-2074. DOI: 10.12114/j.issn.1007-9572.2024.0323.
曹沁涵,卓肖,夏雨菡等. 2024年V1/V2版《NCCN直肠癌临床实践指南》更新要点解读[J]. 中国全科医学, 2025, 28(17): 2070-2074. DOI: 10.12114/j.issn.1007-9572.2024.0323.

Figures/Tables 2

References 20

[1]	郑荣寿，陈茹，韩冰峰，等. 2022年中国恶性肿瘤流行情况分析[J]. 中华肿瘤杂志，2024，46(3)：221-231. DOI：10.3760/cma.j.cn112152-20240119-00035.
[2]	LI N, LU B, LUO C Y, et al. Incidence，mortality，survival，risk factor and screening of colorectal cancer：a comparison among China，Europe，and northern America[J]. Cancer Lett，2021，522：255-268. DOI：10.1016/j.canlet.2021.09.034.
[3]	KAYSER S, LEVIS M J. Updates on targeted therapies for acute myeloid leukaemia[J]. Br J Haematol，2022，196(2)：316-328. DOI：10.1111/bjh.17746.
[4]	MUR P, GARCÍA-MULERO S, DEL VALLE J, et al. Role of POLE and POLD1 in familial cancer[J]. Genet Med，2020，22(12)：2089-2100. DOI：10.1038/s41436-020-0922-2.
[5]	YANG C J, ZHAO L, LIN Y L, et al. Biomarkers for immune checkpoint inhibitors in colorectal cancer：recent advances and future perspectives[J]. Cancer Biol Med，2023，20(9)：633-639. DOI：10.20892/j.issn.2095-3941.2023.0201.
[6]	FENIZIA F, WOLSTENHOLME N, FAIRLEY J A, et al. Tumor mutation burden testing：a survey of the International Quality Network for Pathology（IQN Path）[J]. Virchows Arch，2021，479(6)：1067-1072. DOI：10.1007/s00428-021-03093-7.
[7]	MUR P, VIANA-ERRASTI J, GARCÍA-MULERO S, et al. Recommendations for the classification of germline variants in the exonuclease domain of POLE and POLD1[J]. Genome Med，2023，15(1)：85. DOI：10.1186/s13073-023-01234-y.
[8]	LI F R, LIN Y P, LI R, et al. Molecular targeted therapy for metastatic colorectal cancer：current and evolving approaches[J]. Front Pharmacol，2023，14：1165666. DOI：10.3389/fphar.2023.1165666.
[9]	O'SULLIVAN N J, TEMPERLEY H C, KYLE E T, et al. Assessing circulating tumour DNA（ctDNA）as a prognostic biomarker in locally advanced rectal cancer：a systematic review and meta-analysis[J]. Int J Colorectal Dis，2024，39(1)：82. DOI：10.1007/s00384-024-04656-1.
[10]	KIM M, BAREKET R, ELEFTHERIADIS N P, et al. Endoscopic submucosal dissection（ESD）offers a safer and more cost-effective alternative to transanal endoscopic microsurgery（TEM）：an international collaborative study[J]. J Clin Gastroenterol，2023，57(5)：486-489. DOI：10.1097/MCG.0000000000001708.
[11]	National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology：rectal cancer. Version 2.2024[EB/OL].[2024-07-01].
[12]	TAN L, TRAN B, TIE J, et al. A phase ib/Ⅱ trial of combined BRAF and EGFR inhibition in BRAF V600E positive metastatic colorectal cancer and other cancers：the EVICT（erlotinib and vemurafenib in combination trial）study[J]. Clin Cancer Res，2023，29(6)：1017-1030. DOI：10.1158/1078-0432.CCR-22-3094.
[13]	YOSHINO T, DI BARTOLOMEO M, RAGHAV K, et al. Final results of DESTINY-CRC01 investigating trastuzumab deruxtecan in patients with HER2-expressing metastatic colorectal cancer[J]. Nat Commun，2023，14(1)：3332. DOI：10.1038/s41467-023-38032-4.
[14]	VALTORTA E, MARTINO C, SARTORE-BIANCHI A, et al. Assessment of a HER2 scoring system for colorectal cancer：results from a validation study[J]. Mod Pathol，2015，28(11)：1481-1491. DOI：10.1038/modpathol.2015.98.
[15]	GUARINI C, GRASSI T, PEZZICOLI G, et al. Beyond RAS and BRAF：HER2，a new actionable oncotarget in advanced colorectal cancer[J]. Int J Mol Sci，2021，22(13)：6813. DOI：10.3390/ijms22136813.
[16]	SUWAIDAN A A, LAU D K, CHAU I. HER2 targeted therapy in colorectal cancer：new horizons[J]. Cancer Treat Rev，2022，105：102363. DOI：10.1016/j.ctrv.2022.102363.
[17]	WU Y H, ZHUANG J, QU Z B, et al. Advances in immunotyping of colorectal cancer[J]. Front Immunol，2023，14：1259461. DOI：10.3389/fimmu.2023.1259461.
[18]	ANDRÉ T, SHIU K K, KIM T W, et al. Pembrolizumab in microsatellite-instability-high advanced colorectal cancer[J]. N Engl J Med，2020，383(23)：2207-2218. DOI：10.1056/NEJMoa2017699.
[19]	VAIL E, CHOUBEY A P, ALEXANDER H R, et al. Recurrence-free survival dynamics following adjuvant chemotherapy for resected colorectal cancer：a systematic review of randomized controlled trials[J]. Cancer Med，2024，13(1)：e6884. DOI：10.1002/cam4.6884.
[20]	RANASINGHE R, MATHAI M, ZULLI A. A synopsis of modern - day colorectal cancer：where we stand[J]. Biochim Biophys Acta Rev Cancer，2022，1877(2)：188699. DOI：10.1016/j.bbcan.2022.188699.

分子标志物	治疗方案
HER2扩增、RAS/BRAF野生型	曲妥珠单抗+帕妥珠单抗/拉帕替尼/图卡替尼
HER2扩增（IHC3+）	德曲妥珠单抗
BRAF V600E突变阳性	恩可拉非尼+（西妥昔单抗/帕尼单抗）
KRAS G12突变阳性	（索托拉西布/阿达格拉西布）+（西妥昔单抗/帕尼单抗）
NTRK基因融合阳性	恩曲替尼/拉罗替尼
RET基因融合阳性	塞尔帕替尼

分子标志物	治疗方案
HER2扩增、RAS/BRAF野生型	曲妥珠单抗+帕妥珠单抗/拉帕替尼/图卡替尼
HER2扩增（IHC3+）	德曲妥珠单抗
BRAF V600E突变阳性	恩可拉非尼+（西妥昔单抗/帕尼单抗）
KRAS G12突变阳性	（索托拉西布/阿达格拉西布）+（西妥昔单抗/帕尼单抗）
NTRK基因融合阳性	恩曲替尼/拉罗替尼
RET基因融合阳性	塞尔帕替尼