Interpretation of Updated NCCN Guidelines for Colon Cancer and Rectal Cancer （Version 1.2019）

doi:10.12114/j.issn.1007-9572.2019.00.655

Abstract

Abstract: Compared with NCCN Guidelines for Colon Cancer and Rectal Cancer （Version 4.2018），the NCCN Guidelines for Colon Cancer and Rectal Cancer （Version 1.2019） have made some significant updates that can change clinical practice.This paper analyses and interprets the most important updates in the NCCN Guidelines for Colon Cancer and Rectal Cancer （Version 1.2019），which mainly include：（1） BRAF WT was added as an indication for treatment，where KRAS and NRAS WT are noted；（2） Microsatellite Instability （MSI） or Mismatch Repair （MMR） Testing was modified and supplemented：BRAF V600E mutation and the diagnosis of Lynch syndrome，the result and meaning of immunohistochemistry；（3）The following regimens were added as treatment options in subsequent therapy：dabrafenib + trametinib + （cetuximab or panitumumab），encorafenib + binimetinib + （cetuximab or panitumumab）.The purpose of this article was to provide a reference for clinical selection of diagnosis and treatment options of colorectal cancer.

Key words: Colorectal neoplasms, Guidebooks, National Comprehensive Cancer Network, BRAF gene, Lynch syndrome

摘要： 2019.V1版《NCCN结直肠癌诊治指南》与2018.V4版《NCCN结直肠癌诊治指南》相比，其做出了一些能改变临床实践的更新。本文就2019.V1版《NCCN结直肠癌诊治指南》中最为重要的几个更新要点进行了分析与解读，主要包括：（1）新增“BRAF基因”作为指导治疗的一个指标；在所有标记“KRAS野生型和NRAS野生型”作为指征的地方，同时需标记“BRAF野生型”；（2）“微卫星不稳定性（MSI）和错配修复基因（MMR）检测”章节中对“BRFA基因V600E突变与林奇综合征相关性的内容”做了修改和补充，并且说明了免疫组化检查的结果及其含义；（3）新增了2个针对BRAF基因V600E突变患者的后续治疗方案：达拉非尼+曲美替尼+（西妥昔单抗或帕尼单抗）和康奈非尼+比美替尼+（西妥昔单抗或帕尼单抗）。本文旨在为临床诊断、治疗结直肠癌的策略选择提供参考。

关键词: 结直肠肿瘤, 指南, 美国国家综合癌症网络, BRAF基因, 林奇综合征

BAI Xueshan,LIN Guole. Interpretation of Updated NCCN Guidelines for Colon Cancer and Rectal Cancer （Version 1.2019）　[J]. Chinese General Practice, 2019, 22(33): 4031-4034. DOI: 10.12114/j.issn.1007-9572.2019.00.655.
白雪杉,林国乐. 2019.V1版《NCCN结直肠癌诊治指南》更新要点解析[J]. 中国全科医学, 2019, 22(33): 4031-4034. DOI: 10.12114/j.issn.1007-9572.2019.00.655.

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