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Emil Lou, Donna D'Souza and Andrew C. Nelson

carcinoembryonic antigen (CEA) biomarker while on combination chemotherapy (FOLFIRI with bevacizumab), bevacizumab was discontinued in favor of initiating an EGFR inhibitor (panitumumab) while continuing the FOLFIRI backbone. This alteration to her treatment

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Al B. Benson III, J. Pablo Arnoletti, Tanios Bekaii-Saab, Emily Chan, Yi-Jen Chen, Michael A. Choti, Harry S. Cooper, Raza A. Dilawari, Paul F. Engstrom, Peter C. Enzinger, James W. Fleshman Jr., Charles S. Fuchs, Jean L. Grem, James A. Knol, Lucille A. Leong, Edward Lin, Kilian Salerno May, Mary F. Mulcahy, Kate Murphy, Eric Rohren, David P. Ryan, Leonard Saltz, Sunil Sharma, David Shibata, John M. Skibber, William Small Jr., Constantinos T. Sofocleous, Alan P. Venook and Christopher Willett

bevacizumab, cetuximab, panitumumab, or irinotecan in adjuvant therapy for nonmetastatic disease outside the setting of a clinical trial. Adenocarcinomas of the small bowel or appendix, for which no NCCN Guidelines exist, may be treated with systemic

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Barbara Burtness, Milan Anadkat, Surendra Basti, Miranda Hughes, Mario E. Lacouture, Joan S. McClure, Patricia L. Myskowski, Jennifer Paul, Clifford S. Perlis, Leonard Saltz and Sharon Spencer

cetuximab in head and neck cancer . N Engl J Med 2008 ; 359 : 1116 – 1127 . 11 Van Cutsem E Peeters M Siena S . Open-label phase III trial of panitumumab plus best supportive care compared with best supportive care alone in patients with

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Zi-Xian Wang, Hao-Xiang Wu, Ming-Ming He, Ying-Nan Wang, Hui-Yan Luo, Pei-Rong Ding, Dan Xie, Gong Chen, Yu-Hong Li, Feng Wang and Rui-Hua Xu

efficacy of chemotherapy + cetuximab (Cet) or panitumumab (Pani) versus chemotherapy ± bevacizumab (Bev) reported significant improvement in overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) with chemotherapy + Cet

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Robin K. Kelley, Stephanie L. Van Bebber, Kathryn A. Phillips and Alan P. Venook

panitumumab, the 2 EGFR-targeted monoclonal antibodies approved for use in colorectal cancer. 35 – 61 The strength of this association was later substantiated in retrospective analyses of patients treated in 6 large randomized studies. 62 – 67 Search results

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Robin K. Kelley, Grace Wang and Alan P. Venook

EGFR-targeted therapy with cetuximab or panitumumab. 11 Patients whose tumors harbor certain mutations in the KRAS gene do not respond to cetuximab or panitumumab and should not be treated with either of these agents. 4 – 7 , 18 BRAF mutational

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Noman Ashraf, Nishi Kothari and Richard Kim

mutations, and how these data may impact clinical decision-making Identify established predictive markers for cetuximab and panitumumab Discuss the clinical implications of data regarding potential new biomarkers for anti-EGFR therapy Colorectal

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Kristen Keon Ciombor and Tanios Bekaii-Saab

cetuximab and panitumumab (Tables 2 and 3 ); or multiple tyrosine kinases, such as regorafenib, 13 , 14 have also improved the efficacy of mCRC treatment in selected patients, both in combination with cytotoxic chemotherapy and as single agents in some

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Doreen A. Ezeife, Sunil Parimi, Ellen R. Cusano, Matthew K. Smith, Tony H. Truong, Soundouss Raissouni, Yongtao Lin, Jose G. Monzon, Haocheng Li, Vincent C. Tam and Patricia A. Tang

panitumumab to combination chemotherapy yielded a 4-month OS improvement in the PRIME clinical trial. 5 However, this targeted therapy costs approximately $6,300 USD per month and is accompanied by cutaneous and other side effects. Value is a dynamic concept

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Paul F. Engstrom

I am pleased to work with the editor-in-chief of JNCCN, Hal Burstein, MD, PhD, in organizing this issue of the journal dedicated to colon and rectum cancer management, and I appreciate the opportunity to note some of the updates to the field in the past year. In 2009, the NCCN Clinical Practice Guidelines in Oncology were expanded to include a survivorship component. Long-term follow-up care of colorectal cancer survivors should include management of late complications and encouraging patients to modify their lifestyle through improved exercise and diet. Another major change in the guidelines represented the determination of tumor KRAS gene status before starting treatment with an epidermal growth factor receptor (EGFR) inhibitor, such as cetuximab or panitumumab. Data included in the guidelines show that patients whose tumor expresses KRAS mutation have little or no likelihood of responding to the EGFR inhibitors. The edition of the guidelines published in this issue also emphasizes the use of systemic combination chemotherapy such as FOLFOX or FOLFIRI with or without bevacizumab in the attempt to reduce the size of colorectal metastasis as well as the primary tumor and to allow patients with initially unresectable disease to be candidates for resection. These changes in the guidelines are reflected and expanded in the authored manuscripts. For example, Denlinger and Barsevick review the literature on colorectal cancer survivorship. They note clear evidence that quality of life is diminished when treatment-related symptoms, such as fatigue, distress, and sleep difficulties) plague colorectal cancer survivors. The long-term effects of treatment,...