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. 2019 Feb;31(1):117–134. doi: 10.21147/j.issn.1000-9604.2019.01.07

8.

First-line regimens for palliative therapy

Stratification Class I recommendation Class II recommendation Class III recommendation
a, Recently, many retrospective studies have shown that the prognosis of metastatic colon cancer with right-sided primary lesions (ileocecal junction to splenic flexure) is worse than that of left-sided primary lesions (splenic flexure to the rectum). Retrospective subgroup analysis data of randomized, controlled trials showed that the objective response rate and overall survival of cetuximab are both better than that of bevacizumab for patients with left-sided colorectal cancer. For patients with right-sided colon cancer, cetuximab shows minor advantages over bevacizumab in objective response rate but overall survival is worse than that of bevacizumab (1).
b, Capecitabine combined with cetuximab is not recommended.
Suitable for intensive treatment (both RAS and BRAF wild-type) FOLFOX/FOLFIRI ± cetuximaba,b (Level 1A evidence); FOLFOX/CapeOx/FOLFIRI ± bevacizumab (Level 1A evidence) FOLFOXIRI ± bevacizumab (Level 2A evidence) Hepatic arterial infusion chemotherapy or other local treatments (Level 3 evidence)
Not suitable for intensive treatment (both RAS and BRAF wild-type) Fluorouracil monotherapy ± bevacizumab (Level 1A evidence) Cetuximab monotherapya,b (Level 2A evidence);
Dose-reduced dual chemotherapy (FOLFOX/FOLFIRI) ± cetuximab (Level 2A evidence);
Dose-reduced dual chemotherapy (FOLFOX/CapeOx/FOLFIRI) ± bevacizumab (Level 2A evidence) 		Hepatic arterial infusion chemotherapy or other local treatments (Level 3 evidence)
Suitable for intensive treatment (both RAS or BRAF mutations) FOLFOX/CapeOx/FOLFIRI ± bevacizumab (Level 1A evidence) FOLFOXIRI ± bevacizumab (Level 2A evidence) Hepatic arterial infusion chemotherapy or other local treatments (Level 3 evidence)
Not suitable for intensive treatment (both RAS or BRAF mutations) Fluorouracil monotherapy ± bevacizumab (Level 1A evidence) Dose-reduced dual chemotherapy (FOLFOX/CapeOx/FOLFIRI) ± bevacizumab (Level 2A evidence) Hepatic arterial infusion chemotherapy or other local treatments (Level 3 evidence)