Colorectal Cancer

Regimen Options

Last Updated: 10/03/2025 See Details

NOTE: FOR BEVACIZUMAB, THE USE OF A BIOSIMILAR OR THE REFERENCE PRODUCT IS ON PATHWAY

	Evolent Pathways	Febrile Neutropenic Risk	Emetogenic Risk	References
EARLY STAGE II - III
Neoadjuvant Chemoradiation (for rectal only)	5FU (fluorouracil) with Radiation	Low	Low	NCCN Guidelines® for Rectal Cancer. V.3.2017. Tepper JE, et al. J Clin Oncol. 2002;20(7):1744-50.
	capecitabine with Radiation	Low	Low	NCCN Guidelines® for Rectal Cancer. V.3.2017. Twelves C, et al. N Engl J Med. 2005;352(26):2696-704. Van Cutsem E, t al. J Clin Oncol. 2001;19(21):4097-106.
Adjuvant	5FU (fluorouracil) and leucovorin	Low	Low	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Haller DG, et al. J Clin Oncol. 2005;23(34):8671-8. Petrelli N, et al. J Clin Oncol. 1987;5(10):1559-65. Wolmark N, et al. J Clin Oncol. 1993;11(10):1879-87. André T, et al. Eur J Cancer. 1999;35(9):1343-7.
	capecitabine	Low	Low	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Twelves C, et al. N Engl J Med. 2005;352(26):2696-704. Van Cutsem E, t al. J Clin Oncol. 2001;19(21):4097-106.
	CapeOx (capecitabine and oxaliplatin)	Low	Moderate	NCCN Guidelines® for Colon Cancer. V.2.2017. Schmoll HJ et al. J Clin Oncol. 2007 Jan 1;25(1):102-9. Grothey A et al. N Engl J Med 2018; 378:1177-1188
	FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin)	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. André T, et al. N Engl J Med. 2004;350(23):2343-51. Cassidy J, et al. J Clin Oncol. 2008;26(12):2006-12. Cheeseman S, et al. Br J Cancer. 2002;87(4):393-9.
STAGE IV ECOG 0-2
KRAS/NRAS MUTATION - Initial Therapy	FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin)	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Cassidy J, et al. J Clin Oncol. 2008;26(12):2006-12. Cheeseman, et al. Br J Cancer. 2002;87(4):393-9. André T, et al. N Engl J Med. 2004;350(23):2343-51.
	FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin) and bevacizumab 5mg/kg	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Emmanouilides C, et al. BMC Cancer. 2007; 7: 91
	CapeOx (capecitabine and oxaliplatin)	Low	Moderate	NCCN Guidelines® for Colon Cancer. V.1.2024. NCCN Guidelines® for Rectal Cancer. V.1.2024. Cassidy J, et al. J Clin Oncol. 2008;26(12):2006-12. Saltz LB, et al. J Clin Oncol. 2008;26(12):2013-9.
	CapeOx (capecitabine and oxaliplatin) and bevacizumab 7.5mg/kg	Low	Moderate	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Cassidy J, et al. J Clin Oncol. 2008;26(12):2006-12. Saltz LB, et al. J Clin Oncol. 2008;26(12):2013-9.
	FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan)	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. André T, et al. Eur J Cancer. 1999;35(9):1343-7.
	FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan) and bevacizumab 5mg/kg	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. André T, et al. Eur J Cancer. 1999;35(9):1343-7. Heinemann, et al. Lancet Oncol. 2014 Sep;15(10):1065-75.
	capecitabine	Low	Low	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Twelves C, et al. N Engl J Med. 2005;352(26):2696-704. Van Cutsem E, t al. J Clin Oncol. 2001;19(21):4097-106. Van Cutsem E, et al. J Clin Oncol. 2001 Nov 1;19(21):4097-106.
	capecitabine and bevacizumab 7.5mg/kg	Low	Low	NCCN Guidelines® for Colon Cancer. V.6.2023. NCCN Guidelines® for Rectal Cancer. V.3.2017. Twelves C, et al. N Engl J Med. 2005;352(26):2696-704. Van Cutsem E, t al. J Clin Oncol. 2001;19(21):4097-106. Van Cutsem E, et al. J Clin Oncol. 2001 Nov 1;19(21):4097-106.
	5FU (fluorouracil) and leucovorin	Low	Low	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017.
KRAS/NRAS MUTATION - Subsequent Therapy	CapeOx (capecitabine and oxaliplatin)	Low	Moderate	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Cassidy J, et al. J Clin Oncol. 2008;26(12):2006-12. Saltz LB, et al. J Clin Oncol. 2008;26(12):2013-9.
	CapeOx (capecitabine and oxaliplatin) and bevacizumab 7.5mg/kg	Low	Moderate	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Cassidy J, et al. J Clin Oncol. 2008;26(12):2006-12. Saltz LB, et al. J Clin Oncol. 2008;26(12):2013-9.
	FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan)	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. André T, et al. Eur J Cancer. 1999;35(9):1343-7. Fuchs CS, et al. J Clin Oncol. 2007;25(30):4779-86. Heinemann V, et al. Lancet Oncol. 2014;15(10):1065-75.
	FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan) and bevacizumab 5mg/kg	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. André T, et al. Eur J Cancer. 1999;35(9):1343-7. Fuchs CS, et al. J Clin Oncol. 2007;25(30):4779-86. Heinemann V, et al. Lancet Oncol. 2014;15(10):1065-75.
	FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin)	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Cassidy J, et al. J Clin Oncol. 2008;26(12):2006-12. Cheeseman, et al. Br J Cancer. 2002;87(4):393-9. Emmanouilides C, et al. BMC Cancer. 2007;7(91):1-7.
	FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin) and bevacizumab 5mg/kg	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Cassidy J, et al. J Clin Oncol. 2008;26(12):2006-12. Cheeseman, et al. Br J Cancer. 2002;87(4):393-9. Emmanouilides C, et al. BMC Cancer. 2007;7(91):1-7.
	irinotecan	Low	Moderate	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Hurwitz H, et al. N Engl J Med. 2004;350(23):2335-42. Fuchs CS, et al. J Clin Oncol. 2007;25(30):4779-86.
	irinotecan and bevacizumab 5mg/kg	Low	Moderate	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Hurwitz H, et al. N Engl J Med. 2004;350(23):2335-42. Fuchs CS, et al. J Clin Oncol. 2007;25(30):4779-86.
	IROX (irinotecan, oxaliplatin)	Low	Moderate	NCCN Guidelines® for Colon Cancer V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Cassidy J, et al. J Clin Oncol. 2008;26(12):2006-12. Cheeseman, et al. Br J Cancer. 2002;87(4):393-9. André T, et al. N Engl J Med. 2004;350(23):2343-51.
	IROX (irinotecan, oxaliplatin) and bevacizumab 7.5mg/kg	Low	Moderate	NCCN Guidelines® for Colon Cancer V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Cassidy J, et al. J Clin Oncol. 2008;26(12):2006-12. Cheeseman, et al. Br J Cancer. 2002;87(4):393-9. André T, et al. N Engl J Med. 2004;350(23):2343-51.
	trifluridine and tipiracil plus bevacizumab	Low	Low	NCCN Guidelines® for Colon Cancer V.2.2023. Pfeiffer P et al. Lancet Oncol . 2020 Mar;21(3):412-420.
	Best Supportive Care or Clinical Trial	Not Applicable	Not applicable	Best Supportive Care or Clinical Trial
STAGE IV ECOG 0-2
K-RAS/NRAS WILD TYPE - Initial Therapy	FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan)	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. André T, et al. Eur J Cancer. 1999;35(9):1343-7.
	FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan) and bevacizumab 5mg/kg	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. André T, et al. Eur J Cancer. 1999;35(9):1343-7. Fuchs CS, et al. J Clin Oncol. 2007;25(30):4779-86. Heinemann V, et al. Lancet Oncol. 2014;15(10):1065-75.
	FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin)	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Cassidy J, et al. J Clin Oncol. 2008;26(12):2006-12. Cheeseman, et al. Br J Cancer. 2002;87(4):393-9. André T, et al. N Engl J Med. 2004;350(23):2343-51.
	FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin) and bevacizumab 5mg/Kg	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Cassidy J, et al. J Clin Oncol. 2008;26(12):2006-12. Cheeseman, et al. Br J Cancer. 2002;87(4):393-9. Emmanouilides C, et al. BMC Cancer. 2007;7:91.
	CapeOx (capecitabine and oxaliplatin)	Low	Moderate	NCCN Guidelines® for Colon Cancer. V.1.2024. NCCN Guidelines® for Rectal Cancer. V.1.2024. Cassidy J, et al. J Clin Oncol. 2008;26(12):2006-12. Saltz LB, et al. J Clin Oncol. 2008;26(12):2013-9.
	CapeOx (capecitabine and oxaliplatin) and bevacizumab 7.5mg/kg	Low	Moderate	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Cassidy J, et al. J Clin Oncol. 2008;26(12):2006-12. Saltz LB, et al. J Clin Oncol. 2008;26(12):2013-9.
	5FU (fluorouracil) and leucovorin	Low	Low	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Haller DG, et al. J Clin Oncol. 2005;23(34):8671-8. Petrelli N, et al. J Clin Oncol. 1987;5(10):1559-65. Wolmark N, et al. J Clin Oncol. 1993;11(10):1879-87. André T, et al. Eur J Cancer. 1999;35(9):1343-7. Jäger E, et al. J Clin Oncol. 1996;14(8):2274-9. Douillard JY, et al. Lancet. 2000;355(9209):1041-7.
	capecitabine	Low	Low	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Twelves C, et al. N Engl J Med. 2005;352(26):2696-704. Van Cutsem E, t al. J Clin Oncol. 2001;19(21):4097-106.
	capecitabine and bevacizumab 7.5mg/kg	Low	Low	NCCN Guidelines® for Colon Cancer. V.6.2023. NCCN Guidelines® for Rectal Cancer. V.3.2017. Twelves C, et al. N Engl J Med. 2005;352(26):2696-704. Van Cutsem E, t al. J Clin Oncol. 2001;19(21):4097-106. Van Cutsem E, et al. J Clin Oncol. 2001 Nov 1;19(21):4097-106.
	FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan) and cetuximab	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. André T, et al. Eur J Cancer. 1999;35(9):1343-7. Cunningham D, et al. N Engl J Med. 2004;351(4):337-45. Martin-Martorell P, et al. Br J Cancer. 2008;99(3):455-8.
	FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan) and panitumumab	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. André T, et al. Eur J Cancer. 1999;35(9):1343-7. Peeters M, et al. J Clin Oncol. 2010;28(31):4706-13.
	FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin) and cetuximab	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Cassidy J, et al. J Clin Oncol. 2008 Apr 20;26(12):2006-12. Cheeseman SL, et al. Br J Cancer. 2002 Aug 12;87(4):393-9. Douillard JY, et al. J Clin Oncol. 2010 Nov 1;28(31):4697-705.
	FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin) and panitumumab	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Cheeseman SL, et al. Br J Cancer. 2002 Aug 12;87(4):393-9. Venook AP et al. J Clin Oncol. 2014 32:15_suppl, LBA3-LBA3.
	CapeOx (capecitabine and oxaliplatin) and cetuximab or panitumumab	Low	Moderate	NCCN Guidelines® for Colon Cancer. V.3.2023. Bridgewater JA et al. Lancet Oncol . 2020 Mar;21(3):398-411.
KRAS/NRAS WILD TYPE - Subsequent Therapy	CapeOx (capecitabine and oxaliplatin)	Low	Moderate	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Cassidy J, et al. J Clin Oncol. 2008;26(12):2006-12. Schmoll HJ, et al. J Clin Oncol. 2007;25(1):102-9.
	CapeOx (capecitabine and oxaliplatin) and bevacizumab 7.5mg/kg	Low	Moderate	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Cassidy J, et al. J Clin Oncol. 2008;26(12):2006-12. Saltz LB, et al. J Clin Oncol. 2008;26(12):2013-9.
	FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan)	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. André T, et al. Eur J Cancer. 1999;35(9):1343-7.
	FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan) and bevacizumab 5mg/kg	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. André T, et al. Eur J Cancer. 1999;35(9):1343-7. Fuchs CS, et al. J Clin Oncol. 2007;25(30):4779-86. Heinemann V, et al. Lancet Oncol. 2014;15(10):1065-75.
	FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin)	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Cassidy J, et al. J Clin Oncol. 2008;26(12):2006-12. Cheeseman, et al. Br J Cancer. 2002;87(4):393-9. André T, et al. N Engl J Med. 2004;350(23):2343-51.
	FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin) and bevacizumab 5mg/kg	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Cassidy J, et al. J Clin Oncol. 2008;26(12):2006-12. Cheeseman, et al. Br J Cancer. 2002;87(4):393-9. Emmanouilides C, et al. BMC Cancer. 2007;7(91):1-7.
	irinotecan	Low	Moderate	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017.
	irinotecan and bevacizumab 5mg/kg	Low	Moderate	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Hurwitz H, et al. N Engl J Med. 2004;350(23):2335-42. Fuchs CS, et al. J Clin Oncol. 2007;25(30):4779-86.
	IROX (irinotecan, oxaliplatin)	Low	Moderate	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Meropol NJ, et al. Cancer. 2017. DOI:10.1002/cncr.30967. Welch S. et al. Ann Oncol. 2010;21(6):1152-62.
	IROX (irinotecan, oxaliplatin) and bevacizumab 5mg/kg	Low	Moderate	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Meropol NJ, et al. Cancer. 2017. DOI:10.1002/cncr.30967. Welch S. et al. Ann Oncol. 2010;21(6):1152-62.
	FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin) and panitumumab	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Cassidy J, et al. J Clin Oncol. 2008 Apr 20;26(12):2006-12. Cheeseman SL, et al. Br J Cancer. 2002 Aug 12;87(4):393-9. Douillard JY, et al. J Clin Oncol. 2010 Nov 1;28(31):4697-705.
	FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin) and cetuximab	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. Cheeseman SL, et al. Br J Cancer. 2002 Aug 12;87(4):393-9. Venook AP et al. J Clin Oncol. 2014 32:15_suppl, LBA3-LBA3.
	CapeOx (capecitabine and oxaliplatin) and cetuximab or panitumumab	Low	Moderate	NCCN Guidelines® for Colon Cancer. V.3.2023. Bridgewater JA et al. Lancet Oncol . 2020 Mar;21(3):398-411.
	FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan) and panitumumab	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. André T, et al. Eur J Cancer. 1999;35(9):1343-7. Peeters M, et al. J Clin Oncol. 2010;28(31):4706-13.
	FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan) and cetuximab	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer. V.2.2017. NCCN Guidelines® for Rectal Cancer. V.3.2017. André T, et al. Eur J Cancer. 1999;35(9):1343-7. Cunningham D, et al. N Engl J Med. 2004;351(4):337-45. Martin-Martorell P, et al. Br J Cancer. 2008;99(3):455-8.
	trifluridine and tipiracil plus bevacizumab	Low	Low	NCCN Guidelines® for Colon Cancer V.2.2023. Pfeiffer P et al. Lancet Oncol . 2020 Mar;21(3):412-420.
BRAF V600E MUTATION - Initial Therapy	encorafenib and cetuximab or panitumumab plus FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin)	Intermediate	Moderate	NCCN Guidelines® for Colon Cancer. V.4.2025. Elez E et al. N Engl J Med 2025;392:2425-2437
BRAF V600E MUTATION - Subsequent Therapy	encorafenib and cetuximab	Low	Moderate	NCCN Guidelines® for Colon Cancer. V.4.2025. Kopetz S et al. N Engl J Med 2019; 381:1632-1643
DEFICIENT MISMATCH REPAIR/MICROSATELLITE INSTABILITY-HIGH [DMMR/MSI-H] OR POLE/POLD1 MUTATION - Initial/Subsequent Therapy	pembrolizumab	Low	Low	NCCN Guidelines® for Colon Cancer. V.2.2017. Andre T et al. N Engl J Med 2020; 383:2207-2218
	dostarlimab-gxly	Low	Low	NCCN Guidelines® for Colon Cancer. V.1.2024. Berton D et al. https://doi.org/10.1200/JCO.2021.39.15_suppl.2564
	Best Supportive Care or Clinical Trial	Not Applicable	Not applicable	Best Supportive Care or Clinical Trial

EARLY STAGE II - III

Neoadjuvant Chemoradiation (for rectal only)

Evolent Pathways

5FU (fluorouracil) with Radiation

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

capecitabine with Radiation

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Adjuvant

Evolent Pathways

5FU (fluorouracil) and leucovorin

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

capecitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

CapeOx (capecitabine and oxaliplatin)

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

STAGE IV ECOG 0-2

KRAS/NRAS MUTATION - Initial Therapy

Evolent Pathways

FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin) and bevacizumab 5mg/kg

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

CapeOx (capecitabine and oxaliplatin)

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

CapeOx (capecitabine and oxaliplatin) and bevacizumab 7.5mg/kg

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan) and bevacizumab 5mg/kg

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

capecitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

capecitabine and bevacizumab 7.5mg/kg

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

5FU (fluorouracil) and leucovorin

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

KRAS/NRAS MUTATION - Subsequent Therapy

Evolent Pathways

CapeOx (capecitabine and oxaliplatin)

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

CapeOx (capecitabine and oxaliplatin) and bevacizumab 7.5mg/kg

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan) and bevacizumab 5mg/kg

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin) and bevacizumab 5mg/kg

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

irinotecan

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

irinotecan and bevacizumab 5mg/kg

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

IROX (irinotecan, oxaliplatin)

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

IROX (irinotecan, oxaliplatin) and bevacizumab 7.5mg/kg

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

trifluridine and tipiracil plus bevacizumab

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

Best Supportive Care or Clinical Trial

Febrile Neutropenic Risk

Emetogenic Risk

References

STAGE IV ECOG 0-2

K-RAS/NRAS WILD TYPE - Initial Therapy

Evolent Pathways

FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan) and bevacizumab 5mg/kg

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin) and bevacizumab 5mg/Kg

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

CapeOx (capecitabine and oxaliplatin)

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

CapeOx (capecitabine and oxaliplatin) and bevacizumab 7.5mg/kg

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

5FU (fluorouracil) and leucovorin

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

capecitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

capecitabine and bevacizumab 7.5mg/kg

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan) and cetuximab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan) and panitumumab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin) and cetuximab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin) and panitumumab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

CapeOx (capecitabine and oxaliplatin) and cetuximab or panitumumab

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

KRAS/NRAS WILD TYPE - Subsequent Therapy

Evolent Pathways

CapeOx (capecitabine and oxaliplatin)

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

CapeOx (capecitabine and oxaliplatin) and bevacizumab 7.5mg/kg

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan) and bevacizumab 5mg/kg

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin) and bevacizumab 5mg/kg

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

irinotecan

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

irinotecan and bevacizumab 5mg/kg

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

IROX (irinotecan, oxaliplatin)

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

IROX (irinotecan, oxaliplatin) and bevacizumab 5mg/kg

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin) and panitumumab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin) and cetuximab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

CapeOx (capecitabine and oxaliplatin) and cetuximab or panitumumab

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan) and panitumumab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan) and cetuximab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

trifluridine and tipiracil plus bevacizumab

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

BRAF V600E MUTATION - Initial Therapy

Evolent Pathways

encorafenib and cetuximab or panitumumab plus FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

BRAF V600E MUTATION - Subsequent Therapy

Evolent Pathways

encorafenib and cetuximab

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

DEFICIENT MISMATCH REPAIR/MICROSATELLITE INSTABILITY-HIGH [DMMR/MSI-H] OR POLE/POLD1 MUTATION - Initial/Subsequent Therapy

Evolent Pathways

pembrolizumab

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

dostarlimab-gxly

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

Best Supportive Care or Clinical Trial

Febrile Neutropenic Risk

Emetogenic Risk

References

	Regimen	Alternative
LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES
Subsequent Therapy	FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan) and ramucirumab	Alternative: FOLFIRI + bevacizumab
	FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan) and ziv-aflibercept	Alternative: FOLFIRI + bevacizumab
	irinotecan and ramucirumab or ziv-aflibercept	Alternative: irinotecan + bevacizumab

LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES

Subsequent Therapy

Regimen

** FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan) and ramucirumab **

Regimen

** FOLFIRI (leucovorin calcium, 5-fluorouracil, and irinotecan) and ziv-aflibercept **

Regimen

** irinotecan and ramucirumab or ziv-aflibercept **

Pathways and Low-Value Regimens

Colorectal Cancer