In the VALENTINO phase II trial of non-inferiority, maintenance therapy with 5-FU/leucovorin?+?panitumumab after eight cycles with FOLFOX?+?panitumumab demonstrated superiority to panitumumab monotherapy in PFS [42]

In the VALENTINO phase II trial of non-inferiority, maintenance therapy with 5-FU/leucovorin?+?panitumumab after eight cycles with FOLFOX?+?panitumumab demonstrated superiority to panitumumab monotherapy in PFS [42]. Conversely, experts did not recommend anti-EGFR (80%) or antiangiogenic (97%) monotherapy as a maintenance treatment in unresectable mCRC. According to the experts, induction therapy in the first-line treatment for patients with unresectable mCRC should be maintained until the maximum response is achieved (87%, consensus) [8]. statements were proposed, which incorporated the following areas: (1) overarching principles; (2) tumor location; (3) triplets; (4) maintenance; (5) second-line and beyond treatments; (6) Rechallenge and liquid biopsy. After the two Delphi rounds, only six statements maintained a lack of clear consensus. Conclusions This document aims to describe the experts attitude when dealing with several common clinical questions regarding patients with wt mCRC. Electronic supplementary material The online version of this article (10.1007/s12094-020-02475-8) contains supplementary material, which is available to authorized users. wild-type, Treatment patterns, Primary tumor sidedness, Maintenance, Liquid biopsy, Rechallenge, Delphi Introduction Colorectal cancer (CRC) is the fourth most commonly diagnosed malignancy and the second-leading cause of global cancer-related deaths [1]. Approximately 20C25% of patients exhibit metastatic disease (mCRC) at disease onset and 50% of patients will eventually develop metastases [2]. The prognosis of mCRC has dramatically improved in recent decades, due to a range of factors, including improvements in treatment strategies and new biological agents [3C5]. Another factor that has contributed to this improvement is biomarker-based patient selection. mutations have been associated with a lack of response to anti-epidermal growth factor receptor (EGFR) monoclonal antibody therapies, which are used in mCRC treatment [6, 7]. Based on these data, guidelines from the European Society for Medical Oncology (ESMO) note that expanded analyses should be conducted on all patients at the time of diagnosis of mCRC, as well as on all patients that are eligible or being considered for anti-EGFR therapy [8]. However, this requirement has increased the need for more information about clinical and tumor characteristics based on mutational status. For example, in wild-type (wt) mCRC patients, published data suggest that primary Furin tumor location might have a predictive effect, depending NSC 663284 on the treatment applied NSC 663284 [9, 10]. Consequently, oncologists may face different questions in daily practice, when considering the best treatment option to manage wt mCRC patients. Therefore, the aim of this consensus document was to provide a guide to managing wt mCRC patients, focusing on those areas that might generate clinical questions or controversies. Methodology Nominal group and Delphi techniques were used, and a comprehensive narrative review supported the statements. Expert panel selection and clinical statement generation A steering committee of seven experts on mCRC was established, who were responsible of: (1) the selection of the expert panel; (2) identification of current relevant clinical questions and controversies in the field; (3) generation of statements. These statements were subsequently organized into six main sections: (a) general aspects; (b) tumor sidedness; (c) chemotherapy (CT) triplets; (d) maintenance; (e) second-line and beyond treatments; (f) rechallenge and liquid biopsy; (4) Interpretation of the results from the Delphi rounds; (5) Final edition of the document. The expert panel comprised 30 experts that were selected according to the following criteria. Experts must be medical oncologists, specialize in mCRC, have clinical experience??8?years or??5 publications, and be members of the Sociedad Espa?ola de Oncologa Mdica (SEOM) or Grupo Espa?ol de Tratamiento de Tumores Digestivos (TTD). Delphi process The expert panel completed two Delphi NSC 663284 rounds using an online platform. After each round, a facilitator offered an anonymous summary of the experts forecasts as well as the individual responses of each expert from the previous round. In the 1st round, the panelists voted using the following options: 1?=?totally agree, 2?=?basically agree, 3?=?basically disagree, 4?=?totally disagree. Consensus was defined if there were??75% of answers in categories 1 or 2 2 or 3 3 or 4 4. Any statement that reached consensus with this round did not proceed to a second round. The rest of the statements were analyzed from the steering committee, who reformulated the statement or maintained the original statement for the next Delphi round. In the second round, votes for statements used the same groups. However, with this stage, consensus was defined if??75% of responses in categories 1 and 2 (sum of the responses of both categories), consensus in the agreement, or in categories 3 and 4 (sum of the responses of both categories), consensus in the disagreement. When the pace of sum of reactions in categories.