Original Title: Algorithme de traitement systémique du cancer colorectal métastatique ou avancé, visée palliative

Authors' objectives: Colorectal cancer (CRC) originates in the cells of the mucosa of the large intestine and results from the transformation of normal epithelium of the colon or rectum into a precancerous lesion, and then into an invasive tumour. This gradual process can take place over a period of 10 to 15 years. Colorectal cancer is generally asymptomatic in its early stages. It is the fourth most diagnosed cancer in the country and the second leading cause of cancer-related death. At the request of the Programme québécois de cancérologie (PQC) of the Ministère de la Santé et des Services Sociaux (MSSS), the Institut national d’excellence en santé et en services sociaux (INESSS) has produced an update of the algorithm for the treatment of metastatic colorectal cancer.

Authors' results and conclusions: RESULTS: The web format of the algorithm is divided into three main levels: the algorithms which map the care pathways (level 1), the recommendations for clinical practice (level 2), and the evidence and discussion (level 3). Clickable links can be used to navigate between the different levels. This document presents levels 1 and 2. The main treatments for advanced or metastatic CRC (chemotherapy, targeted therapies, and immunotherapy) approved by Health Canada are presented in the algorithm with their indication and reimbursement status. The different care pathways (algorithms; level 1) are presented according to the status of certain biomarkers (RAS and BRAF), the location of the primary cancer, and the presence or absence of high microsatellite instability or deficiency in the mismatch repair system (dMMR/MSI-H): • RAS and BRAF wild-type, primary cancer in the left colon (from the splenic flexure to the rectum) • RAS and BRAF wild-type, primary cancer in the right colon (from the cecum to the splenic flexure) • RAS mutated • BRAF V600E mutation • dMMR/MSI-H The preferred treatment sequence is presented, where applicable, as well as other available options, according to the treatment intent. The recommendations supporting the proposed clinical practice algorithms at level 1 are also provided in this document.

Authors' methods: This algorithm is a decision-making tool containing all of INESSS’s recommendations and the best available evidence regarding the treatment of CRC in a dynamic web format. It was developed in collaboration with clinicians and is intended to facilitate the work of healthcare professionals involved in CRC care pathways. The algorithm is updated on an ongoing basis.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/cancer-colorectal-algorithmes-dinvestigation-de-traitement-et-de-suivi.html

Year Published: 2024

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/cancer-colorectal-algorithmes-dinvestigation-de-traitement-et-de-suivi.html

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: Gouvernement du Québec