Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain.
Medical Oncology Department, Complejo Hospitalario Universitario de Ourense, Ourense, Spain.
Clin Transl Oncol. 2021 Apr;23(4):827-839. doi: 10.1007/s12094-020-02475-8. Epub 2020 Aug 13.
To provide guidance for the management of RAS wild-type (wt) metastatic colorectal cancer (mCRC) in daily practice.
Nominal group and Delphi techniques were used. A steering committee of seven experts analyzed the current management of RAS wt mCRC, through which they identified controversies, critically analyzed the available evidence, and formulated several guiding statements for clinicians. Subsequently, a group of 30 experts (the expert panel) was selected to test agreement with the statements, through two Delphi rounds. The following response categories were established in both rounds: 1 = totally agree, 2 = basically agree, 3 = basically disagree, 4 = totally disagree. Agreement was defined if ≥ 75% of answers were in categories 1 and 2 (consensus with the agreement) or 3 and 4 (consensus with the disagreement).
Overall, 71 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.
This document aims to describe the expert's attitude when dealing with several common clinical questions regarding patients with RAS wt mCRC.
为 RAS 野生型（wt）转移性结直肠癌（mCRC）的日常管理提供指导。
采用名义群体法和德尔菲技术。一个由 7 名专家组成的指导委员会分析了 RAS wt mCRC 的当前管理情况，通过该分析确定了争议点，对现有证据进行了批判性分析，并为临床医生制定了几项指导陈述。随后，选择了一组 30 名专家（专家小组）来测试他们对这些陈述的一致性，通过两轮德尔菲法。在两轮中都建立了以下反应类别：1=完全同意，2=基本同意，3=基本不同意，4=完全不同意。如果回答中≥75%属于类别 1 和 2（与一致性一致）或 3 和 4（与不一致一致），则表示达成一致。
总体而言，提出了 71 项陈述，涵盖了以下领域：（1）总体原则；（2）肿瘤位置；（3）三联治疗；（4）维持治疗；（5）二线及以上治疗；（6）再挑战和液体活检。经过两轮德尔菲法，只有 6 项陈述仍缺乏明确的共识。
本文旨在描述专家在处理 RAS wt mCRC 患者的几个常见临床问题时的态度。
