The Chinese Society of Clinical Oncology (CSCO) has been updating its Clinical Guidelines for the Diagnosis and Treatment of Colorectal Cancer annually since the release of the first edition in 20174. The 2024 update was published in the Chinese Journal of Cancer Research in its English - language version. Compared with the 2023 version, the 2024 CSCO guidelines for colorectal cancer diagnosis and treatment have the following main updates4:
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Diagnostic methods: Rectal digital examination is newly added as a grade - I recommendation.
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Pathological diagnosis principles: POLE/POLD1 mutation gene testing is newly added as a grade - III recommendation.
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Treatment of potentially resectable patients:
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For RAS/BRAF wild - type patients suitable for intensive chemotherapy, the "FOLFOXIRI plus cetuximab" regimen is deleted from the grade - III recommendation.
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For RAS/BRAF wild - type patients with the primary tumor located in the right colon who are suitable for intensive chemotherapy, the evidence level of the "FOLFOXIRI ± bevacizumab" regimen in the grade - I recommendation is upgraded from 2A to 1A.
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For RAS - or BRAF - mutant patients suitable for intensive chemotherapy, the evidence level of the "FOLFOXIRI ± bevacizumab" regimen in the grade - I recommendation is upgraded from 2A to 1A.
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Second - line treatment for palliative care patients:
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For MSI - H/dMMR patients who have not received first - line immune checkpoint inhibitor treatment, the second - line treatment grade - II recommendation is modified to "envafolimab, serplulimab, tislelizumab, or putrelizumab (category 2A), pembrolizumab, and nivolumab (category 2A)", and the grade - III recommendation is modified to "nivolumab plus ipilimumab (category 2A)".
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For MSS or MSI - L/pMMR, RAS/BRAF wild - type patients who have received first - line irinotecan treatment, the "cetuximab plus irinotecan (category 2A)" regimen is deleted from the second - line treatment.
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Third - line treatment for palliative care patients:
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For MSI - H/dMMR patients who have not received immune checkpoint inhibitor treatment in the first and second lines, the third - line treatment grade - II recommendation is modified to "envafolimab, serplulimab, tislelizumab, or putrelizumab (category 2A), pembrolizumab, and nivolumab (category 2A)", and the grade - III recommendation is modified to "nivolumab plus ipilimumab (category 2A)".
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For MSS or MSI - L/pMMR patients who have received oxaliplatin and irinotecan treatment, regardless of the RAS/BRAF status, the "TAS - 102 (category 1A)" in the grade - I recommendation for the third - line treatment is changed to "TAS - 102 ± bevacizumab (category 1A)", and the "TAS - 102 plus bevacizumab (category 2A)" regimen is deleted from the grade - II recommendation.
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Treatment principles for pMMR/MSS or MMR/MS - unknown rectal cancer patients: For cT3, any N and negative mesorectal fascia (MRF), cT1 - 2, N + and patients without difficulty in preserving the anal sphincter, a new grade - II recommendation is added: for highly selective, low - recurrence - risk patients, "chemotherapy (assessment) + selective chemoradiotherapy (re - assessment) + radical resection of rectal cancer ± chemotherapy (select chemoradiotherapy/chemotherapy based on postoperative pathological results) (category 1B)" can be selected.