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Colorectal Cancer — SCE Medical Oncology MCQ

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HardGI CancersColorectal CancerSCE Medical Oncology

A fit patient has untreated unresectable metastatic colorectal adenocarcinoma with confirmed mismatch-repair deficiency and high microsatellite instability. Which first-line treatment is NICE recommended?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — First-line pembrolizumab monotherapy for MSI-high disease

Explanation lettering: D = shown as B · E = shown as D · B = shown as E

B is correct. NICE TA709 recommends pembrolizumab for untreated metastatic colorectal cancer with MSI-high or dMMR biology. The molecular phenotype predicts substantial sensitivity to PD-1 blockade; it does not mean chemotherapy is universally ineffective, and urgent disease may still require individualised decisions. Nivolumab-ipilimumab has a different NICE position and is not the established answer represented here. Cetuximab also requires appropriate RAS/BRAF and sidedness assessment, while bevacizumab-chemotherapy does not have to precede pembrolizumab. Treatment is stopped according to the appraisal and product schedule, including the defined maximum duration.

Reference: NICE TA709 first-line pembrolizumab in MSI-high metastatic colorectal cancer: https://www.nice.org.uk/guidance/ta709/chapter/1-Recommendations