Colorectal Cancer — SCE Medical Oncology MCQ

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HardGI CancersColorectal CancerSCE Medical Oncology

Left-sided RAS- and BRAF-wild-type metastatic colorectal cancer progresses during first-line FOLFOX-panitumumab. The patient remains fit, and further EGFR-directed treatment is not selected. Which second-line regimen matches the 2026 NICE bevacizumab appraisal?

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Correct answer: A — FOLFIRI with bevacizumab

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

A is correct. After progression on an oxaliplatin backbone, switching to irinotecan-based chemotherapy is coherent; NICE TA1136 now permits bevacizumab with fluoropyrimidine-based chemotherapy in the second line when targeted treatment or immunotherapy is unsuitable and chemotherapy would otherwise be used. Repeating FOLFOX-panitumumab continues both progressed components. Trifluridine-tipiracil with bevacizumab is commissioned after two systemic lines, not here. Capecitabine-cetuximab is not a standard post-panitumumab combination, and regorafenib-irinotecan is not a licensed regimen. Molecular evolution and future anti-EGFR rechallenge may be reassessed later.

Reference: NICE TA1136 bevacizumab with chemotherapy recommendations: https://www.nice.org.uk/guidance/ta1136/chapter/1-Recommendations