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KRAS G12C CRC — SCE Medical Oncology MCQ

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HardGI CancersKRAS G12C CRCSCE Medical Oncology

A 72-year-old with KRAS-G12C metastatic colorectal cancer has progressed after fluoropyrimidine, oxaliplatin and irinotecan treatment. Which phase III evidence-based targeted strategy should be discussed, with current NHS commissioning or trial access confirmed?

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Correct answer: A — Use sotorasib plus panitumumab under trial or commissioned access

CodeBreaK 300 supports sotorasib plus panitumumab after fluoropyrimidine, oxaliplatin and irinotecan exposure; UK trial or commissioning access must still be confirmed. Use adagrasib monotherapy after fluoropyrimidine, oxaliplatin and irinotecan treatment: EGFR feedback limits the activity of KRAS-G12C monotherapy in colorectal cancer. Use cetuximab monotherapy after fluoropyrimidine, oxaliplatin and irinotecan treatment: an activating KRAS mutation predicts resistance to EGFR-antibody monotherapy. Use encorafenib-cetuximab after standard doublet chemotherapy exposure: encorafenib-cetuximab is the matched strategy for BRAF-V600E rather than KRAS-G12C. Use sotorasib-trametinib after fluoropyrimidine, oxaliplatin and irinotecan treatment: MEK combination is not the evidence-based pathway partner in colorectal cancer.

Reference: CodeBreaK 300: sotorasib plus panitumumab in chemotherapy-refractory KRAS-G12C colorectal cancer (Published October 2023): https://www.nejm.org/doi/abs/10.1056/NEJMoa2308795; NICE NG151 colorectal cancer: recommendations (Current NICE recommendations, accessed July 2026): https://www.nice.org.uk/guidance/ng151/chapter/Recommendations