NCCN Updates Guidelines to Include KRAS Testing

The National Comprehensive Cancer Network (NCCN) has updated their Clinical Practice Guidelines in Oncology for Colon Cancer to include testing tumors from patients with metastatic colon cancer for the KRAS gene.  The Guidelines also now say that cetuximab (Erbitux®) and panitumumab (Vectibix™) should only be given to patients whose tumors have normal (wild-type) KRAS.

Version 3.2008 includes the following changes:

  • UPDATES: “The Guidelines were updated to version 3.2008 to represent the addition of KRAS gene testing in the workup of all patients with stage IV disease.  Cetuximab and panitumumab are only indicated for patients with tumors that express the wild-type KRAS gene.”
  • COL-5: Workup for suspected or proven metastatic adenocarcinoma from the large bowel includes “Determination of tumor KRAS gene status.”
  • COL-9 and COL-10: Recurrence with documented metachronous metastases now includes the note “* Determination of tumor KRAS gene status.”
  • COL-10 (1 of 6): Now has “(KRAS wild-type gene only)” after every mention of cetuximab or panitumumab.

Similar changes have been made in NCCN Clinical Practice Guidelines for Rectal Cancer.

The NCCN Clinical Practice Guidelines in Oncology are the recognized standard for cancer care. Multidisciplinary panels of experts continuously update the guidelines to reflect new evidence.  Panels address cancer prevention, detection, workup and diagnosis, treatment, and supportive care.

You can find more information on tumors with mutations in the KRAS gene in C3 Patient Information.  Patients who have been diagnosed with stage IV colorectal cancer or recurrent colorectal cancer should talk to their doctors about KRAS testing.  The NCCN Guidelines now call for that testing to be part of the initial workup before deciding on a treatment plan.


  1. Kim says

    This could be wonderful news. I haven’t read the whole guidelines yet but I will ask my oncologist about this on my next appointment.

  2. Erica Paul says

    For those who do not have the “wild-type” gene, what are our options? Are Erbitux and Vectibix the end of the road for those who are already receiving Avastin?

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