# Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation

Source: https://onco.cc/roadmaps/colorectal-roadmap/  
OnCo record `colorectal-roadmap` (Roadmap). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Bowel cancer grows from a polyp over years, so removing the polyp prevents it. This roadmap follows the evidence from that discovery through the stool tests and scopes that built the screening programmes, the operation that changed rectal cancer, the chemotherapy and antibody era, immunotherapy that dissolves some tumours without surgery, and the unexplained rise in young adults, to 2032.

## Summary

Colorectal cancer is the cancer with the best-understood natural history. Vogelstein and Fearon's 172 tumours (1988) showed that it accumulates mutations as an adenoma grows, and the National Polyp Study (2012) showed that cutting the adenoma out halves the death rate two decades later. That logic built the screening programmes: the Nottingham (1996), Funen (1996) and Minnesota (1993) stool-blood trials, the UK flexible sigmoidoscopy trial (2010, 17-year follow-up 2017) and finally NordICC (2022), the first randomised trial of colonoscopy itself, whose modest 18 percent reduction in incidence turned on the fact that only 42 percent of those invited came.

Treatment moved on two tracks. In the rectum the change was surgical: Heald's total mesorectal excision (1982) cut pelvic recurrence from a quarter of patients to a few percent, and the Swedish (1997), Dutch TME (2001) and MRC CR07 (2009) trials settled that radiotherapy before the operation buys local control rather than survival. In the colon the change was chemical: fluorouracil with levamisole (1990), oxaliplatin added in MOSAIC (2004), then a long de-escalation as QUASAR (2007) measured how small the stage II benefit is, the IDEA collaboration (2018) halved the duration for lower-risk stage III disease and FOxTROT (2023) moved six weeks of it before the operation.

The metastatic era began with bevacizumab (2004) and cetuximab (CRYSTAL, 2009), and immediately produced the field's first negative predictive biomarker: the EGFR antibodies work only when RAS is normal (PRIME's extended testing, 2013) and, as the pooled analysis of six trials showed (2017), only when the primary tumour is on the left. Refractory lines arrived with regorafenib (2013), trifluridine-tipiracil (2015), the combination with bevacizumab (SUNLIGHT, 2023) and fruquintinib (2023), each measured in weeks.

Then the disease split in two. Le's 41 patients (2015) showed that mismatch repair-deficient tumours respond to PD-1 blockade and proficient ones do not, KEYNOTE-177 (2020) made immunotherapy the first-line standard for that 5 percent, CheckMate 8HW (2024) added the CTLA-4 antibody, NICHE-2 (2024) produced 68 percent pathological complete responses before surgery and Cercek's dostarlimab series (2022, 2025) made surgery unnecessary in every mismatch repair-deficient rectal cancer treated. BRAF V600E disease got a targeted doublet (BEACON, 2019) and then a first-line triplet, HER2 got three regimens, KRAS G12C got sotorasib with panitumumab (2023). Circulating tumour DNA became the first reliable measure of residual disease in a solid tumour (Tie 2016), and DYNAMIC (2022) used it to halve chemotherapy in stage II without losing recurrence-free survival.

What has not been solved: 95 percent of metastatic disease is microsatellite stable and still ignores immunotherapy, screening uptake rather than test performance sets what programmes achieve, and incidence in people under 50 is rising by about 3 percent a year in the United States and by 1.6 to 7.9 percent a year across Europe for reasons nobody can name, with colibactin-producing gut bacteria the strongest current lead.

## Fields

- Kind: Roadmap
- Last checked: 2026-09-24
- Also known as: Colorectal cancer history; Bowel cancer roadmap; CRC evidence roadmap; Colon and rectal cancer roadmap
- Tags: colorectal; gi; roadmap; colorectal-evidence

## Notes

- Dates in 'What to watch' are quoted from the registry as read on 2026-09-24 and are not predictions; estimated completion dates move.
- Papers that already had a record here are linked rather than rewritten: Fearon and Vogelstein 1990, Guinney's consensus molecular subtypes, the Minnesota faecal occult blood trial, Sauer's German chemoradiotherapy trial, Hurwitz on bevacizumab, Amado and Van Cutsem on KRAS and anti-EGFR therapy, Galon's immune contexture, NICHE-2 and Cercek 2022.
- A few trials and glossary entries named on this page have no record of their own yet and appear here as text only.
- UK and NHS specifics (screening programme ages and uptake, the symptomatic FIT threshold in NG12, NICE NG151 positions, Cancer Drugs Fund status, endoscopy capacity, audit indicators and trial access) are on the UK and NHS page for colorectal cancer and are not restated here.

## Sources

- NICE NG151: colorectal cancer (published 29 January 2020): https://www.nice.org.uk/guidance/ng151
- NICE NG12: suspected cancer, recognition and referral: https://www.nice.org.uk/guidance/ng12
- ESMO clinical practice guidelines: gastrointestinal cancers: https://www.esmo.org/guidelines/esmo-clinical-practice-guidelines-gastrointestinal-cancers
- NCCN guidelines: colon cancer: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1428
- NCCN guidelines: rectal cancer: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1461
- National Bowel Cancer Audit (NATCAN): https://www.natcan.org.uk/audits/bowel/
- ClinicalTrials.gov NCT05174169: https://clinicaltrials.gov/study/NCT05174169
- ClinicalTrials.gov NCT05253651: https://clinicaltrials.gov/study/NCT05253651

## Connected records

- roadmaps: [Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs](https://onco.cc/roadmaps/chemotherapy-roadmap/), [ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment](https://onco.cc/roadmaps/ctdna-tests/), [Early detection roadmap: organ screening → blood tests for many cancers](https://onco.cc/roadmaps/early-detection-roadmap/), [Immunotherapy roadmap: Coley's toxins → checkpoint inhibitors → engineered immunity](https://onco.cc/roadmaps/immunotherapy-roadmap/), [KRAS roadmap: undruggable → G12C → pan-RAS](https://onco.cc/roadmaps/kras-roadmap/), [Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work](https://onco.cc/roadmaps/surgery-roadmap/)
- pairings: [Anti-EGFR antibody + chemotherapy in left-sided RAS/BRAF wild-type mCRC](https://onco.cc/pairings/anti-egfr-left-sided/), [Neoadjuvant checkpoint inhibitor → surgery (or no surgery) in dMMR colorectal cancer](https://onco.cc/pairings/neoadjuvant-io-dmmr/)
- ideas: [ctDNA-guided adjuvant therapy as the default in stage II-III colon cancer](https://onco.cc/ideas/idea-ctdna-guided-adjuvant-crc/), [Find out what is driving early-onset bowel cancer, starting with colibactin, before extending screening any further](https://onco.cc/ideas/idea-crc-early-onset-cause-hunt/), [Find peritoneal spread while it is still small, and run complete cytoreduction through networks rather than adding heated chemotherapy](https://onco.cc/ideas/idea-crc-peritoneal-disease-found-early-and-treated-in-networks/), [Fund structured exercise after colon cancer surgery as a treatment, because a randomised trial says it works as well as a drug](https://onco.cc/ideas/idea-crc-exercise-as-a-funded-treatment/), [Making microsatellite-stable colorectal cancer immunotherapy-responsive](https://onco.cc/ideas/idea-immunotherapy-mss-crc/), [Randomise organ preservation against surgery in mismatch repair-proficient rectal cancer, with bowel function as a co-primary endpoint](https://onco.cc/ideas/idea-crc-organ-preservation-randomised-in-pmmr-rectal/), [Select microsatellite stable patients for immunotherapy by a measured immune biomarker, not by how many treatments they have already failed](https://onco.cc/ideas/idea-crc-mss-immunotherapy-by-biomarker-not-by-line/), [Take ctDNA-guided de-escalation beyond stage II, and stop escalating on a positive result until a trial says it helps](https://onco.cc/ideas/idea-crc-ctdna-de-escalation-beyond-stage-ii/), [Treat screening uptake, not test sensitivity, as the thing to optimise, and settle the age extension with a trial rather than a model](https://onco.cc/ideas/idea-crc-screening-uptake-and-age-extension/), [UK gap: match endoscopy capacity and quality to the faecal immunochemical test thresholds the NHS has already set](https://onco.cc/ideas/idea-crc-uk-colonoscopy-capacity-and-fit-threshold/), [UK gap: shorten the route to diagnosis for patients below the screening age, where the rise in incidence is](https://onco.cc/ideas/idea-crc-uk-young-patient-referral-and-diagnostic-interval/)
- cancers: [BRAF V600E-mutant colorectal cancer](https://onco.cc/cancers/braf-v600e-colorectal/), [Colon cancer (adenocarcinoma of the colon)](https://onco.cc/cancers/colon-cancer/), [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Early-onset colorectal cancer (under 50)](https://onco.cc/cancers/early-onset-colorectal/), [HER2-amplified colorectal cancer](https://onco.cc/cancers/her2-amplified-colorectal/), [KRAS G12C-mutant colorectal cancer](https://onco.cc/cancers/kras-g12c-colorectal/), [Mismatch-repair deficient (MSI-high) colorectal cancer](https://onco.cc/cancers/msi-high-colorectal/), [Rectal cancer](https://onco.cc/cancers/rectal-cancer/)
- fronts: [Chemotherapy](https://onco.cc/fronts/chemotherapy/), [Diagnostics & Biomarkers](https://onco.cc/fronts/diagnostics/), [Early Detection & Screening](https://onco.cc/fronts/early-detection/), [Immunotherapy](https://onco.cc/fronts/immunotherapy/), [Prevention & Risk](https://onco.cc/fronts/prevention/), [Radiation Therapy](https://onco.cc/fronts/radiation/), [Surgery & Interventional](https://onco.cc/fronts/surgery/), [Targeted Therapy](https://onco.cc/fronts/targeted-therapy/)
- technologies: [Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)](https://onco.cc/technologies/colorectal-screening/), [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Exercise & lifestyle oncology](https://onco.cc/technologies/exercise-oncology/), [HIPEC / PIPAC (intraperitoneal chemotherapy)](https://onco.cc/technologies/hipec/), [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [KRAS & RAS inhibitors](https://onco.cc/technologies/kras-inhibitors/), [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/), [Monoclonal antibodies](https://onco.cc/technologies/monoclonal-antibody/), [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/), [Robotic & minimally invasive surgery](https://onco.cc/technologies/robotic-surgery/), [Whole-exome & whole-genome sequencing](https://onco.cc/technologies/wes-wgs/)
- terms: [Circulating tumour DNA (ctDNA)](https://onco.cc/terms/ctdna/), [Clinical complete response (cCR)](https://onco.cc/terms/clinical-complete-response/), [Colonoscopy](https://onco.cc/terms/colonoscopy/), [Consensus molecular subtypes (CMS1-4)](https://onco.cc/terms/cms-subtypes/), [Faecal immunochemical test (FIT)](https://onco.cc/terms/fit-test/), [FOLFOX, FOLFIRI, FOLFIRINOX and CAPOX](https://onco.cc/terms/folfox-family/), [Gut microbiome diversity and composition](https://onco.cc/terms/gut-microbiome-diversity/), [Lynch syndrome](https://onco.cc/terms/lynch-syndrome/), [Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)](https://onco.cc/terms/msi/), [Minimal / molecular residual disease (MRD)](https://onco.cc/terms/mrd/), [Organ preservation (watch-and-wait, bladder-sparing, larynx preservation)](https://onco.cc/terms/organ-preservation/), [Radiotherapy](https://onco.cc/terms/radiotherapy/), [Sidedness (left vs right colon)](https://onco.cc/terms/sidedness/), [Total mesorectal excision (TME)](https://onco.cc/terms/total-mesorectal-excision/), [Total neoadjuvant therapy (TNT, rectal cancer)](https://onco.cc/terms/total-neoadjuvant-therapy/)
- drugs: [Bevacizumab](https://onco.cc/drugs/bevacizumab/), [Botensilimab](https://onco.cc/drugs/botensilimab/), [CAPOX (capecitabine, oxaliplatin)](https://onco.cc/drugs/capox/), [Cetuximab](https://onco.cc/drugs/cetuximab/), [Dostarlimab](https://onco.cc/drugs/dostarlimab/), [Encorafenib](https://onco.cc/drugs/encorafenib/), [Fluorouracil (5-FU)](https://onco.cc/drugs/fluorouracil/), [FOLFIRI (5-FU, leucovorin, irinotecan)](https://onco.cc/drugs/folfiri/), [FOLFOX (5-FU, leucovorin, oxaliplatin)](https://onco.cc/drugs/folfox/), [Irinotecan (and liposomal irinotecan)](https://onco.cc/drugs/irinotecan/), [Oxaliplatin](https://onco.cc/drugs/oxaliplatin/), [Panitumumab](https://onco.cc/drugs/panitumumab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Regorafenib](https://onco.cc/drugs/regorafenib/), [Signatera](https://onco.cc/drugs/signatera/), [Sotorasib](https://onco.cc/drugs/sotorasib/), [Trifluridine/tipiracil](https://onco.cc/drugs/trifluridine-tipiracil/), [Tucatinib](https://onco.cc/drugs/tucatinib/)
- targets: [APC](https://onco.cc/targets/apc/), [BRAF](https://onco.cc/targets/braf/), [CTLA-4](https://onco.cc/targets/ctla4/), [EGFR](https://onco.cc/targets/egfr/), [HER2](https://onco.cc/targets/her2/), [KRAS](https://onco.cc/targets/kras/), [Mismatch repair proteins (MLH1, MSH2, MSH6, PMS2)](https://onco.cc/targets/mmr/), [PD-1](https://onco.cc/targets/pd1/), [TP53](https://onco.cc/targets/tp53/)
- companies: [Alliance for Clinical Trials in Oncology](https://onco.cc/companies/alliance-oncology/), [Amgen](https://onco.cc/companies/amgen/), [Bristol Myers Squibb](https://onco.cc/companies/bms/), [GSK](https://onco.cc/companies/gsk/), [Merck & Co. (MSD)](https://onco.cc/companies/merck/), [Natera](https://onco.cc/companies/natera/), [Pfizer (incl. Seagen)](https://onco.cc/companies/pfizer/), [Servier](https://onco.cc/companies/servier/), [UNICANCER](https://onco.cc/companies/unicancer/)
- institutions: [Cancer Research UK](https://onco.cc/institutions/cruk/), [European Society for Medical Oncology (ESMO)](https://onco.cc/institutions/esmo/), [International Agency for Research on Cancer (IARC / WHO)](https://onco.cc/institutions/iarc/), [Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center](https://onco.cc/institutions/johns-hopkins/), [Memorial Sloan Kettering Cancer Center](https://onco.cc/institutions/mskcc/), [National Cancer Center Hospital](https://onco.cc/institutions/ncc-japan/), [National Institute for Health and Care Excellence](https://onco.cc/institutions/nice/), [Netherlands Cancer Institute (NKI-AvL)](https://onco.cc/institutions/nki/)
- pathways: [Microbiome-tumour interactions](https://onco.cc/pathways/microbiome-tumour/), [RAS / RAF / MEK / ERK (MAPK)](https://onco.cc/pathways/ras-mapk/), [Wnt / β-catenin](https://onco.cc/pathways/wnt/)
- trials: [ATOMIC (Alliance A021502)](https://onco.cc/trials/atomic/), [AZUR-1](https://onco.cc/trials/azur-1/), [BEACON CRC](https://onco.cc/trials/beacon-crc/), [BREAKWATER](https://onco.cc/trials/breakwater/), [CheckMate 8HW](https://onco.cc/trials/checkmate-8hw/), [CIRCULATE-Japan (GALAXY / VEGA / ALTAIR)](https://onco.cc/trials/circulate-japan/), [CodeBreaK 300](https://onco.cc/trials/codebreak-300/), [CRYSTAL & FIRE-3](https://onco.cc/trials/crystal-fire3/), [DYNAMIC](https://onco.cc/trials/dynamic/), [FRESCO-2](https://onco.cc/trials/fresco-2/), [KEYNOTE-177](https://onco.cc/trials/keynote-177/), [MOUNTAINEER](https://onco.cc/trials/mountaineer/), [NICHE-2](https://onco.cc/trials/niche-2/), [NordICC (Nordic-European Initiative on Colorectal Cancer)](https://onco.cc/trials/nordicc/), [OPRA](https://onco.cc/trials/opra/), [PARADIGM](https://onco.cc/trials/paradigm/), [PRODIGE 23](https://onco.cc/trials/prodige-23/), [RAPIDO](https://onco.cc/trials/rapido/), [SUNLIGHT](https://onco.cc/trials/sunlight/)
- people: [Andrea Cercek](https://onco.cc/people/andrea-cercek/), [Bert Vogelstein](https://onco.cc/people/bert-vogelstein/), [Cornelis J. H. van de Velde](https://onco.cc/people/cornelis-van-de-velde/), [Dung T. Le](https://onco.cc/people/dung-le/), [Eric Van Cutsem](https://onco.cc/people/eric-van-cutsem/), [Jeanne Tie](https://onco.cc/people/jeanne-tie/), [Julio Garcia-Aguilar](https://onco.cc/people/julio-garcia-aguilar/), [Michael Bretthauer](https://onco.cc/people/michael-bretthauer/), [Myriam Chalabi](https://onco.cc/people/myriam-chalabi/), [Scott Kopetz](https://onco.cc/people/scott-kopetz/), [Thierry André](https://onco.cc/people/thierry-andre/)
- bottlenecks: [Acquired resistance to every therapy](https://onco.cc/bottlenecks/b-resistance/), [Dormant cells and minimal residual disease](https://onco.cc/bottlenecks/b-dormancy-mrd/), [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [No one can predict who responds to immunotherapy](https://onco.cc/bottlenecks/b-immunotherapy-response/), [Not enough oncologists, nurses, pathologists, physicists](https://onco.cc/bottlenecks/b-workforce/), [Prevention we already have is not deployed](https://onco.cc/bottlenecks/b-prevention-adoption/), [Surgery and radiotherapy cure most, get least](https://onco.cc/bottlenecks/b-surgery-radiation-innovation/), [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- key papers: [A genetic model for colorectal tumorigenesis](https://onco.cc/key-papers/paper-fearon-cell/), [Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study (QUASAR)](https://onco.cc/key-papers/paper-quasar-adjuvant-chemotherapy-vs-observation-lancet-2007/), [Botensilimab plus balstilimab in relapsed/refractory microsatellite stable metastatic colorectal cancer: a phase 1 trial](https://onco.cc/key-papers/paper-bullock-botensilimab-balstilimab-mss-colorectal-nat-med-2024/), [Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer (CRYSTAL)](https://onco.cc/key-papers/paper-van-cutsem-crystal-cetuximab-folfiri-nejm-2009/), [Circulating tumor DNA analysis detects minimal residual disease and predicts recurrence in patients with stage II colon cancer](https://onco.cc/key-papers/paper-tie-ctdna-minimal-residual-disease-stage-ii-colon-sci-transl-med-2016/), [Circulating tumor DNA analysis guiding adjuvant therapy in stage II colon cancer (DYNAMIC)](https://onco.cc/key-papers/paper-tie-dynamic-ctdna-guided-adjuvant-stage-ii-colon-nejm-2022/), [Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths (National Polyp Study)](https://onco.cc/key-papers/paper-zauber-national-polyp-study-colonoscopic-polypectomy-nejm-2012/), [Colorectal cancer incidence patterns in the United States, 1974-2013](https://onco.cc/key-papers/paper-siegel-colorectal-incidence-birth-cohort-jnci-2017/), [Colorectal cancer statistics, 2023](https://onco.cc/key-papers/paper-siegel-colorectal-cancer-statistics-ca-2023/), [Comprehensive molecular characterization of human colon and rectal cancer](https://onco.cc/key-papers/paper-tcga-colon-rectal-molecular-characterization-nature-2012/), [Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy versus cytoreductive surgery alone for colorectal peritoneal metastases (PRODIGE 7)](https://onco.cc/key-papers/paper-quenet-prodige-7-hipec-peritoneal-colorectal-lancet-oncol-2021/), [Dostarlimab alone cures mismatch-repair-deficient rectal cancer without surgery or radiotherapy](https://onco.cc/key-papers/paper-cercek-dmmr-rectal-nejm-2022/), [Dual-targeted therapy with trastuzumab and lapatinib in treatment-refractory, KRAS codon 12/13 wild-type, HER2-positive metastatic colorectal cancer (HERACLES)](https://onco.cc/key-papers/paper-sartore-bianchi-heracles-trastuzumab-lapatinib-lancet-oncol-2016/), [Duration of adjuvant chemotherapy for stage III colon cancer (the IDEA collaboration)](https://onco.cc/key-papers/paper-idea-duration-adjuvant-stage-iii-colon-nejm-2018/), [Effect of colonoscopy screening on risks of colorectal cancer and related death (NordICC)](https://onco.cc/key-papers/paper-bretthauer-nordicc-colonoscopy-screening-nejm-2022/), [Effect of first-line chemotherapy combined with cetuximab or bevacizumab on overall survival in KRAS wild-type advanced or metastatic colorectal cancer (CALGB/SWOG 80405)](https://onco.cc/key-papers/paper-venook-calgb-80405-cetuximab-vs-bevacizumab-jama-2017/), [Encorafenib, binimetinib, and cetuximab in BRAF V600E-mutated colorectal cancer (BEACON CRC)](https://onco.cc/key-papers/paper-kopetz-beacon-encorafenib-braf-colorectal-nejm-2019/), [FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3)](https://onco.cc/key-papers/paper-heinemann-fire-3-cetuximab-vs-bevacizumab-lancet-oncol-2014/), [Fruquintinib versus placebo in patients with refractory metastatic colorectal cancer (FRESCO-2)](https://onco.cc/key-papers/paper-dasari-fresco-2-fruquintinib-lancet-2023/), [Galon 2006: the type, density and location of immune cells in colorectal tumours predict outcome](https://onco.cc/key-papers/paper-galon-immune-contexture-colorectal-science-2006/), [Genetic alterations during colorectal-tumor development](https://onco.cc/key-papers/paper-vogelstein-genetic-alterations-colorectal-tumor-development-nejm-1988/), [Geographic and age variations in mutational processes in colorectal cancer](https://onco.cc/key-papers/paper-diaz-gay-colibactin-geographic-age-mutational-processes-nature-2025/), [Hurwitz 2004: bevacizumab with chemotherapy for metastatic colorectal cancer, the first anti-angiogenic drug to extend life](https://onco.cc/key-papers/paper-hurwitz-bevacizumab-crc-nejm-2004/), [Improved survival with preoperative radiotherapy in resectable rectal cancer (Swedish Rectal Cancer Trial)](https://onco.cc/key-papers/paper-swedish-rectal-cancer-trial-preoperative-radiotherapy-nejm-1997/), [Increasing incidence of colorectal cancer in young adults in Europe over the last 25 years](https://onco.cc/key-papers/paper-vuik-early-onset-colorectal-europe-gut-2019/), [Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma](https://onco.cc/key-papers/paper-moertel-levamisole-fluorouracil-adjuvant-colon-nejm-1990/), [Long term effects of once-only flexible sigmoidoscopy screening after 17 years of follow-up](https://onco.cc/key-papers/paper-atkin-flexible-sigmoidoscopy-17-year-follow-up-lancet-2017/), [Minnesota trial: a yearly stool blood test cuts bowel cancer deaths by a third](https://onco.cc/key-papers/paper-minnesota-fobt-nejm-1993/), [Mismatch repair deficiency predicts response of solid tumors to PD-1 blockade](https://onco.cc/key-papers/paper-le-mismatch-repair-deficiency-pd1-solid-tumours-science-2017/), [Molecular residual disease and efficacy of adjuvant chemotherapy in patients with colorectal cancer (GALAXY, CIRCULATE-Japan)](https://onco.cc/key-papers/paper-kotani-galaxy-molecular-residual-disease-nat-med-2023/), [Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23)](https://onco.cc/key-papers/paper-conroy-prodige-23-neoadjuvant-folfirinox-rectal-lancet-oncol-2021/), [NICHE-2: a single dose of ipilimumab and two of nivolumab before surgery clears dMMR colon cancer in most patients](https://onco.cc/key-papers/paper-niche-2-neoadjuvant-colon-nejm-2024/), [Nivolumab plus ipilimumab in microsatellite-instability-high metastatic colorectal cancer (CheckMate 8HW)](https://onco.cc/key-papers/paper-andre-checkmate-8hw-nivolumab-ipilimumab-nejm-2024/), [Nonoperative management of mismatch repair-deficient tumors](https://onco.cc/key-papers/paper-cercek-nonoperative-management-mismatch-repair-deficient-tumours-nejm-2025/), [Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial](https://onco.cc/key-papers/paper-atkin-once-only-flexible-sigmoidoscopy-lancet-2010/), [Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results](https://onco.cc/key-papers/paper-habr-gama-nonoperative-stage-0-rectal-ann-surg-2004/), [Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy (OPRA)](https://onco.cc/key-papers/paper-garcia-aguilar-opra-organ-preservation-jco-2022/), [Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer (MOSAIC)](https://onco.cc/key-papers/paper-mosaic-oxaliplatin-adjuvant-colon-nejm-2004/), [Panitumumab-FOLFOX4 treatment and RAS mutations in colorectal cancer (PRIME)](https://onco.cc/key-papers/paper-douillard-prime-panitumumab-ras-nejm-2013/), [PD-1 blockade in tumors with mismatch-repair deficiency](https://onco.cc/key-papers/paper-le-pd1-blockade-mismatch-repair-deficiency-nejm-2015/), [Pembrolizumab in microsatellite-instability-high advanced colorectal cancer (KEYNOTE-177)](https://onco.cc/key-papers/paper-andre-keynote-177-pembrolizumab-msi-high-nejm-2020/), [Preoperative chemotherapy for operable colon cancer: mature results of an international randomized controlled trial (FOxTROT)](https://onco.cc/key-papers/paper-foxtrot-preoperative-chemotherapy-colon-jco-2023/), [Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer (Dutch TME trial)](https://onco.cc/key-papers/paper-kapiteijn-dutch-tme-preoperative-radiotherapy-nejm-2001/), [Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016)](https://onco.cc/key-papers/paper-sebag-montefiore-cr07-preoperative-radiotherapy-lancet-2009/), [Prognostic and predictive value of primary tumour side in patients with RAS wild-type metastatic colorectal cancer treated with chemotherapy and EGFR directed antibodies in six randomized trials](https://onco.cc/key-papers/paper-arnold-primary-tumour-side-ras-wild-type-ann-oncol-2017/), [Quality indicators for colonoscopy and the risk of interval cancer](https://onco.cc/key-papers/paper-kaminski-adenoma-detection-rate-interval-cancer-nejm-2010/), [Randomised controlled trial of faecal-occult-blood screening for colorectal cancer (Nottingham)](https://onco.cc/key-papers/paper-hardcastle-nottingham-faecal-occult-blood-lancet-1996/), [Randomised study of screening for colorectal cancer with faecal-occult-blood test (Funen)](https://onco.cc/key-papers/paper-kronborg-funen-faecal-occult-blood-lancet-1996/), [Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer](https://onco.cc/key-papers/paper-verwaal-cytoreduction-hipec-peritoneal-colorectal-jco-2003/), [Randomized trial of TAS-102 for refractory metastatic colorectal cancer (RECOURSE)](https://onco.cc/key-papers/paper-mayer-recourse-tas-102-nejm-2015/), [Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT)](https://onco.cc/key-papers/paper-grothey-correct-regorafenib-lancet-2013/), [Sauer 2004: chemoradiotherapy before rather than after surgery for rectal cancer (CAO/ARO/AIO-94)](https://onco.cc/key-papers/paper-sauer-preoperative-chemoradiotherapy-rectal-nejm-2004/), [Short-course radiotherapy followed by chemotherapy before total mesorectal excision versus preoperative chemoradiotherapy in locally advanced rectal cancer (RAPIDO)](https://onco.cc/key-papers/paper-bahadoer-rapido-short-course-radiotherapy-lancet-oncol-2021/), [Sotorasib plus panitumumab in refractory colorectal cancer with mutated KRAS G12C (CodeBreaK 300)](https://onco.cc/key-papers/paper-fakih-codebreak-300-sotorasib-panitumumab-nejm-2023/), [Sugar-sweetened beverage intake in adulthood and adolescence and risk of early-onset colorectal cancer among women](https://onco.cc/key-papers/paper-hur-sugar-sweetened-beverages-early-onset-colorectal-gut-2021/), [The consensus molecular subtypes of colorectal cancer](https://onco.cc/key-papers/paper-cms-guinney-nat-med-2015/), [The mesorectum in rectal cancer surgery: the clue to pelvic recurrence?](https://onco.cc/key-papers/paper-heald-mesorectum-rectal-cancer-surgery-br-j-surg-1982/), [Trastuzumab deruxtecan (DS-8201) in patients with HER2-expressing metastatic colorectal cancer (DESTINY-CRC01)](https://onco.cc/key-papers/paper-siena-destiny-crc01-trastuzumab-deruxtecan-lancet-oncol-2021/), [Trifluridine-tipiracil and bevacizumab in refractory metastatic colorectal cancer (SUNLIGHT)](https://onco.cc/key-papers/paper-prager-sunlight-trifluridine-tipiracil-bevacizumab-nejm-2023/), [Tucatinib plus trastuzumab for chemotherapy-refractory, HER2-positive, RAS wild-type unresectable or metastatic colorectal cancer (MOUNTAINEER)](https://onco.cc/key-papers/paper-strickler-mountaineer-tucatinib-trastuzumab-lancet-oncol-2023/), [Wild-type KRAS is required for panitumumab efficacy in patients with metastatic colorectal cancer](https://onco.cc/key-papers/paper-kras-colorectal-j-clin-oncol-2008/)

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JSON: https://onco.cc/api/v1/entities/colorectal-roadmap.json