# Metastatic colorectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up

Source: https://onco.cc/key-papers/paper-esmo-metastatic-colorectal-cancer-guideline-ann-oncol-2023/  
OnCo record `paper-esmo-metastatic-colorectal-cancer-guideline-ann-oncol-2023` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The European oncology society's 2023 guideline for bowel cancer that has spread, covering which tests every patient needs, how to choose the first combination of drugs, when to operate on liver secondaries and how to follow patients up.

## Summary

ESMO Clinical Practice Guideline for metastatic colorectal cancer, published in Annals of Oncology in 2023 by Cervantes, Adam, Roselló, Arnold, Normanno, Taïeb, Seligmann, De Baere, Osterlund, Yoshino and Martinelli for the ESMO Guidelines Committee. Europe PMC indexes no abstract for this article, so OnCo carries no figures from it; the guideline itself is open on the ESMO website and is maintained as a living document there.

It is the document that fixes the molecular work-up OnCo's colorectal pages assume: RAS and BRAF status, mismatch repair or microsatellite instability status, and HER2 on every patient with metastatic disease, with primary tumour sidedness used alongside RAS status to choose between an EGFR antibody and bevacizumab.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: colorectal-evidence
- Journal: Annals of Oncology
- Year: 2023
- DOI: 10.1016/j.annonc.2022.10.003
- Authors: Cervantes A, Adam R, Roselló S, et al.
- Findings: No abstract is indexed on Europe PMC; recommendations are read from the guideline itself.
- What it means: This is the European standard the UK and NHS page for colorectal cancer is compared against; NICE NG151 covers the same ground for England with a narrower set of funded drugs.
- Caveats: Published before BREAKWATER moved the BRAF V600E triplet into first line and before the 2024 and 2025 CheckMate 8HW and ATOMIC readouts.; Guideline text, not a trial; each recommendation carries its own level and grade within the document.

## Sources

- Ann Oncol 2023: https://doi.org/10.1016/j.annonc.2022.10.003
- PubMed: https://pubmed.ncbi.nlm.nih.gov/36307056/
- ESMO guidelines: gastrointestinal cancers: https://www.esmo.org/guidelines/esmo-clinical-practice-guidelines-gastrointestinal-cancers
- NICE NG151: colorectal cancer (published 29 January 2020): https://www.nice.org.uk/guidance/ng151

## Connected records

- collections: [ESMO Clinical Practice Guidelines & MCBS](https://onco.cc/collections/esmo-guidelines/)
- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/)
- institutions: [European Society for Medical Oncology (ESMO)](https://onco.cc/institutions/esmo/)
- terms: [Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)](https://onco.cc/terms/msi/), [Sidedness (left vs right colon)](https://onco.cc/terms/sidedness/)
- trials: [BEACON CRC](https://onco.cc/trials/beacon-crc/), [KEYNOTE-177](https://onco.cc/trials/keynote-177/), [PARADIGM](https://onco.cc/trials/paradigm/)
- people: [Andrés Cervantes](https://onco.cc/people/andres-cervantes/), [Eric Van Cutsem](https://onco.cc/people/eric-van-cutsem/), [Josep Tabernero](https://onco.cc/people/josep-tabernero/)
- journals: [Annals of Oncology](https://onco.cc/journals/annals-of-oncology/)
- key papers: [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/)

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