17
ASCO Resource Levels
Strength of
Recommendation Enhanced Maximal
Irinotecan or irinotecan-doublet (with fluoropyrimidine) Strong
Oxaliplatin-based doublet chemotherapy (with fluoropyrimidine) Strong
N/A Patients may receive alternate chemotherapy ±
bevacizumab
Moderate
N/A Patients may receive an alternate chemotherapy
regimen ± bevacizumab
Weak
OR irinotecan-based chemotherapy ± ziv-
aflibercept (when treated in first-line with
oxaliplatin)
Weak
OR irinotecan-based chemotherapy ±
ramucirumab (when treated in first-line with
oxaliplatin)
Weak
OR anti-EGFR therapy + irinotecan-based
chemotherapy if RAS wild-type
Moderate
Anti-EGFR therapy alone (if not candidate for
irinotecan)
Weak
Alternative
chemotherapy
Alternative chemotherapy ± anti-VEGF therapy Moderate
N/A (see full text guideline: Second-Line Systemic
Treatment, Enhanced and Maximal Resource
Settings)
N/A
N/A Immune checkpoint inhibitors (if not previously
given)
Moderate
