21
ASCO Resource Levels
Strength of
Recommendation Basic Limited Enhanced Maximal
If high risk of obstruction,
significant bleeding,
perforation or tumor
related symptoms: resection
of primary tumor OR if
obstruction from primary
tumor or from peritoneal
metastases: diverting ostomy
If high risk of obstruction, significant
bleeding, perforation or tumor related
symptoms: resection of primary
tumor OR if obstruction from
primary tumor or from peritoneal
metastases: diverting ostomy OR if
obstruction from primary tumor:
stenting
Strong
(resection and
diverting ostomy)
Moderate
(stenting )
N/A If symptomatic primary rectal tumor,
radiation therapy (± chemotherapy)
should be discussed
Moderate
N/A Fluoropyrimidines Fluoropyrimidines
plus oxaliplatin
OR irinotecan
Fluoropyrimidines
plus oxaliplatin
OR irinotecan +
anti-VEGF OR
anti-EGFR OR
immune check-
point inhibitors
OR BRAF
inhibitors
Strong
(fluoropyrimidines,
oxaliplatin, irinotecan)
Moderate
(anti-VEGF, anti-
EGFR, immune
checkpoint inhibitors)
Weak
(BRAF inhibitors)
N/A Synchronized or
staged resection ±
ablation of colon/
rectal primary
tumors and
metastatic lesions
if they become
resectable/
amenable to
ablation aer
NACT
Strong
N/A Fluoropyrimidines Fluoropyrimidines
plus oxaliplatin
OR irinotecan
Fluoropyrimidines
plus oxaliplatin
Strong
(fluoropyrimidines,
oxaliplatin,
irinotecan)
