Therapeutic advances in medical oncology · 2026
Optimizing third-line and beyond therapies for metastatic colorectal cancer in Taiwan: an evidence-based consensus.
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Chang Pei-Hung, Hsieh Meng-Che, Teng Hao-Wei, Liang Yi-Hsin, Chen Hong-Hwa, Hsu Hung-Chih, Jiang Jeng-Kai, Chiang Feng-Fan, Lin Johnson, Lin Been-Ren, Hsieh Yao-Yu, Ke Tao-Wei, Kuan Feng-Che, Huang Wen-Shih, Lin Bo-Wen, Chang Yu-Yao, Su Yu-Li, Chen William Tzu-Liang, Liu Chien-Kuo, Wang Jaw-Yuan
Аннотация
BACKGROUND: Metastatic colorectal cancer (mCRC) is a major public health burden in Taiwan. Despite multiple later-line therapies, outcomes remain suboptimal. International guidelines provide valuable direction, but are difficult to apply locally due to differences in drug accessibility, reimbursement policies, and practice patterns.
OBJECTIVES: This initiative developed a Taiwan-specific, consensus framework for managing mCRC in the third line and beyond.
DESIGN: This consensus integrated global evidence with local practice, real-world data, and reimbursement considerations.
METHODS: A multidisciplinary panel of 20 experts convened by the Taiwan Society of Colon and Rectal Surgeons (TSCRS) used a modified Delphi process. Initial recommendations were adapted from European Society for Medical Oncology (ESMO), Pan-Asian ESMO, and National Comprehensive Cancer Network (NCCN) guidelines, supplemented by Taiwan real-world data. Consensus was achieved through three structured rounds of voting and discussion, with final statements graded by level of evidence and strength of agreement.
RESULTS: Twelve recommendations spanning three domains were endorsed: disease management, third-line options, and extended strategies. Key local adaptations include aligning imaging schedule intervals with Taiwan's National Health Insurance reimbursement policies and prioritizing trifluridine/tipiracil and regorafenib as preferred third-line agents. The panel acknowledged emerging options such as fruquintinib, epidermal growth factor receptor antibody rechallenge, and novel chemotherapy combinations. While the panel strongly supported biomarker-informed treatments, their broader implementation is constrained by limited reimbursement coverage for next-generation sequencing. Other challenges included limited drug access, suboptimal uptake of biomarker testing, and reimbursement constraints.
CONCLUSION: This Taiwan-specific consensus provides a practical, evidence-based framework for late-line mCRC treatment, bridging global standards with local realities to improve policy alignment and optimize patient outcomes.
OBJECTIVES: This initiative developed a Taiwan-specific, consensus framework for managing mCRC in the third line and beyond.
DESIGN: This consensus integrated global evidence with local practice, real-world data, and reimbursement considerations.
METHODS: A multidisciplinary panel of 20 experts convened by the Taiwan Society of Colon and Rectal Surgeons (TSCRS) used a modified Delphi process. Initial recommendations were adapted from European Society for Medical Oncology (ESMO), Pan-Asian ESMO, and National Comprehensive Cancer Network (NCCN) guidelines, supplemented by Taiwan real-world data. Consensus was achieved through three structured rounds of voting and discussion, with final statements graded by level of evidence and strength of agreement.
RESULTS: Twelve recommendations spanning three domains were endorsed: disease management, third-line options, and extended strategies. Key local adaptations include aligning imaging schedule intervals with Taiwan's National Health Insurance reimbursement policies and prioritizing trifluridine/tipiracil and regorafenib as preferred third-line agents. The panel acknowledged emerging options such as fruquintinib, epidermal growth factor receptor antibody rechallenge, and novel chemotherapy combinations. While the panel strongly supported biomarker-informed treatments, their broader implementation is constrained by limited reimbursement coverage for next-generation sequencing. Other challenges included limited drug access, suboptimal uptake of biomarker testing, and reimbursement constraints.
CONCLUSION: This Taiwan-specific consensus provides a practical, evidence-based framework for late-line mCRC treatment, bridging global standards with local realities to improve policy alignment and optimize patient outcomes.