- Bevacizumab in second-line therapy (even if used in the first line) is supported due to its potential to improve overall survival. Ziv-aflibercept and ramucirumab in the second-line setting are also supported.
- In the third line, if patients have not been previously treated with epidermal growth factor receptor (EGFR)-directed therapies, then panitumumab or cetuximab may be used. If obtaining an objective response is important, then one of these anti-EGFR therapies should be favored over treatment with regorafenib or trifluridine/tipiracil.
- Checkpoint inhibitors, currently limited to treatment of patients with mismatch repair–deficient tumors, hold promise for the treatment of patients with metastatic colorectal cancer.