[The anti EGFR antibody indication between the Japanese and overseas guidelines]

The revised version of the Japanese colorectal cancer treatment guidelines by the Japanese Society for Cancer of the Colon and Rectum published in July 2009 showed remarkable changes in the field of systemic chemotherapy compared with the 2005 edition. Bevacizumab was approved in 2004 in United States, in 2005 in Europe, and in 2007 in Japan. On the other hand, cetuximab was approved in 2004 in Europe and United States, and in July 2008 in Japan. Besides, capecitabine was approved in September 2009 in Japan for not only adjuvant chemotherapy but also unresectable advanced colorectal cancer. Thus, we had one more treatment option of capecitabine with Oxaliplatin as CapeOx (XELOX). Therefore, most of the standard chemotherapy regimens in Western countries then became available in Japan. There has been no major difference in the drug treatment strategy except for the approval of panitumumab in Europe and the US, but this was not true in Japan. Now KRAS testing is recommended, and the indication for cetuximab is limited to KRAS wild type. Cetuximab can not be administered as the first-line treatment in Japan because KRAS testing is not covered by health insurance. This article deals with the difference in the anti EGFR antibody indication between the Japanese and overseas guidelines.