NCCN Guidelines for Patients® | Colon Cancer - page 30

NCCN Guidelines for Patients
®
Colon Cancer, Version 1.2014
28
4
Overview of cancer treatments Targeted therapy
Targeted therapy
Targeted therapy is a class of cancer drugs that
is newer than chemotherapy. It stops the action
of molecules that aid the growth of cancer cells.
Targeted therapy is less likely to harm normal cells
than chemotherapy. There are five targeted therapy
drugs used to treat colon cancer:
Bevacizumab
Cancer cells need the food and oxygen in blood to
grow. Thus, cancer cells release VEGF (
v
ascular
e
ndothelial
g
rowth
f
actor). VEGF is a molecule
that binds to cells that form blood vessels. The
binding starts changes within the cells that cause
blood vessels to form and to grow into tumors.
Bevacizumab attaches to VEGF, which stops VEGF
from binding to cells. Cancer cells then don’t receive
the blood they need to live.
Bevacizumab is given by infusion. It takes about
90 minutes to get the first dose and 30 minutes
for later doses. Bevacizumab is always given with
chemotherapy. It is given every two or three weeks
depending on the chemotherapy.
Common side effects of bevacizumab are high blood
pressure, diarrhea, and feeling tired and weak. You
might also have nosebleeds, shortness of breath,
nausea, and vomiting. Rare but serious side effects
include stroke, heart attack, kidney damage, holes in
the intestine, and bleeding within the body.
Cetuximab
EGFR (
e
pidermal
g
rowth
f
actor
r
eceptor) is a surface
receptor. A surface receptor is a protein in the outer
membrane of cells. When molecules outside the cells
attach to EGFRs, changes within the cell occur that
start cell growth.
Some people with colon cancer have abnormal
changes in their gene that controls EGFRs. These
changes cause EGFRs to be overactive, which in turn
causes new cancer cells to form quickly. Cetuximab
treats colon cancer by binding to the ends of EGFRs
that are outside of the cell—like a key into a lock—to
stop cell growth. It also attracts immune cells that
help to kill the cancer cells.
Cetuximab is given by IV (
i
ntra
v
enous) infusion,
usually once a week or every other week. It may take
2 hours to receive the first dose, but later doses will
take only 1 hour. Cetuximab may be given with or
without chemotherapy.
Some people have an infusion reaction to cetuximab.
Symptoms of a reaction include chills and fever. If you
have a reaction, you will be given cetuximab more
slowly.
Besides a reaction, common side effects of cetuximab
include an acne-like rash, infections, mouth sores,
and feeling tired and weak. Other possible side
effects are nausea, diarrhea, trouble sleeping, and
swelling of feet. Rare but serious side effects include
heart, lung, eye, or kidney damage.
Panitumumab
Panitumumab works much like cetuximab by targeting
EGFRs and attracting immune cells. It is given by
IV infusion over 1 hour every other week. It may be
given with or without chemotherapy.
Panitumumab rarely causes infusional reactions.
Common side effects include skin rash, diarrhea,
feeling tired, and constipation. Rare but serious side
effects include lung and eye damage and blood clots
in the lungs.
Regorafenib
Regorafenib attaches to surface receptors within cells
that form blood vessels. This may stop new blood
vessels from forming so that cancer cells don’t get the
blood supply they need. Regorafenib may also attach
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