NCCN Guidelines for Patients® | Colon Cancer - page 46

NCCN Guidelines for Patients
®
Colon Cancer, Version 1.2014
44
Chart 5.3.2
presents the nonsurgical options for
stage IV liver or lung tumors that can’t be treated with
surgery. Recommended chemotherapy regimens with
or without targeted therapy are listed. Panitumumab
and cetuximab should only be used for tumors that
have normal
KRAS
and
NRAS
genes.
Most people with stage IV colon cancer aren’t able to
be cured of their cancer. However, for a few people,
chemotherapy may shrink the tumors enough so
a surgical cure is possible. Surgery is more likely
possible if you only have liver metastases and have
very few metastatic tumors.
After the start of chemotherapy, get tested every 2
months to see if you can have surgery. Chemotherapy
should be only given for 2 to 4 months before surgery
to avoid harmful side effects to the liver. Limiting
chemotherapy should also reduce complications
from surgery. Bevacizumab can cause bleeding
and slow healing after surgery. Thus, if you will take
bevacizumab, surgery should be done about 6 to 8
weeks after your last dose.
If surgery alone won’t cure your cancer, ablation
may be right for you. Ablation with or without surgery
should only be done when a cure is possible. You
may qualify for ablation if surgery can’t be done
because of other illnesses, tumor location, or the size
of your liver would be too small after surgery. Ablation
for this purpose has not been tested in clinical trials.
After surgery, starting follow-up testing or limited
chemotherapy is an option. Together, chemotherapy
before and after surgery should not exceed 6 months.
The treatment regimens in Part 7 are another option
for after surgery.
5
Treatment guide
Stage IV colon cancer
Chart 5.3.2 Nonsurgical options
Chemotherapy regimens
• FOLFIRI ± bevacizumab
• FOLFOX ± bevacizumab
• CapeOX ± bevacizumab
• FOLFOXIRI ± bevacizumab
• If normal
KRAS/NRAS
gene:
– FOLFIRI ± panitumumab,
– FOLFIRI ± cetuximab, or
– FOLFOX ± panitumumab
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