NCCN Guidelines for Patients® | Colon Cancer - page 54

NCCN Guidelines for Patients
®
Colon Cancer, Version 1.2014
52
6
Treatment guide
Nonsurgical options for recurrent colon cancer
6.2 Nonsurgical options for recurrent colon cancer
Chart 6.2
presents options for stage IV recurrences
that can’t be treated with surgery. Treatment is
based on your history of chemotherapy. If you’ve
had FOLFOX or CapeOX within the past 12 months,
treatment options are listed in the chart. If you haven’t
had FOLFOX or CapeOX within the past 12 months,
you may start a treatment regimen listed in Part 7.
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 or lung 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.
After surgery, you may start a treatment regimen
listed in Part 7. Another option is to start observation.
Observation is a period of testing to assess for cancer
growth.
Chart 6.2 Nonsurgical options
Chemotherapy history
Primary treatment
Adjuvant FOLFOX or CapeOX ≤12 months ago
• FOLFIRI ± bevacizumab,
• FOLFIRI ± ziv-aflibercept,
• Irinotecan ± bevacizumab,
• Irinotecan ± ziv-aflibercept, or
• If normal
KRAS
/
NRAS
gene:
– FOLFIRI + panitumumab,
– FOLFIRI + cetuximab,
– Irinotecan + panitumumab, or
– Irinotecan + cetuximab
Adjuvant FOLFOX or CapeOX >12 months ago • Treatments listed in Part 7
Prior 5-FU/LV
• Treatments listed in Part 7
Prior capecitabine
• Treatments listed in Part 7
Never had chemotherapy
• Treatments listed in Part 7
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