NCCN Guidelines for Patients® | Colon Cancer - page 58

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NCCN Guidelines for Patients™: Colon Cancer
Version 1.2012
Part 7: A step-by-step treatment guide
Systemic therapy for colon cancer includes chemotherapy.
Chemotherapy can treat colon cancer but can also cause
side effects. Be sure to tell your doctor about any new or
worsening symptoms. To prevent severe side effects, the
following is recommended.
• 5-FU has fewer severe side effects when given by infusion
rather than bolus. Thus, bolus 5-FU shouldn’t be given
with irinotecan or oxaliplatin since severe side effects are
likely. Another option is to give capecitabine rather than
5-FU with oxaliplatin.
• Oxaliplatin can harm your nervous system when used in a
FOLFOX or CapeOX regimen. Stopping oxaliplatin after 3
to 4 months may prevent harm. If your cancer progresses,
oxaliplatin may be restarted after it has been stopped
because of side effects.
• Irinotecan should be used with caution and in low doses
for patients with Gilbert’s disease or high serum bilirubin.
Chemotherapy may be used alone or with targeted therapy
There is good proof that cetuximab and panitumumab don’t
work if you have a
KRAS
mutation. These targeted therapies
should only be used if you have a normal
KRAS
gene.
Cetuximab and panitumumab appear to have a benefit
when used as a first-line treatment in people with any
BRAF
status. However, there is no good proof to keep
taking either cetuximab or panitumumab on a second-line
regimen if they were used with a first-line regimen. Also, the
doctor won’t use panitumumab after cetuximab failure or
cetuximab after panitumumab failure because these drugs
work in a similar way.
More research is needed to test the safety of bevacizumab
when used with 5-FU. The NCCN Guidelines Panel
suggests not having surgery until 6 weeks after the last
dose of neoadjuvant bevacizumab. Adjuvant bevacizumab
can be started 6 to 8 weeks after surgery.
There is no good proof that continuing bevacizumab on a
second-line regimen will help if it was used with a first-line
regimen. Bevacizumab may increase risk of stroke and
other cardiovascular events if you are 65 years old or older.
It may also reduce your ability to heal from wounds.
Chemotherapy can be given through the hepatic artery
into the liver by an implanted device. There is some proof
that this method may have greater benefits than systemic
chemotherapy, but more research is needed. Not all of the
NCCN Guidelines Panelists agree that implanted devices
should be the standard of care. Instead, the panel suggests
that a hepatic arterial port or implantable pump be used
only in patients with liver metastases treated by doctors
with experience in using such devices.
Principles of systemic therapy
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