NCCN Guidelines for Patients® | Colon Cancer - page 60

NCCN Guidelines for Patients
®
Colon Cancer, Version 1.2014
58
7
Treatment guide
Oxaliplatin pathways
7.1 Oxaliplatin pathways
1
st
progression
FOLFIRI,
FOLFIRI + bevacizumab,
FOLFIRI + ziv-aflibercept,
Irinotecan,
Irinotecan + bevacizumab, or
Irinotecan +
ziv-aflibercept
2
nd
progression
If normal
KRAS
and
NRAS
genes:
– Irinotecan + panitumumab,
– Irinotecan + cetuximab, or
– Panitumumab or cetuximab if unable to
take irinotecan
Regorafenib
3
rd
progression
Regorafenib,
Clinical trial, or
Best supportive care
1
st
progression
If normal
KRAS
and
NRAS
genes:
– Follow pathway on left,
– FOLFIRI + panitumumab,
– FOLFIRI + cetuximab,
– Irinotecan + panitumumab, or
– Irinotecan + cetuximab
2
nd
progression
Regorafenib,
Clinical trial, or
Best supportive care
Initial treatment
FOLFOX,
FOLFOX + bevacizumab,
CapeOX,
CapeOX + bevacizumab, or
If normal
KRAS
and
NRAS
genes:
– FOLFOX + panitumumab
Chart 7.1
Oxaliplatin pathways
1...,50,51,52,53,54,55,56,57,58,59 61,62,63,64,65,66,67,68,69,70,...88
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