NCCN Guidelines for Patients® | Colon Cancer - page 61

NCCN Guidelines for Patients
®
Colon Cancer, Version 1.2014
59
Chart 7.1 Oxaliplatin pathways
start with
oxaliplatin. You may start with either FOLFOX
or CapeOX. Bevacizumab may be added either
chemotherapy regimen or if the
RAS
genes are
normal, panitumumab.
Oxaliplatin in the FOLFOX or CapeOX regimens can
harm your nervous system. Stopping oxaliplatin—
but not the other drugs—after 3 months of use may
prevent harm. Keep taking the other drugs for 6
months. If the cancer grows (progresses), oxaliplatin
may be restarted if it was stopped because of side
effects. You should only restart if the side effects stop.
Capecitabine in the CapeOx regimen can also
cause a side effect known as hand-foot syndrome.
Symptoms include redness, swelling, and pain on
the palms of the hands, bottoms of feet, or both.
Sometimes blisters appear. Your dose of capecitabine
may be changed at the earliest signs of hand-foot
syndrome.
The oxaliplatin regimens may not prevent the cancer
from growing. If this happens, you may start to take
irinotecan regimens. If the
RAS
genes are normal,
you may also take panitumumab or cetuximab.
If panitumumab or cetuximab don’t work the first time,
there is no good proof to keep taking them. Also, your
doctor won’t use panitumumab after cetuximab failure
or cetuximab after panitumumab failure because
these drugs work in a similar way.
If oxaliplatin and irinotecan regimens fail, treatment
options include regorafenib, clinical trials, and best
supportive care. Supportive care treats the symptoms
of cancer but not the cancer itself.
7
Treatment guide
Oxaliplatin pathways
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