NCCN Guidelines for Patients® | Colon Cancer - page 62

NCCN Guidelines for Patients
®
Colon Cancer, Version 1.2014
60
7
Treatment guide
Irinotecan pathways
7.2 Irinotecan pathways
1
st
progression
FOLFOX,
FOLFOX + bevacizumab,
CapeOX
, or
CapeOX + bevacizumab
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,
– Irinotecan + panitumumab
*
,
– Irinotecan + cetuximab
*
, or
– Panitumumab
*
or cetuximab
*
if unable to
take irinotecan
2
nd
progression
FOLFOX, or
CapeOX
3
rd
progression
Regorafenib,
Clinical trial, or
Best supportive care
*
Panitumumab and cetuximab should not be given if received before and didn’t work.
Initial treatment
FOLFIRI,
FOLFIRI + bevacizumab, or
If normal
KRAS
and
NRAS
genes:
– FOLFIRI + panitumumab or
– FOLFIRI + cetuximab
Chart 7.2
Irinotecan pathways
1...,52,53,54,55,56,57,58,59,60,61 63,64,65,66,67,68,69,70,71,72,...88
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