NCCN Guidelines for Patients® | Colon Cancer - page 63

NCCN Guidelines for Patients
®
Colon Cancer, Version 1.2014
61
7
Treatment guide
Irinotecan pathways
Chart 7.2 Irinotecan pathways
start with
irinotecan. You may start taking FOLFIRI with or
without bevacizumab. If the
RAS
genes are normal,
you may take FOLFIRI with or without panitumumab
or cetuximab.
Irinotecan should be used with caution and at a low
dose if you have Gilbert’s disease. Gilbert’s disease
is a health problem that people are born with. The
disease impairs the liver from correctly processing
bilirubin. This advice for irinotecan also applies if you
have high bilirubin levels in your blood for any reason.
The irinotecan regimens may not prevent the cancer
from growing. If this happens, you may start to take
oxaliplatin regimens. If the
RAS
genes are normal,
you may also take panitumumab or cetuximab.
If cetuximab or panitumumab 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 irinotecan and oxaliplatin regimens fail, treatment
options include regorafenib, clinical trials, and best
supportive care. Supportive care treats the symptoms
of cancer but not the cancer itself.
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