NCCN Guidelines for Patients® | Colon Cancer - page 64

NCCN Guidelines for Patients
®
Colon Cancer, Version 1.2014
62
7
Treatment guide
5-FU and capecitabine pathways
7.3 5-FU and capecitabine pathways
1
st
progression
FOLFOX,
FOLFOX + bevacizumab,
CapeOX, or
CapeOX + bevacizumab
2
nd
progression
Irinotecan
3
rd
progression
If normal
KRAS
and
NRAS
genes:
– Irinotecan + panitumumab,
– Irinotecan + cetuximab, or
– Panitumumab or cetuximab if
unable to take irinotecan
Regorafenib
4
th
progression
Regorafenib,
Clinical trial, or
Best supportive care
1
st
progression
Irinotecan + oxaliplatin, or
Irinotecan + oxaliplatin +
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
Irinotecan,
Irinotecan + bevacizumab,
Irinotecan + ziv-aflibercept,
FOLFIRI,
FOLFIRI + bevacizumab,
FOLFIRI + ziv-aflibercept
2
nd
progression
FOLFOX or
CapeOX
3
rd
progression
If normal
KRAS
and
NRAS
genes:
– Irinotecan + panitumumab,
– Irinotecan + cetuximab, or
– Panitumumab or cetuximab if
unable to take irinotecan
Regorafenib
4
th
progression
Regorafenib,
Clinical trial, or
Best supportive care
Chart 7.3.1
5-FU and capecitabine
pathways
Initial treatment
Infusional 5-FU/LV,
Capecitabine, or
Capecitabine + bevacizumab
1...,54,55,56,57,58,59,60,61,62,63 65,66,67,68,69,70,71,72,73,74,...88
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