NCCN Guidelines for Patients® | Colon Cancer - page 65

65
NCCN Guidelines for Patients™: Colon Cancer
Version 1.2012
Part 7: A step-by-step treatment guide
7.6.3 Conversion therapy for metastases
Conversion treatment for metachronous metastases is based on your history of
chemotherapy. If you’ve had FOLFOX within the past 12 months, your choices for
conversion treatment are limited. If you haven’t have FOLFOX within the past 12
months, you may choose from a longer list of chemotherapy drugs. See
Principles
of systemic therapy
on page 58 for more information. If conversion treatment works,
you may be able to have surgery to remove your metastases. Colectomies are not
done for metachronous metastases. Talk with your doctor about having adjuvant
treatment after surgery.
Notes:
Primary
treatment
Adjuvant
treatment
Conversion
treatment
Chemotherapy
history
If conversion treatment fails, see Part 7.7.
For systemic treatment, see Part 7.7.
For follow-up tests, see Part 7.5.
▪ FOLFIRI ±
bevacizumab or
▪ FOLFIRI ±
cetuximab or
FOLFIRI ±
panitumumab
if normal
KRAS
gene
FOLFOX within
last 12 months
FOLFOX over 12
months ago
Prior 5-FU/LV
Prior capecitabine
No prior chemotherapy
Systemic
treatment for
advanced
cancer
• Systemic
treatment, or
• Observation
Surgical
removal of
metastases
Assess if
surgery is
possible
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