NCCN Guidelines for Patients® | Colon Cancer - page 65

NCCN Guidelines for Patients
®
Colon Cancer, Version 1.2014
63
7
Treatment guide
5-FU and capecitabine pathways
Chart 7.3 5-FU and capecitabine pathways
don’t start with either irinotecan or oxaliplatin.
Instead, you may start with 5-FU/LV given by infusion.
The other option is capecitabine with or without
bevacizumab.
The side effects of 5-FU/LV or capecitabine aren’t
usually as bad as those caused by irinotecan or
oxaliplatin. Thus, if these regimens are too harsh, you
should start supportive care if the cancer grows.
If you get better and then the cancer progresses, you
should try regimens with irinotecan or oxaliplatin. Side
effects of these drugs are discussed in the first two
pathways. 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 oxaliplatin or 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.
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