NCCN Guidelines for Patients® | Colon Cancer - page 66

NCCN Guidelines for Patients
®
Colon Cancer, Version 1.2014
64
7
Treatment guide
FOLFOXIRI pathway
7.4 FOLFOXIRI pathways
Chart 7.4 The FOLFOXIRI pathways
start with
FOLFOXIRI. FOLFIRI may be taken with or without
bevacizumab. You may have worse side effects with
FOLFOXIRI than if you were taking FOXFIRI. Thus,
this pathway is only recommended if the tumor is
likely to shrink enough so surgery would be possible.
If the cancer progresses, regorafenib is an option.
If the
RAS
genes are normal, you may also take
panitumumab or cetuximab with irinotecan. If you’re
unable to take irinotecan, you may take panitumumab
or cetuximab alone.
If these regimens fail, treatment options include
regorafenib, clinical trials, and best supportive care.
Supportive care treats the symptoms of cancer but
not the cancer itself.
Initial treatment
FOLFOXIRI or
FOLFOXIRI + bevacizumab,
1
st
progression
If normal
KRAS
and
NRAS
genes:
– Irinotecan + panitumumab,
– Irinotecan + cetuximab, or
– Panitumumab or cetuximab if unable to
take irinotecan
Regorafenib
2
nd
progression
Regorafenib,
Clinical trial, or
Best supportive care
Chart 7.4 FOLFOXIRI pathways
1...,56,57,58,59,60,61,62,63,64,65 67,68,69,70,71,72,73,74,75,76,...88
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