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NCCN Guidelines for Patients



Colon Cancer, Version 1.2017

VEGF pathway

Cancer cells need the food and oxygen in blood to

grow. Cancer cells get blood from blood vessels

that have grown into the tumor. VEGF is one of the

molecules that triggers the growth of these blood


VEGF is made by cancer cells. It travels from cancer

cells to endothelial cells. Endothelial cells form blood


Surface receptors are proteins within cell membranes

that extend from the inside to the outside of cells.

VEGF attaches to surface receptors on the outside

of endothelial cells. Attachment of VEGF to receptors

triggers growth signals. There are four medicines

used to stop the growth signals caused by VEGF.


Bevacizumab attaches to VEGF before it attaches to

receptors on endothelial cells.

See Figure 11

. As

a result, VEGF can’t attach to receptors. No growth

signals caused by VEGF are started.

Bevacizumab is given by infusion. It takes about

90 minutes to get the first dose and 30 minutes

for later doses. Bevacizumab is always given with

chemotherapy. It is given every two or three weeks

depending on the chemotherapy.

Common side effects of bevacizumab are high blood

pressure, diarrhea, and feeling tired and weak. You

might also have nosebleeds, shortness of breath,

nausea, and vomiting. Rare but serious side effects

include stroke, heart attack, kidney damage, holes in

the intestine, and bleeding within the body.


Overview of cancer treatments

Targeted therapy

Figure 11

VEGF targeted therapy

Cancer cells need blood to grow.

They send VEGF to endothelial

cells to start the growth of blood

vessels. Regorafenib stops

growth signals within endothelial

cells. Ramucirumab blocks VEGF

from attaching to receptors. Ziv-

aflibercept traps VEGF by being

a receptor decoy. Bevacizumab

disables VEGF from attaching to


endothelial cell









Copyright © 2017 National Comprehensive Cancer Network