NCCN Guidelines for Patients
Colon Cancer, Version 1.2017
Overview of cancer treatments
Ramucirumab attaches to VEGF receptors on the
outside of endothelial cells. This blocks VEGF from
attaching. No growth signals caused by VEGF are
Ramucirumab is given by infusion. It takes 60
minutes to receive the full dose. Ramucirumab is
always given with chemotherapy. It is given every
two weeks on the first day of chemotherapy.
Common side effects of ramucirumab are high blood
pressure and diarrhea. Serious side effects include
bleeding, blood clots, holes in the gut, abnormal
passage between body parts, and slow wound
Regorafenib attaches to VEGF receptors on the
inside of endothelial cells. This blocks growth signals
from the receptor. Regorafenib may also attach to
surface receptors within cancer cells and stop growth
Regorafenib is made as a pill that is taken once
a day. However, it is taken in cycles consisting of
treatment days followed by a period of no treatment.
The cycle for regorafenib consists of 3 weeks of
treatment then 1 week of no treatment. The cycle is
Common side effects of regorafenib include feeling
tired or week, fever, and diarrhea. Your hands
and feet may become red and have pain. This
is called hand-foot skin reaction. It is important
to remove calluses on hands and feet before
starting regorafenib. Rare but serious side effects
of regorafenib include severe liver damage, heart
attack, and blindness.
Ziv-aflibercept works by acting as a decoy. VEGF
thinks ziv-aflibercept is a surface receptor and
attaches to it. Thus, ziv-aflibercept traps VEGF so
it is unable to bind to the real receptor. Hence its
other name is VEGF-trap. By trapping VEGF, growth
signals caused by VEGF within endothelial cells
won’t be started.
Ziv-aflibercept is given by infusion in about 1 hour
every two weeks. Ziv-aflibercept is given with
Common side effects include diarrhea, mouth sores,
high blood pressure, feeling tired, voice changes,
and nose bleeds. You may also experience blood
clots, urinary tract infection, and darkening of the
skin. Rare but serious side effects include stroke,
holes in the intestine, bleeding in the brain or lungs,
and kidney damage.
Cell growth is started by growth signals. EGFR is one
of the surface receptors in colon cancer cells that can
trigger growth signals. When EGF (
actor) attaches to EGFR, the chemical pathway that
sends growth signals is turned on.
Some people with colon cancer have abnormal
changes in their gene that controls EGFRs. These
changes cause the cancer cells to have too many
EGFRs. For a small group of people, the EGFRs
may be overactive.
With too many or overactive EGFRs, new cancer
cells form quickly. There are two medicines used
to block the growth signals from EGFRs.
. These medicines don’t work if the cancer
cells have mutations in
Cetuximab treats colon cancer by attaching to the
ends of EGFRs that are outside of the cell. Thus,
EGF is blocked from attaching and triggering growth
signals. Cetuximab also attracts immune cells that
help to kill the cancer cells.