NCCN Guidelines for Patients
Colon Cancer, Version 1.2017
Metastases at diagnosis
lists nonsurgical options for liver or lung
metastases present at diagnosis. Chemotherapy with
or without bevacizumab is advised. Panitumumab or
cetuximab should only be used for left-sided tumors
that have normal
these drugs won’t likely work if the tumor has a
mutation. Surgery before chemotherapy may
be done only to relieve symptoms.
For some people, chemotherapy may greatly
shrink the tumors. If they shrink enough, surgery
to cure the cancer may be an option. Most people
with metastatic colon cancer won’t be able to have
surgery. If surgery is possible, tests to assess the
tumor size are advised every two months during
Bevacizumab should be stopped 6 weeks before
surgery. It increases your chance for a stroke,
bleeding, and other arterial events. These events
are even more likely if you are older than 65 years.
Bevacizumab can be re-started 6 to 8 weeks after
surgery. Otherwise, it can slow healing.
After surgery, more chemotherapy is advised.
Chemotherapy received before and after surgery
should not exceed 6 months. Targeted therapy may
be added but more research is needed. Read Part 6
Talk to your doctor about other options after surgery.
You may be able to start follow-up care. Another
option may be a short course of chemotherapy.
Guide 12. Nonsurgical treatment
What are the options?
• FOLFIRI ± bevacizumab
• FOLFOX ± bevacizumab
• CAPEOX ± bevacizumab
• FOLFOXIRI ± bevacizumab
• For left-sided tumors with normal
◦◦ FOLFIRI + panitumumab
◦◦ FOLFIRI + cetuximab
◦◦ FOLFOX + panitumumab