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NCCN Guidelines for Patients



Colon Cancer, Version 1.2017


Metastatic disease

Metastases at diagnosis

Guide 12

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




genes. However,

these drugs won’t likely work if the tumor has a



mutation. Surgery before chemotherapy may

be done only to relieve symptoms.

After chemotherapy

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

for options.

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