NCCN Guidelines for Patients
Colon Cancer, Version 1.2017
Metastases at recurrence
another option. However, NCCN experts prefer
surgery over local therapy.
Results of primary treatment should be assessed
with CT with contrast. Scans of your chest, abdomen,
and pelvis are needed. Imaging should be done prior
to adjuvant treatment.
Adjuvant treatment is based on the success of
neoadjuvant treatment. If neoadjuvant chemotherapy
worked, you may re-start that treatment or take
FOLFOX. Together, chemotherapy given before and
after surgery should not exceed 6 months. A third
option is observation.
If neoadjuvant treatment didn’t work, you may
have two options. One option is chemotherapy.
Targeted therapy may be added but more research
is needed. Regimens are listed in Part 6. Six months
of chemotherapy is preferred. The second option is
HAI ± 5-FU/LV
Instead of systemic chemotherapy, HAI may be an
option. Systemic 5-FU/LV may be added. NCCN
experts advise that this option should only be
received at treatment centers with much experience
in this method. More research is needed to learn how
well this treatment works.
lists nonsurgical options for liver or lung
metastases present at recurrence. Options are based
on your history of chemotherapy. Options for people
who had FOLFOX or CAPEOX in the past 12 months
are explained below. Options for everyone else are
listed in Part 6.
FOLFOX or CAPEOX ≥12 months
Two options are FOLFIRI and irinotecan. Targeted
therapy may be added. Bevacizumab is preferred
but other options are ziv-aflibercept or ramucirumab.
If the tumor has normal
options are to add panitumumab or cetuximab to
chemotherapy. However, these drugs won’t likely
work if the tumor has a
The cancer cells may have a dMMR system or
MSI-H. The MMR system is explained in Part 2. In
this case, nivolumab or pembrolizumab may be an
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