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61

NCCN Guidelines for Patients

®

:

Colon Cancer, Version 1.2017

6

Chemotherapy

Least toxic regimens

|

Review

Least toxic regimens

Guide 20

lists regimens that are likely to be the

least harmful to you. Infusional 5-FU/LV is an option.

5-FU has fewer severe side effects when given by

infusion rather than bolus. Another option is to take

capecitabine with or without bevacizumab.

Cetuximab or panitumumab may be an option. These

drugs treat tumors with normal

RAS

genes that are in

the left side of the colon. Neither drug is likely to work

if a

BRAF V600E

mutation is present.

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

option. If these drugs don’t work, your next options

include other second-line options listed above.

If treatment works, you may find that you are able to

do more activities. In this case, the regimens listed

in the prior sections may be options. Otherwise,

supportive care may give you relief from symptoms.

Review

†

†

There are five pathways used to treat advanced

colon cancer.

†

†

The oxaliplatin pathway starts with either

FOLFOX or CAPEOX.

†

†

The irinotecan pathway starts with FOLFIRI.

†

†

The FOLFOXIRI pathway starts with both

oxaliplatin and irinotecan.

†

†

The 5-FU/LV and capecitabine pathway starts

with intense but less harsh regimens.

†

†

The least toxic pathway starts with regimens

likely to be the least harmful to you.

Guide 20. Least toxic pathway

What are first-line options?

• Infusional 5-FU/LV ± bevacizumab

• Capecitabine ± bevacizumab

• Cetuximab or panitumumab for left-sided tumors

with normal

KRAS/NRAS

genes

• Pembrolizumab or nivolumab if dMMR or MSI-H

What are second-line options?

• More intense chemotherapy

• Supportive care