NCCN Guidelines for Patients® | Lung Cancer - Non-Small Cell Lung Cancer

54 NCCN Guidelines for Patients ® : Lung Cancer – Non-Small Cell, 2018 5 Overview of cancer treatments Targeted therapy Serious side effects include allergic or skin reactions, heart problems, liver or kidney damage, and eye problems. VEGF pathway Cancer cells need the food and oxygen in blood to grow. Cancer cells get blood from blood vessels that have grown into the tumor. VEGF ( v ascular e ndothelial g rowth f actor) is one of the molecules that triggers the growth of these blood vessels. Unlike other biomarkers, VEGF is not mutated. However, it plays a role in most lung cancers. VEGF is made by cancer cells. It travels from cancer cells to endothelial cells. Endothelial cells form blood vessels. VEGF attaches to surface receptors on the outside of endothelial cells. Attachment of VEGF to surface receptors triggers growth signals. There are two medicines used to stop the growth signals caused by VEGF. Bevacizumab Bevacizumab attaches to VEGF before it attaches to receptors on endothelial cells. See Figure 19 . As a result, VEGF can’t attach to receptors. No growth signals caused by VEGF are started. Bevacizumab is given by infusion. It takes about 90 minutes to get the first dose and 30 minutes for later doses. Bevacizumab is always first given with chemotherapy and after 4 to 6 treatments, may be given alone to maintain good results. It is given every 2 or 3 weeks depending on the chemotherapy. Common side effects of bevacizumab are high blood pressure, nosebleeds, and headache. You might also have a runny nose, protein in the urine, and rectal bleeding. Rare but serious side effects include stroke, heart attack, blood clots, kidney damage, a tear in your gut, abnormal passage between body parts, and bleeding. Very rarely, brain damage occurs. Don’t take bevacizumab if you are pregnant, trying to get pregnant, or breastfeeding. Figure 19 VEGF target Cancer cells need blood to grow. They send VEGF to endothelial cells to start the growth of blood vessels. Ramucirumab blocks VEGF from attaching to receptors. Bevacizumab disables VEGF from attaching to receptors. endothelial cell VEGF bevacizumab ramucirumab VEGF Copyright © 2017 National Comprehensive Cancer Network ® (NCCN ® ).