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34

NCCN Guidelines for Patients

®

:

Rectal Cancer, Version 1.2017

Targeted therapy

Targeted therapy is a class of drugs that stops the

action of molecules that help cancer cells grow. It is

less likely to harm normal cells than chemotherapy.

Targeted therapy for rectal cancer targets either the

VEGF (

v

ascular

e

ndothelial

g

rowth

f

actor) or EGFR

(

e

pidermal

g

rowth

f

actor

r

eceptor) pathway. Targeted

therapy used for rectal cancer is listed in

Guide 3

.

Targeted therapies are briefly described next. Some

side effects are listed. Ask your treatment team for

a full list of common and rare side effects. In Parts 4

through 6, information on who should receive these

drugs is provided.

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 is one of the

molecules that triggers the growth of these blood

vessels.

VEGF is made by cancer cells. It travels from cancer

cells to endothelial cells. Endothelial cells form blood

vessels.

Surface receptors are proteins within cell membranes

that extend from the inside to the outside of cells.

VEGF attaches to surface receptors on the outside

of endothelial cells. Attachment of VEGF to receptors

triggers growth signals. There are four 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 13

. 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 given with

chemotherapy. It is given every two or three 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,

holes in the gut, abnormal passage between body

parts, and bleeding. Very rarely, brain damage

occurs.

3

Overview of cancer treatments

Targeted therapy

Guide 3. Targeted therapy

Generic (chemical) name

Brand name (sold as)

Bevacizumab

Avastin

®

Cetuximab

Erbitux

®

Panitumumab

Vectibix

®

Ramucirumab

Cyramza

®

Regorafenib

Stivarga

®

Ziv-aflibercept

Zaltrap

®