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35

NCCN Guidelines for Patients

®

:

Rectal Cancer, Version 1.2017

3

Overview of cancer treatments

Targeted therapy

Ramucirumab

Ramucirumab attaches to VEGF receptors on the

outside of endothelial cells. This blocks VEGF from

attaching. No growth signals caused by VEGF are

started.

Ramucirumab is given by infusion. It takes 60

minutes to receive the full dose. Ramucirumab is

always given with chemotherapy. It is given every

two weeks on the first day of chemotherapy.

Common side effects of ramucirumab are high blood

pressure and diarrhea. Serious side effects include

bleeding, blood clots, holes in the gut, abnormal

passage between body parts, and slow wound

healing. Very rarely, brain damage occurs.

Regorafenib

Regorafenib attaches to VEGF receptors on the

inside of endothelial cells. This blocks growth signals

from the receptor. Regorafenib may also attach to

surface receptors within cancer cells and stop growth

signals.

Regorafenib is made as a pill that is taken once

a day. However, it is taken in cycles consisting of

treatment days followed by a period of no treatment.

The cycle for regorafenib consists of 3 weeks of

treatment then 1 week of no treatment. The cycle is

then repeated.

While on regorafenib, you may feel tired or weak. You

may also feel pain including stomach (abdominal)

pain. Other common side effects are diarrhea,

nausea, decreased appetite, and weight loss.

Figure 13

VEGF targeted therapy

Cancer cells need blood to grow.

They send VEGF to endothelial

cells to start the growth of blood

vessels. Regorafenib stops

growth signals within endothelial

cells. Ramucirumab blocks VEGF

from attaching to receptors. Ziv-

aflibercept traps VEGF by being

a receptor decoy. Bevacizumab

disables VEGF from attaching to

receptors.

Copyright © 2017 National Comprehensive Cancer Network

®

(NCCN

®

).

www.nccn.org

endothelial cell

ramucirumab

ziv-aflibercept

P

regorafenib

bevacizumab

VEGF

VEGF

VEGF