NCCN Guidelines for Patients
Rectal Cancer, Version 1.2017
Overview of cancer treatments
Ramucirumab attaches to VEGF receptors on the
outside of endothelial cells. This blocks VEGF from
attaching. No growth signals caused by VEGF are
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 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
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
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.
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
Copyright © 2017 National Comprehensive Cancer Network