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NCCN Guidelines for Patients


Stomach Cancer, Version 1.2016

NCCN Guidelines for Patients


Stomach Cancer, Version 1.2016

Figure 14.

VEGF targeted therapy

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.

endothelial cell




Overview of cancer treatments Targeted therapy

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 stomach cancer targets either









actor) or HER2.

These treatments are briefly described next. Some

side effects are listed. Ask your treatment team for

a full list of common and rare side effects. In Part 5,

information on who should receive these drugs is


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


VEGF is made by cancer cells. It travels from cancer

cells to endothelial cells, which form blood vessels.

VEGF attaches to surface receptors on the outside

of endothelial cells. Surface receptors are proteins

within cell membranes that extend from the inside to

the outside of cells. Attachment of VEGF to receptors

triggers growth signals. Ramucirumab is a medicine

that targets VEGF.


Ramucirumab attaches to VEGF receptors on the

outside of endothelial cells.

See Figure 14

. 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



Overview of cancer treatments Chemotherapy

Side effects of chemotherapy

Side effects of chemotherapy depend on many

factors. These factors include the drug type, amount

taken, length of treatment, and the person. Some

people have many side effects. Others have few.

Some side effects can be very serious while others

can be unpleasant but not serious. Most side effects

appear shortly after treatment starts and will stop after

treatment. However, other side effects are long-term

or may appear years later.

In general, most side effects are caused by the death

of fast-growing cells. These cells are found in the

blood, gut, hair follicles, and mouth. Thus, common

side effects include low blood cell counts, not feeling

hungry, nausea, vomiting, diarrhea, hair loss, and

mouth sores. Your nails may also change in color,

strength, dryness, and smoothness.

Another common side effect of some chemotherapy

drugs is sensory neuropathy. Sensory neuropathy

is damage to sensory nerves. It can be caused by

oxaliplatin, paclitaxel, docetaxel, and 5-FU.

Symptoms of sensory neuropathy include numbness,

tingling, and pain in fingers and toes. You may also

have sensitivity to cold and pain to light touch. It may

take months or years for symptoms to resolve. For

some people, sensory neuropathy is permanent. Talk

with your doctor about ways to prevent or reduce the

symptoms of sensory neuropathy.

Not all side effects of chemotherapy are listed here.

Please ask your treatment team for a complete list of

common and rare side effects. If a side effect bothers

you, tell your treatment team. There may be ways to

help you feel better.

Copyright © 2016 National Comprehensive Cancer Network® (NCCN®).

Complementary and alternative medicine



omplementary and




edicine) is a group of treatments that

aren’t often given by doctors. There is much interest today in CAM for cancer.

Many CAMs are being studied to see if they are truly helpful.

Complementary medicines are treatments given along with usual medical

treatments. While CAMs aren’t known to kill cancer cells, they may improve

your comfort and well-being. Two examples are acupuncture for pain

management and yoga for relaxation.

Alternative medicine is used in place of usual medicine. Some alternative

medicines are sold as cures even though they haven’t been proven to work. If

there was good proof that CAMs or other treatments cured cancer, they would

be included in this book.

It is important to tell your treatment team if you are using any CAMs. They

can tell you which CAMs may be helpful and which CAMs may limit how well

medical treatments work.