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We can connect you with trained cancer information specialists who will answer questions about a cancer diagnosis and provide guidance and a compassionate ear. We connect patients, caregivers, and family members with essential services and resources at every step of their cancer journey. Ask us how you can get involved and support the fight against cancer. Some of the topics we can assist with include:. Colorectal Cancer. As researchers learn more about changes in cells that cause colon or rectal cancer, they have developed new types of drugs to specifically target these changes. Targeted drugs work differently from chemotherapy chemo drugs. They can be used either along with chemo, by themselves, or in combination with another targeted therapy drug. Like chemotherapy, these drugs enter the bloodstream and reach almost all areas of the body, which makes them useful against cancers that have spread to distant parts of the body. Vascular endothelial growth factor VEGF is a protein that helps tumors form new blood vessels a process known as angiogenesis to get nutrients they need to grow. Drugs that stop VEGF from working can be used to treat some colon or rectal cancers. These include:. Most of these drugs are given as infusions into your vein IV every 2 or 3 weeks, in most cases along with chemotherapy. Fruquinitinib is given as a capsule and not combined with chemotherapy. These drugs can often help people with advanced colon or rectal cancers live longer. Rare but possibly serious side effects include blood clots, severe bleeding, holes forming in the colon called perforations , heart problems, kidney problems, and slow wound healing. If a hole forms in the colon, it can lead to severe infection and surgery may be needed to fix it. Another rare but serious side effect of these drugs is an allergic reaction during the infusion, which could cause problems with breathing and low blood pressure. Epidermal growth factor receptor EGFR is a protein that helps cancer cells grow. The combination of these two drugs appears to help people with advanced colorectal cancer live longer. The most common side effects of these drugs are skin problems such as an acne-like rash on the face and chest during treatment, which can sometimes lead to infections. Developing this rash often means the cancer is responding to treatment. People who develop this rash often live longer, and those who develop more severe rashes also seem to respond better than those with a milder rash. Other side effects can include:. A rare but serious side effect of these drugs is an allergic reaction during the infusion, which could cause problems with breathing and low blood pressure. You may be given medicine before treatment to help prevent this. Other serious but rare serious side effects include eye, heart, or lung damage. A small portion of colorectal cancers have changes mutations in the BRAF gene. Colorectal cancer cells with these changes make an abnormal BRAF protein that helps them grow. Some drugs target this abnormal BRAF protein. When given with cetuximab or panitumumab, an EGFR inhibitor see above , this drug can shrink or slow the growth of colorectal cancer in some people whose cancer has spread. The combination of these two drugs also appears to help people with advanced colorectal cancer live longer. Common side effects of encorafenib, in combination with an EGFR inhibitor, can include skin thickening, diarrhea, rash, loss of appetite, abdominal pain, joint pain, fatigue, and nausea. Some people treated with a BRAF inhibitor might develop new squamous cell skin cancers. These cancers can often be treated by removing them. Still, your doctor will want to check your skin regularly during treatment and for several months afterward. You should also let your doctor know right away if you notice any new growths or abnormal areas on your skin. In a small percentage of people with colorectal cancer, the cancer cells have too much of a growth-promoting protein called HER2 on their surface. Drugs that target the HER2 protein can often be helpful in treating these cancers. For advanced, HER2-positive colorectal cancer that has already been treated with chemotherapy, the most common targeted drug regimens include trastuzumab plus either tucatinib, lapatinib, or pertuzumab. Among these drugs, only tucatinib is FDA approved specifically to treat colorectal cancer at this time, but the others are present in treatment guidelines. The side effects of HER2-targeted drugs tend to be mild overall, but some can be serious, and different drugs can have different possible side effects. Discuss what you can expect with your doctor. Some of these drugs can cause heart damage during or after treatment, which might lead to congestive heart failure. Because of this, your doctor will likely check your heart function with an echocardiogram or a MUGA scan before treatment, and regularly while you are getting any of these drugs. Let your doctor know if you develop symptoms, such as shortness of breath, a fast heartbeat, leg swelling, and severe fatigue. Lapatinib and tucatinib can also cause hand-foot syndrome , in which the hands and feet become sore and red, and may blister and peel. Lapatinib and tucatinib can cause liver problems. Your doctor will do blood tests to check your liver function during treatment. Let your health care team know right away if you have possible signs or symptoms of liver problems, such as itchy skin, yellowing of the skin or the white parts of your eyes, dark urine, or pain in the right upper belly area. Fam-trastuzumab deruxtecan can cause serious lung disease in some people, which might even be life threatening. A very small number of colorectal cancers have changes in one of the NTRK genes. This causes them to make abnormal TRK proteins, which can lead to abnormal cell growth and cancer. These drugs can be used to treat advanced cancers with NTRK gene changes that are still growing despite other treatments. Common side effects of these drugs can include dizziness, fatigue, nausea, vomiting, constipation, weight gain, and diarrhea. Less common but serious side effects can include abnormal liver tests, increased risk for fractures, heart problems, vision changes, and confusion. A very small number of colorectal cancers have changes in one of the RET genes. This causes them to make abnormal RET proteins, which can lead to abnormal cell growth and cancer. Selpercatinib Retevmo is a drug that targets the RET protein. These drugs can be used to treat advanced cancers with RET gene changes that are still growing despite other treatments. This drug is approved to treat other types of cancer, but doctors can prescribe it off-label for colorectal cancer. Common side effects of these drugs can include decrease in white blood cell count and calcium, changes in liver function tests, high blood pressure, fatigue, changes in kidney function, and increased cholesterol. Less common but serious side effects can include abnormal heart function QT interval prolongation , bleed, allergic reaction, and inability to heal from a wound. This causes them to make abnormal KRAS proteins, which can lead to continued cell growth and cancer. Sotorasib is not approved specifically to treat colorectal cancer at this time. It is approved to treat other types of cancer, but doctors can prescribe them off-label for colorectal cancer. Common side effects of these drugs can include nausea, vomiting, diarrhea, muscle and joint pain, fatigue, decreased appetite, and changes in liver and kidney function. Less common but serious side effects can include effects to the heart QTc interval prolongation , liver, and lungs interstitial lung disease. Regorafenib Stivarga is a type of targeted therapy known as a multikinase inhibitor. Regorafenib blocks several kinase proteins that either help tumor cells grow or help form new blood vessels to feed the tumor. Blocking these proteins can help stop the growth of cancer cells. This drug can be used to treat advanced colorectal cancer, typically when other drugs are no longer helpful. Common side effects include fatigue, rash, hand-foot syndrome redness and irritation of the hands and feet , diarrhea, high blood pressure, weight loss, and abdominal pain. Less common but more serious side effects can include confusion, severe bleeding, or perforations holes in the stomach or intestines. To learn more about how targeted drugs are used to treat cancer, see Targeted Cancer Therapy. To learn about some of the side effects listed here and how to manage them, see Managing Cancer-related Side Effects. The American Cancer Society medical and editorial content team. Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as editors and translators with extensive experience in medical writing. Kelly SR and Nelson H. Chapter 75 — Cancer of the Rectum. Philadelphia, Pa. Elsevier: Chapter 74 — Colorectal Cancer. Ch 62 - Cancer of the Colon. Ch 63 - Cancer of the Rectum. National Cancer Institute. Colon Cancer Treatment. Rectal Cancer Treatment. Int J Mol Sci. American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy. Sign up to stay up-to-date with news, valuable information, and ways to get involved with the American Cancer Society. If this was helpful, donate to help fund patient support services, research, and cancer content updates. Skip to main content. Sign Up For Email. Sign Up For Text Messages. Understanding Cancer What Is Cancer? Cancer Glossary Anatomy Gallery. Patient Navigation. End of Life Care. When Your Child Has Cancer. For Health Professionals. Cancer News. Explore All About Cancer. Resource Search. Explore Ways to Give. Making Strides Against Breast Cancer. Explore Get Involved. Explore Our Research. Explore About Us. Contact Us Online Help. Chat live online Select the Live Chat button at the bottom of the page. Call us at Available any time of day or night. Some of the topics we can assist with include: Referrals to patient-related programs or resources Donations, website, or event-related assistance Tobacco-related topics Volunteer opportunities Cancer Information For medical questions, we encourage you to review our information with your doctor. Colorectal Cancer About Colorectal Cancer. Download Section as PDF. Targeted Therapy Drugs for Colorectal Cancer. On this page. When is targeted therapy used? Several types of targeted drugs might be used to treat colorectal cancer. Drugs that target blood vessel formation VEGF Vascular endothelial growth factor VEGF is a protein that helps tumors form new blood vessels a process known as angiogenesis to get nutrients they need to grow. These include: Bevacizumab Avastin Ramucirumab Cyramza Ziv-aflibercept Zaltrap Fruquintinib Fruzaqla Most of these drugs are given as infusions into your vein IV every 2 or 3 weeks, in most cases along with chemotherapy. Possible side effects of drugs that target VEGF Common side effects of these drugs include: High blood pressure Protein in the urine Bleeding from the nose or rectum Headaches Taste changes Skin changes Rare but possibly serious side effects include blood clots, severe bleeding, holes forming in the colon called perforations , heart problems, kidney problems, and slow wound healing. These include: Cetuximab Erbitux Panitumumab Vectibix Both of these drugs are given by IV infusion, either once a week or every other week. Possible side effects of drugs that target EGFR The most common side effects of these drugs are skin problems such as an acne-like rash on the face and chest during treatment, which can sometimes lead to infections. Other side effects can include: Headache Tiredness Fever Diarrhea A rare but serious side effect of these drugs is an allergic reaction during the infusion, which could cause problems with breathing and low blood pressure. This drug is taken as capsules, once a day. Drugs that target cells with HER2 changes In a small percentage of people with colorectal cancer, the cancer cells have too much of a growth-promoting protein called HER2 on their surface. Drugs of this type that might be used to treat HER2-positive colorectal cancer include: Trastuzumab Herceptin, other names Pertuzumab Perjeta Tucatinib Tukysa Lapatinib Tykerb Fam-trastuzumab deruxtecan Enhertu, T-DXd For advanced, HER2-positive colorectal cancer that has already been treated with chemotherapy, the most common targeted drug regimens include trastuzumab plus either tucatinib, lapatinib, or pertuzumab. These drugs are taken as pills or an oral solution, once or twice daily. This drug is taken as a capsule twice daily. These drugs are taken as tablets, once or twice daily. Other targeted therapy drugs Regorafenib Stivarga is a type of targeted therapy known as a multikinase inhibitor. More information about targeted therapy To learn more about how targeted drugs are used to treat cancer, see Targeted Cancer Therapy. Written by References. The American Cancer Society medical and editorial content team Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as editors and translators with extensive experience in medical writing. Last Revised: June 28, American Cancer Society Emails Sign up to stay up-to-date with news, valuable information, and ways to get involved with the American Cancer Society. Sign Up for Email. More in Colorectal Cancer. Help us end cancer as we know it, for everyone. Donate with Confidence. Donate Now Maybe Later.

Targeted Therapy Drugs for Colorectal Cancer

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Official websites use. Share sensitive information only on official, secure websites. Correspondence to Cameron Douglas Brown, cameronbrown nhs. A year-old female heroin addict presented with a peritonitic and distended abdomen. Her medical history included depression and a 3-year history of heroin abuse with attendant constipation. CT scan showed free intraperitoneal gas, massive faecal distension of the rectum and sigmoid colon and likely bowel necrosis. She underwent an emergency Hartmann's procedure for perforation of the sigmoid colon. Pathology identified two areas of stercoral ulceration, one of them being the area of perforation. Postoperatively, the patient developed a deep vein thrombosis and is now on anticoagulant therapy. She was discharged 4 weeks after admission. The patient has been reviewed at follow-up clinic by the surgical team and specialist stoma nurses. She is coping well with good stoma function. We will perform a colonoscopy to identify any further areas of stercoral ulceration but there are no plans for further surgery at present. Stercoral perforation of the colon was first reported by Berry in Stercoral ulceration ensues culminating in eventual perforation. Aetiologies implicated in faecaloma development can be separated into chronic constipation, anatomical anorectal abnormalities and functional anorectal abnormalities. The incidence of stercoral perforation is 3. Due to the rarity of stercoral perforation in a heroin addict, we will discuss the presentation, benefits of preoperative imaging, surgical technique and pathology herein. A year-old woman was transferred by air ambulance from a rural hospital to our tertiary referral centre with an acute abdomen with a 1-week history of worsening abdominal pain. There was a hour history of worsening vomiting. There was no history of chronic constipation since childhood. Despite being prescribed sufficient laxatives, poor compliance with prescription medication was noted. On examination, the abdomen was both distended and peritonitic. Blood results demonstrated an inflammatory process white cell count 8. A femoral arterial line, catheter and nasogastric NG tube were inserted. Chest X-ray revealed no subdiaphragmatic air. Invasive monitoring and aggressive resuscitation took place and thereafter the patient was transferred to theatre via the CT scanner. CT scanning of the abdomen and pelvis confirmed the presence of free intraperitoneal fluid and gas, indicating a perforated viscus and massive faecal distension of the rectum and sigmoid colon figures 1 and 2. Portal venous gas was noted within the liver indicating likely concomitant bowel necrosis. The patient was taken to theatre for an emergency laparotomy. On entering the abdomen, a significant volume of faeculent fluid was noted. A pinhole perforation was identified anteriorly, low in the sigmoid colon just proximal to the peritoneal reflection. It was surrounded by a halo of pressure necrosis. This was borne out in the subsequent histopathology report. Left ureteric obstruction was evident, secondary to the mass effect from faecal loading of the rectum and colon. A standard emergency Hartmann's procedure was therefore undertaken. Histological examination demonstrated the rectum and sigmoid colon with a normal intrinsic architecture including normal ganglionic innervation figure 5. The areas of ulceration demonstrated full thickness haemorrhagic necrosis with fissuring ulceration figure 6. Granulomas and evidence of vasculitis are not identified. Ganglion cell identified by arrow. Broad-spectrum intravenous antibiotic therapy was instituted on the first assessment and tailored following advice from microbiology and bacterial sensitivites. Patient-controlled analgesia morphine was required for pain control and NG tube feeding was initiated until her stoma was active. The patient had a prolonged postoperative ileus as well as developed a deep vein thrombosis. This was treated with dalteparin during admission with apixaban for 6 months thereafter. The patient was discharged 4 weeks postoperatively and remains well at follow-up clinic, 8 weeks after discharge. Stercoral perforation of the colon remains an uncommon condition. It carries a high mortality and morbidity. The incidence of stercoral perforation has increased over the last 20 years from 2. Maurer et al proposed that the diagnostic criteria should include:. Furthermore, Noussias addressed the issue of misreporting by differentiating spontaneous perforation disease pathology identified and idiopathic perforation disease pathology not identified which are sometimes reported as one entity. The diagnosis of stercoral perforation remains difficult. Patients at highest risk include those who are elderly, incapacitated, children and institutionalised. The advantage of cross-sectional imaging is to rule out other pathology, such as diverticular perforation, which unlike stercoral perforation, has medical and interventional radiological management options. Current clinical practice is to obtain cross-sectional imaging, in the form of a CT scan, once the patient is physiologically optimised. It is well documented in the literature that stercoral perforation requires surgical management if there is any hope for patient survival. Current evidence demonstrates better survival with resection of the affected segment. These secondary options are suboptimal with higher mortality rates. An area of contention, and differing practice, is intraoperative use of colonoscopy. The plan is to arrange colonoscopy as part of follow-up. There are reports in the literature of stercoral perforation in patients on a methadone programme and opioids. The previous cases highlight the difficulty in accurately diagnosing stercoral perforation and the importance of a low threshold for cross-sectional imaging and early operative intervention. I didn't know what was happening when I came into the hospital. It all happened very fast. I was unwell but everyone helped and told me what was wrong. After my operation, it took me a long time to get better. I didn't like my bag stoma but got use to it. I have seen my nurse specialist stoma after my operation who has helped me use it. I am feeling a lot better. I still don't know what exactly was wrong with me but the doctors have explained my heroin made me constipated and made a hole in my bowel or something like that. Stercoral perforation of the bowel is a disease with a poor prognosis, despite more accurate diagnosis and a constellation of recognised aetiologies. We report here on one of the rarer of these, namely perforation secondary to opiate abuse and constipation. The diagnostic criteria suggested in the literature are imperfect and where diagnostic doubt remains, emergency laparotomy is indicated based on clinical findings. The abuse of heroin on a chronic basis remains a risk factor for constipation. This patient cohort creates a number of management difficulties, foremost of which is their chaotic lifestyle with often poor compliance with prescribed aperients. The use of preoperative CT scanning is now commonplace with a Hartmann's procedure being the demonstrated intervention of choice. Contributors: CDB: project lead; completed write-up of case and coordinated between all coauthors for editing purposes. FM: advisor; gave advice regarding surgical intervention and preoperative work-up during case write-up. PF: contributor; gave pathology input with images and 'pathology' section of case report. GN: advisor and editor; edited all draft case reports and gave feedback throughout case write-up. As a library, NLM provides access to scientific literature. BMJ Case Rep. Find articles by Cameron Douglas Brown. Find articles by Fraser Maxwell. Find articles by Paul French. Find articles by Gary Nicholson. All rights reserved. No commercial use is permitted unless otherwise expressly granted. Open in a new tab. Provenance and peer review: Not commissioned; externally peer reviewed. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Hypothyroidism, uraemia, hypercalcaemia and diabetes. Low-fibre intake, poor oral intake and dehydration. Spinal cord injury, multiple sclerosis, Parkinson's, Alzheimer's, cerebal palsy and spina bifida. Opiates, anticholinergics, antacids iron preparations.

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