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Biological therapies for bowel cancer

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This page tells you about biological therapy for bowel cancer (colorectal cancer). You can find the following information

 

A quick guide to what's on this page

Biological therapies for bowel cancer

Biological therapies are drugs that help the body to control the growth of cancer cells. Doctors may use some types of biological therapies to treat colon or rectal cancer that has spread to another part of the body (advanced bowel cancer).

Cetuximab (Erbitux) is a type of biological therapy called a monoclonal antibody. It is used to treat some people with bowel cancer that has spread. Before you have cetuximab, your doctor will test your cancer cells for changes (mutations) in the RAS genes. You can only have this treatment if your cancer has normal RAS genes. You usually have cetuximab with the chemotherapy drugs 5FU (fluorouracil), oxaliplatin, or irinotecan. 

The monoclonal antibodies bevacizumab (Avastin) and panitumumab (Vectibix), and other types of biological therapy called aflibercept (Zaltrap) and regorafenib (Stivarga) are also licensed in the UK for advanced bowel cancer. Aflibercept works by stopping cancer cells from making their own blood supply (anti angiogenic drug). Regorafenib works by blocking particular proteins on cancer cells that encourage the cancer to grow. It also stops cancer cells from growing blood vessels. These drugs are generally not available on the NHS, but doctors in England may be able to fund panitumumab through the Cancer Drugs Fund. The Scottish Medicines Consortium (SMC) have said doctors can use aflibercept within the NHS in Scotland. 

Some of the most common side effects of these drugs include tiredness, diarrhoea, sore mouth, loss of appetite, low blood counts and feeling sick. Cetuximab and panitumumab can also cause a skin rash.

Researchers are testing other types of biological therapy in trials for bowel cancer. They are also looking into combining biological therapies with chemotherapy to see if they work better together.

There is information about individual biological therapies and their side effects in our cancer drugs section.
 

CR PDF Icon You can view and print the quick guides for all the pages in the treating bowel cancer section.

 

 

What biological therapy is

Biological therapies are drugs that can help the body to control the growth of cancer cells. Some types of biological therapies can be used to treat colon or rectal cancer that has spread to other parts of the body (advanced or metastatic bowel cancer).

 

Cetuximab (Erbitux) for advanced bowel cancer

A biological therapy called cetuximab (Erbitux) is licensed in the UK for advanced bowel cancer. It can help some people with advanced bowel cancer to live longer when they have it with standard chemotherapy treatment. It can also improve their quality of life. You usually have cetuximab with the chemotherapy drugs 5FU (fluorouracil), oxaliplatin, or irinotecan.

Cetuximab (Erbitux) is a type of monoclonal antibody. Some bowel cancer cells have receptors for a protein produced in the body called epidermal growth factor. This protein attaches to receptors on cancer cells and triggers them to grow. Cetuximab blocks epidermal growth factor (EGF). So it is called a growth factor blocker.

Around 4 out of every 10 bowel cancers (40%) have a change (mutation) in a gene called KRAS. And less than 1 out of 10 bowel cancers (10%) have a change in the NRAS gene. Cetuximab doesn't work for bowel cancers that have a mutation in these RAS genes. So doctors can only use cetuximab to treat people whose cancer has normal RAS genes. If your doctor thinks that cetuximab could be a helpful treatment for you they will test your cancer cells first to see if they have mutations in these genes.

For some people, cetuximab and chemotherapy may be able to shrink liver tumours so that they can be removed with surgery. In this situation you usually have cetuximab with FOLFOX or FOLFIRI chemotherapy. The treatment is for up to 16 weeks. Once you have finished the treatment, your doctors will check whether it will be possible to remove the cancer in your liver.

We have more information about cetuximab and its side effects.

 

Other biological therapies for advanced bowel cancer

The monoclonal antibodies bevacizumab (Avastin) and panitumumab (Vectibix) are licensed for advanced bowel cancer. 

Aflibercept (Zaltrap) is another type of biological therapy. It works by stopping cancer cells from making their own blood supply (anti angiogenic drug). It is licensed for people with advanced bowel cancer, when the chemotherapy drug oxaliplatin is no longer working. You have aflibercept with FOLFIRI chemotherapy. 

Regorafenib (Stivarga) is also licensed for advanced bowel cancer. It is a type of cancer growth blocker. It works by blocking particular proteins on cancer cells that encourage the cancer to grow. It also stops the cancer cells from growing blood vessels.

These biological therapy drugs are generally not available on the NHS, but doctors in England may be able to fund panitumumab through the Cancer Drugs Fund. This is only for people whose cancer does not have changes (mutations) in the RAS genes. The Scottish Medicines Consortium (SMC) have said that doctors can use aflibercept within the NHS in Scotland.

Some biological therapies are very new and it will be some time before we know how well they work. All new treatments have to go through the clinical trials process and this takes some years. Research is looking into using biological therapies alongside chemotherapy to see how they work best together. There is information about biological therapies in the bowel cancer research section.

You can search for trials for bowel cancer on our clinical trials database.

 

Side effects of biological therapy

As with all drugs, biological therapies have side effects. Some of the common side effects include

Cetuximab and panitumumab can also cause a skin rash. Your doctor will give you creams and medicines to take when you start treatment to try to prevent or reduce the severity of the rash.

Tell your doctor if you have any side effects as you may be able to have medicines to help control them. We have detailed information about the side effects of cetuximab, bevacizumab, aflibercept, regorafenib and panitumumab.

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Updated: 19 September 2015