Colorectal Cancer Chemotherapy

Chemotherapy uses powerful drugs to kill cancerous cells. Read more about your options and what to expect from colorectal cancer chemotherapy.

Colorectal Cancer Chemotherapy

Colorectal Cancer Chemotherapy 101

Chemotherapy is a type of cancer treatment that uses powerful drugs to kill cancerous cells. It is a systemic treatment, meaning that the drugs affect cancerous cells throughout the body and prevents them from spreading. There are many different types of chemotherapy drugs that are used to treat specific types of cancer, can be prescribed at different stages of treatment, and can be administered in a variety of ways.

Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, or infusion, or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy, or targeted therapy.

Download our 3-part book,Your Guide in the Fight, for more in-depth information on your colorectal cancer chemotherapy options.

For colon cancer, most often, your physician will first perform surgery to remove all or most of a tumor originating in the colon before you undergo chemotherapy. If the cancer has spread to the lymph nodes or to other areas of the body, chemotherapy drugs may be prescribed after surgery to kill the remaining cancer cells after surgery. This is called adjuvant chemotherapy.

For rectal cancer, your doctor may suggest you complete chemotherapy first before undergoing surgery. This is called neoadjuvant chemotherapy. In some cases, neoadjuvant chemotherapy is used concurrently with radiation therapy, as the drugs might increase the radiation’s effectiveness.

The rectum resides near several other organs, like the bladder, the uterus and vagina in women, and the prostate in men. Since this area is more densely packed, shrinking a rectal tumor before surgery helps ease removal. Chemotherapy can also be used after rectal cancer surgery to kill remaining cancer cells after surgery. 

Palliative chemotherapy is used when colorectal cancer has spread to other parts of the body and surgery will not be enough to eliminate the cancer. Palliative colorectal cancer chemotherapy might help shrink tumors and reduce symptoms.

In addition to chemotherapy, there are other treatment options for colorectal cancer:

Download Your Guide in the Fight

Navigate your colorectal cancer chemotherapy options with our 3-part book, Your Guide in the Fight. We know a colorectal cancer diagnosis is overwhelming. With this download, we’ll walk you through the day of diagnosis through survivorship, empower you to make informed treatment decisions, and point you toward trusted, credible resources.

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What to Expect

Your medical team will review your medical records and perform tests to plan your cancer treatment. Whether the team decides on administering chemotherapy for your type of colorectal cancer will depend on:

  • Size and location of the cancer
  • Age
  • General health
  • Other medications you are taking, including vitamins and supplements
  • Other individual factors such as comorbid diseases or conditions

Depending on your exact chemotherapy treatment, the team may advise you on food and drink that you should or should not consume on the days that you receive treatment. Ingesting certain substances can negatively interact with your chemotherapy, so be sure to follow your medical team’s directions.

Colorectal cancer chemotherapy treatment is typically administered in cycles that range from 2 to 6 weeks. Your treatment cycle, schedule, and dosage will depend on the exact drug being given. Most patients will go through several cycles of chemotherapy, as long as they respond well to the treatment.

Chemotherapy treatment comes with side effects. Learn more about what side effects you may experience and how to manage them.

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Side Effects Mini Magazine

This Mini Magazine is written to help you identify common physical side effects that CRC survivors face and provide useful tips for managing them.

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Chemotherapy Drug Names & Combinations

When you get a long list of names of drugs and treatments, it can be overwhelming. Take your time and learn about each drug to help you manage your care and prepare for potential side effects. 

Your doctor may recommend one or more of them at different times during treatment. Sometimes these are combined with targeted therapy drugs. You may know someone who had the same cancer type and stage that you have, but your treatment differed. It’s important to keep in mind that everyone is different, and your doctor is providing the treatment option, which he believes will save your life. 

  • Capecitabine (Xeloda®)
  • Fluorouracil (5-FU)
  • Irinotecan (Camptosar®)
  • Oxaliplatin (Eloxatin®)
  • Trifluridine/tipiracil (Lonsurf®)

Some common treatment regimens using these drugs include:

  • 5-FU alone
  • 5-FU with leucovorin (folinic acid), a vitamin that improves the effectiveness of 5-FU
  • Capecitabine, an oral form of 5-FU
  • FOLFOX: 5-FU with leucovorin and oxaliplatin
  • FOLFIRI: 5-FU with leucovorin and irinotecan
  • Irinotecan alone
  • XELIRI/CAPIRI: Capecitabine with irinotecan
  • XELOX/CAPEOX: Capecitabine with oxaliplatin
  • Any of the above with one of the following targeted therapies: cetuximab (Erbitux®), bevacizumab (Avastin®), or panitumumab (Vectibix®). In addition, FOLFIRI may be combined with either of these targeted therapies: ziv-aflibercept (Zaltrap®) or ramucirumab (Cyramza®).

Oral Treatment Options

If you need colorectal cancer treatment, it’s important to understand your treatment plan, which medications you’ve been prescribed, and your options.

If you’ve been encouraged to undergo chemotherapy or targeted therapy, it’s important to know that not all drugs are the same. You may have options when it comes to how you receive treatment. Some treatment options come in pill form (instead of IV).

Treatment drugs available in oral form

Brand name: Xeloda® (Chemotherapy)

Drug name (generic): capecitabine
How It Works: An oral form of IV 5-fluorouracil (5-FU). It interferes with RNA and DNA to prevent cancer cells from dividing and multiplying.
Dosage: Comes in 150 mg and 500 mg tablets. Dosage is determined by your physician and is based on body size.
When It’s Prescribed: For stage II, III, and IV patients either before (neoadjuvant) or after (adjuvant) surgery to remove the primary tumor and/or any metastases.

Brand name: Lonsurf® Combination drug (Chemotherapy)

Drug name (generic): trifluridine and tipiracil
How It Works: Trifluridine interferes with tumor cell reproduction. Tipiracil helps trifluridine work longer in the body.
Dosage: Comes in 15mg and 20mg tablets. specific dosage will be determined by your doctor.
When It’s Prescribed: For those whose cancer has spread to other parts of the body (stage IV).

Brand name: Fruzaqla® (Targeted therapy)

Drug name (generic): fruquintinib
How It Works: Interferes with tumor blood vessel development.
Dosage: Available in 5mg and 1mg tablets. specific dosage will be determined by your doctor.
When It’s Prescribed: For stage IV patients who have previously received treatment with a fluoropyrimidine, oxaliplatin, irinotecan HCL, and an anti-VEGF therapy.

Brand name: Braftovi® (Targeted therapy)

Drug name (generic): encorafenib
How It Works: Targets a specific mutation in the BRAF gene that drives cancer growth.
Dosage: Recommended dose of 300mg once daily in combination with IV infusion cetuximab.
When It’s Prescribed: For stage IV patients with a specific mutation of BRAF V600E.

Brand name: Stivarga® (Targeted therapy)

Drug name (generic): regorafenib
How It Works: Regorafenib is a multikinase inhibitor. Kinases carry signals to tumor cells encouraging them to grow, which regorafenib blocks.
Dosage: Comes in 40mg tablets. Your specific dose will be determined by your physician.
When It’s Prescribed: For stage IV patients who have not responded to prior treatments.

Brand name: Krazati® (Targeted therapy)

Drug name (generic): adagrasib
How It Works: Targets a specific mutation of the KRAS gene, which leads to uncontrolled cell growth and cancer.
Dosage: Recommended dosage of 600 mg twice daily. Adagrasib ccomes in 200 mg tablets. It may be used with IV cetuximab.
When It’s Prescribed: For stage IV patients with the KRAS G12C mutation who have already received a fluoropyrimidine, oxaliplatin, and irinotecan HCL.

Brand name: Lumakras® (Targeted therapy)

Drug name (generic): sotorasib
How It Works: Targets a specific mutation of the KRAS gene, which leads to uncontrolled cell growth and cancer.
Dosage: Comes in 320 mg and 120 mg tablets. Dosage will be determined by your physician. May be administered with IV cetuximab.
When It’s Prescribed: Sotorasib is not currently approved for CRC treatment, but may be prescribed off-label.

Brand name: Retevmo® (Targeted therapy)

Drug name (generic): selpercatinib
How It Works: Targets a specific mutation of the RET gene that allows cancer to grow despite other treatments.
Dosage: Comes in 40 mg and 80 mg capsules. Specific dosage will be determined by your physician.
When It’s Prescribed: For stage IV patients that possess a RET gene fusion and did not respond to other therapies.

Brand name: Vitrakvi® (Targeted therapy)

Drug name (generic): larotrectinib
How It Works: Targets a specific mutation of the NTRK gene that allows cancer to grow despite other treatments.
Dosage: Comes in 25 mg or 100 mg capsules, or a 20 mg/mL oral solution.
When It’s Prescribed: For stage IV patients with an NTRK gene fusion that has gotten worse after other treatment, or cannot be treated with other therapies.

Brand name: Rozlytrek® (Targeted therapy)

Drug name (generic): entrectinib
How It Works: Targets a specific mutation of the NTRK gene that allows cancer to grow despite other treatments.
Dosage: Comes in 100 mg and 200 mg capsules. Specific dosage will be determined by your physician.
When It’s Prescribed: For stage IV patients with a NTRK gene fusion that has gotten worse after other treatment, or cannot be treated with other therapies.

Brand name: Tukysa® (Targeted therapy)

Drug name (generic): tucatinib
How It Works: Some tumors possess too much of a protein that promotes growth, called HER2. Tucatinib targets that protein.
Dosage: Comes in 50 mg and 150 mg tablets. Recommended dosage for CRC is 300 mg twice daily, in combination with trastuzumab.
When It’s Prescribed: For stage IV patients with an unmutated RAS gene, who have already been treated with a fluoropyrimidine, oxaliplatin, and irinotecan HCL.

Brand name: Tykerb® (Targeted therapy)

Drug name (generic): lapatinib
How It Works: Targets HER2, a protein that promotes cancer growth.
Dosage: Comes in 250 mg tablets, often administered with trastuzumab.
When It’s Prescribed: Lapatinib is not specifically approved to treat CRC, but may be prescribed off-label.

Oral Therapy Tips

  • Always take these medications as prescribed. Be sure to follow all directions, such as taking your medication with a meal.
  • Do not skip doses.
  • Do not discontinue your medication without talking to your physician.
  • Wash your hands after handling chemotherapy agents, or wear gloves.
  • Be sure to keep your medications away from children and pets.
  • Pill organizers can help you keep track of your dosing, especially if you take multiple doses per day.
  • Try taking your medication with a lightly flavored drink, such as a sports drink, to help deal with the taste.

Taking your pills as prescribed will ensure that they work to the best of their ability, and that you get the most benefit from them.

Side Effects

Even if you’re taking pills for cancer treatment, there will likely be side effects. These may include:

  • Nausea
  • Diarrhea
  • Tiredness or weakness
  • Abnormal labs
  • Skin issues

It is crucial to discuss any side effects you’re experiencing with your health care team. Just because your treatment is in a pill, it doesn’t mean you won’t have some of the same side effects that you’d have on treatments you take via an IV.

Pharmacies

Oral treatment is taken like most other pills in your medicine cabinet, but you may not be able to fill your prescription at your local pharmacy. You may need to find a pharmacy with expertise in distributing unique or uncommon drugs, which is called a specialty pharmacy. Your doctor will help you find a pharmacy to fill your prescription if you’re prescribed oral medications for cancer treatment.

Standard of Care

The term “standard of care” means the treatment you are receiving is accepted by medical experts as a proper treatment for colon or rectal cancer. You might hear them refer to it as best practice, standard medical care, and standard therapy.

Fight CRC works hand in hand with National Comprehensive Care Network (NCCN) Clinical Practice Guidelines in Oncology (NCCN Guidelines®) to make sure patients have accurate information. Download the following guidelines to help you manage your care. These guidelines inform “standard of care” for all colon and rectal cancer patients. 

  • Colon Guidelines (PDFs in English, Russian, Ukrainian)
  • Rectal Guidelines (PDFs  in English, Russian)

If you need printed resources, visit our store to receive a free Resource Champion Kit.

Chemotherapy Resources

Medline Plus Drug Information

A service of the U.S. National Library of Medicine and the National Institutes of Health, this database includes information on the precautions, side effects, and proper use of thousands of prescription drugs, over-the-counter medications, herbs, and supplements.

National Cancer Institute (NCI) Drug Information Summaries

The NCI has compiled consumer-friendly overviews for more than 250 common cancer drugs and drug combinations. Each summary includes information on appropriate drug usage, side effects, drug interactions, and links to current clinical trials in which the drug is being used.

WebMD Drugs and Medications Database

This listing summarizes the uses, precautions, side effects, interactions, and overdose information for more than 60,000 medications, herbs, and supplements.

Clinical Trial Finder

Our Clinical Trial Finder can help patients with microsatelite stability (MSS) colorectal cancer (CRC) get a potential list of clinical trials to discuss with their medical teams. Originally created by the late Dr. Tom Marsilje as a curated spreadsheet of clinical trials, the FightCRC’s Trial Finder is a resource to search for clinical trials that are open in your geography, and for which you may be eligible. The current data are limited to MSS (microsatellite-stable) and stage IV CRC patients. The curated list of trials is sourced from the ClinicalTrials.gov website, and reviewed and posted to this finder by Fight CRC research advocates. The tool is not a comprehensive list of all CRC clinical trials – only those that would be most interesting to a patient with MSS-CRC, such as Dr. Tom himself. 

The trials that display in the search results are based on Tom’s review criteria:

  1. Trials with a “reduced” chance of potential failure
  2. Trials with the biggest “potential” long-term benefit

Provider Finder

Fight CRC and Komodo Health’s Provider Finder combines provider experience and knowledge of colorectal cancer with innovation and technology to deliver important information directly to patients’ fingertips. The Provider Finder gives patients easy access to healthcare providers using searchable fields to narrow choices and options of providers in an otherwise overwhelming world. No single organization can cure colorectal cancer alone. We’re building and growing a patient community that’s well-informed, fearless, and devoted to improving outcomes for all. We are constantly inspired by our community’s resilience, strength, and heart.

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Our resource library contains webinars, podcasts, videos, and free informative materials about genetics, biomarker testing, side effect management and more!

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