Targeted therapy

A targeted therapy helps your body control the way cancer cells grow. There are different types of targeted treatment that destroy cancer in different ways. You may also hear it being called biological therapy.

Targeted therapy can be used on its own or with chemotherapy.

Access to targeted therapies

Not all targeted therapies are available on the NHS in England, Scotland and Wales, or the Health and Social Care service in Northern Ireland. If your doctor thinks you might benefit from this type of treatment, they will discuss it with you. Your cancer specialist can apply for funding for a treatment if you both agree that you would benefit from it. This can be a difficult process and it's not always successful. 

Macmillan Cancer Support has information on what to do if a treatment isn't available. 

Who can have targeted therapy?

Targeted therapies don't work for everyone. Your healthcare team might offer you a test to help find out if there are any targeted therapies that could work for you. This is called a biomarker test. The test could be a blood test or a test on a sample of your tumour from a biopsy. 

The biomarker test looks for changes (mutations) in your cancer cells. Speak to your healthcare team to see if a biomarker test is appropriate for you. 

Changes in your cancer cells

Inside each of your cells there are long strings of DNA. Your DNA contains sets of genes. Genes act like instructions for your body, to carry out processes and keep you healthy. 

If a gene is changed, the instructions may not be correct and your body may act differently. Some gene changes can affect how cancer grows. These changes are described as biomarkers. The most common mutations found in bowel cancer are in genes called RAS, BRAF and mismatch repair (MMR) genes. 

The biomarker test is used to see if you have mutations in RAS, BRAF and mismatch repair genes. Finding out which mutations you have can help decide which treatment is more likely to work for you. 

RAS genes

RAS genes help cells grow, survive and multiply. If the cancer has a normal RAS gene, it’s known as RAS wild type. If it has a gene change (mutation), it’s called a mutated RAS gene. There are different types of RAS genes called KRAS and NRAS. You may have a test to see if you have mutations in both of these RAS genes. If you have the wild type RAS gene, you may be able to have targeted treatments called cetuximab or panitumumab. These treatments are not suitable for patients with mutated RAS genes. 

BRAF genes

BRAF genes help cells grow and multiply. They can be mutated in bowel cancer, which helps the cancer grow. If the cancer has a normal BRAF gene it’s known as BRAF wild type. If it has a gene change (mutation), it’s called mutated BRAF. The most common mutation is called BRAF V600E. 

If you have the wild type BRAF gene, you may be able to have targeted treatments called cetuximab and panitumumab. If you have the mutated BRAF gene, the drugs cetuximab and panitumumab are unlikely to work. If you have the BRAF V600E mutations you may be able to have cetuximab and a drug called encorafenib. 

Research studies are currently looking into new ways to treat patients with BRAF mutations. 

Mismatch repair genes

Mismatch repair genes are important for repairing DNA. If mismatch repair genes have a gene change (mutation), they may not be able to repair DNA. Bowel cancers with mutated MMR genes often have lots of mutated genes. This is called deficient mismatch repair (dMMR) or microsatellite instability high (MSI-High) bowel cancer. If you have MSI-High bowel cancer you may be able to have the immunotherapy drugs nivolumab or pembrolizumab through a clinical trial.  

Types of targeted therapy

A targeted therapy helps your body control the way cancer cells grow. There are different types of targeted treatment that destroy cancer in different ways. 

Cetuximab (Erbitux®) 

Pronounced: se-tux-i-mab  

Cetuximab stops cancer cells from growing and multiplying. You may have it if you have a normal (wild type) RAS gene. It’s given to you through a drip into a vein in your arm, hand or chest. You may have cetuximab once a week or once every two weeks and it can take up to two hours. This treatment might be given alongside chemotherapy or radiotherapy 

Panitumumab (Vectibix®) 

Pronounced: pan-i-too-moo-mab  

Panitumumab stops cancer cells from growing and multiplying. You may have it if you have a normal (wild type) RAS gene. It’s given to you through a drip into a vein in your arm, hand or chest. This could take from 30 to 90 minutes depending on how high the dose is and is usually given every two weeks. Bevacizumab (Avastin®) 

You may have bevacizumab given to you as an infusion through a drip into your vein. This can be every two or three weeks. You are likely to have it alongside chemotherapy. 

Encorafenib (BRAFTOVI®) 

You may have encorafenib, alongside the drugs cetuximab and/or binimetinib, if you have the BRAF V600E mutation. It is given to you as a tablet that you take once a day. 

Bevacizumab (Avastin®)  

Pronounced: bev-a-kiz-oo-mab 

Bevacizumab stops the tumour from growing new blood vessels. It’s given to you through a drip into a vein in your arm, hand or chest. This can be every two to three weeks and can take from 30 to 90 minutes. You’re likely to have it alongside chemotherapy. 

Aflibercept (Zaltrap®) 

Pronounced: af-lib-er-sept  

Aflibercept stops the tumour from growing new blood vessels. It’s given to you through a drip into a vein in your arm, hand or chest. You may have this if you have already had a treatment that includes oxaliplatin but the cancer has not responded to the treatment or come back. You’ll receive it every two weeks. 

Regorafenib (Stivarga®) 

Pronounced: re-gor-af-eh-nib  

Regorafenib stops the tumour from growing new blood vessels. You may have regorafenib if you have already tried or cannot have chemotherapy with other targeted therapies. It’s given to you as a tablet that you take once a day for three weeks. After this you will have a week off therapy, before starting the treatment cycle again. 

Ramucirumab (Cyramza®) 

Pronounced: ram-oo-seer-uh-mab  

Ramucirumab stops the tumour from growing new blood vessels. You may have ramucirumab if you have already had bevacizumab and some chemotherapies. It’s given to you as a drip into a vein in your hand, arm or chest. It’s taken in combination with chemotherapy, FOLFIRI. You will receive it every two weeks. 

Side effects

Like most treatments, targeted treatments can cause side effects. Many of them will stop once you have finished treatment. Speak to your healthcare team if you are worried. They will be able to help you manage them.

Common side effects can include:

• tiredness (fatigue)
• diarrhoea
• feeling or being sick (vomiting)
• rashes on your skin
• rapid or uncomfortable breathing
• weight loss or loss of appetite
  
  

New treatments

Researchers are trying to find new treatments for advanced bowel cancer. These therapies may not always be available through the NHS but you may be able to have them through a clinical trial. 

Not everyone is suitable for clinical trials. Speak to your healthcare team to discuss these options. 

Immunotherapy

There is lots of research looking into new immunotherapy drugs. Immunotherapy is a type of targeted treatment that helps your own immune system to destroy the cancer. Some patients may be able to have them by taking part in clinical trials. Immunotherapies don’t

Types of immunotherapies 

One group of immunotherapies are called checkpoint inhibitors. These treatments help your immune system kill cancer cells. 

Nivolumab (Opdivo®)

Pronounced: ni-vol-yoo-mab 

Nivolumab stops cancer cells. It’s given to you as a drip into your vein in your hand, arm or chest. You may have it on its own or combined with another drug called ipilimumab. Nivolumab can be used to treat bowel cancer that has changed (mutations) in mismatch repair genes (dMMR). 

Pembrolizumab (Keytruda®) 

Pronounced: pem-bro-liz-uh-mab  

Pembrolizumab stops cancer cells. You will have it as a drip into a vein in your hand, arm or chest. It can be used to treat bowel cancer that has changes (mutations) in mismatch repair genes (dMMR). 

More information

You can find more information about targeted therapy for advanced bowel cancer on the Cancer Research UK website. 

Join our online community – a welcoming place for everyone affected by bowel cancer to ask questions, read about people’s experiences and support each other. 

Breaking BRAF is support group for people with bowel cancer that have the BRAF mutation and their carers 

Updated June 2025 

Next review June 2028