Targeted Oncology
Targeted Oncology
Targeted Oncology

Case Studies

Expert physicians provide insight on managing oncology-based patient cases that highlight the use of novel agents in clinical practice.
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Featured Case Study
In this case-based interview series, Tanios Bekaii-Saab, MD, FACP, discusses the treatment of a patient with metastatic colorectal cancer who progresses on upfront and second-line therapy.

Metastatic CRC Progressing on Multiple Therapies

October 2015

  • A 64-year-old woman underwent left hemicolectomy for an obstructing mass at the rectosigmoid junction
    • CEA were elevated, 23.3 ng/mL
    • Pathology showed an undifferentiated adenocarcinoma, invading through the muscularis mucosae up to the pericolic fat; 14 nodes were biopsied, 10 of which were metastatic
    • Imaging with PET/CT showed several lung lesions, three measuring up to 3.0 cm in size
    • Mutational status was both RAS and BRAF wild-type
    • Microsatellite stable
    • Diagnosis; high grade colorectal adenocarcinoma, stage T4N2M1
  • PMH includes arterial hypertension, well-controlled on an ACE inhibitor and coronary angioplasty with stent placement 4 years ago
  • The patient received systemic therapy with FOLFIRI + cetuximab; grade 1 rash and grade 2 thrombocytopenia were managed with dose adjustment of FOLFIRI
  • Follow-up imaging at 2 months and 4 months showed significant response in the lung lesions
  • The patient was continued on maintenance therapy with cetuximab

August 2016

  • The patient complains of weight loss, nausea and fatigue
  • CT of the chest, abdomen, and pelvis showed marked progression in 2 of the lung lesions and development of new liver lesions
  • The patient was switched to CAPEOX with bevacizumab. Her blood pressure was closely monitored and remained stable
  • Follow up imaging at 2 months and at 4 months showed stable disease in the lung and liver lesions and improvement of her symptoms
  • At 4 months, oxaliplatin was discontinued; maintenance therapy with capecitabine and bevacizumab was continued

January 2017

  • At 5 months, the patient reports having reappearance of her symptoms, although she continues her normal physical activity
  • CEA level is rising significantly
  • Follow up CT showed further progressive disease in the lung and the appearance of several small boney lesions
  • The patient is motivated to try another therapy and has opted for regorafenib
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