ONCAlert | 2018 ASCO Annual Meeting
Colorectal Cancer Case Studies

Cathy Eng, MD, FACP: Second-Line Options to Prolong Survival

Cathy Eng, MD, FACP
Published Online:Aug 12, 2015
Diane B. is a 72-year-old retired elementary school teacher from Chicago, Illinois.

Metastatic Colorectal Cancer: Part 1

Metastatic Colorectal Cancer: Part 1
Metastatic Colorectal Cancer: Part 2
Metastatic Colorectal Cancer: Part 1
Metastatic Colorectal Cancer: Part 2
Metastatic Colorectal Cancer: Part 1
Metastatic Colorectal Cancer: Part 2


What second-line options are available to prolong survival in patients, like Diane, with recurrent mCRC?

Cathy Eng, MD, FACP, The University of Texas MD Anderson Cancer Center, says it is significant to first consider FOLFIRI/bevacizumab, and then resumption of FOLFOX/bevacizumab at a reduced dose due to her underlying neuropathy. FOLFIRI + anti-EGFR therapy could be considered, if the patient was all RAS WT. FOLFIRI/ ziv-aflibercept and FOLFIRI/ramucirumab are other subsequent options.

CASE: Metastatic Colorectal Cancer (Part 1)

Diane B. is a 72-year-old retired elementary school teacher from Chicago, Illinois.
  • Her prior medical history is notable for stage I cervical cancer at age 20 years, treated with cobalt therapy and total hysterectomy
The patient was diagnosed with metastatic colorectal cancer in January of 2013, after presenting to her PCP with progressive fatigue of 3 month’s duration and irregular bowel movements; Patient’s performance status was 1.
  • CT scan revealed a large nonobstructive mass in the sigmoid colon with multiple large hepatic lesions; the patient’s CEA level was 158 ng/mL
  • Patient was not indicated for surgery due to minimal symptoms and presence of metastatic disease
  • Biopsy of the sigmoid mass and hepatic lesion showed adenocarcinoma, and mutational testing showed KRAS WT; BRAF negative; RAS status was not determined
  • Diane underwent initial therapy for metastatic disease with FOLFOX + bevacizumab
  • Following 6 cycles, patient had a response with a decrease in several stable hepatic lesions the primary mass on CT; her CEA decreased to 25 ng/mL
  • At 4 months, the patient had developed sensory neuropathy (grade 2), and oxaliplatin was discontinued from her regimen; 5-FU, leucovorin, and bevacizumab were continued
In January of 2014, she presented to her oncologist for evaluation after her CEA had increased to 77 ng/mL.
  • The patient was asymptomatic at the time of recurrence, and her neuropathy had improved to grade 1
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