ONCAlert | 2018 ASCO Annual Meeting
Colorectal Cancer Case Studies

Alan Venook, MD: Second-Line Options to Prolong Survival

Alan Venook, MD
Published Online:Jul 10, 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?


Second-line options include chemotherapy with bevacizumab, with ziv-aflibercept, with ramicurumab, and, depending on all-RAS status, perhaps with an EGFR antibody. How I would treat this patient depends on many different factors, but I would probably switch to FOLFIRI/bevacizumab; this is less related to data and more to costs, formulary, and other factors.

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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