ONCAlert | 2017 San Antonio Breast Cancer Symposium
Colorectal Cancer Case Studies

Ki Chung, MD: Fourth-Line Treatment for Progressive Disease

Ki Chung, MD
Published Online:Jul 10, 2015
Following Diane's first-line recurrence, she is switched to FOLFIRI, and bevacizumab is continued.

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


What are your choices for fourth-line treatment in this patient with progressive disease?
Upon progression, it is a reflection of what was received before. If you moved onto FOLFIRI and a VEGF inhibitor of your choice, a common approach would be to possibly recycle the oxaliplatin if there was no progression in disease. Many practitioners would also recommend a molecular analysis to determine if there were any actionable targets or effective therapeutic approaches. We can also consider TAS-102, which will likely be approved, and regorafenib, as well as consider many clinical trials in the third- and fourth-line settings.

CASE: Metastatic Colorectal Cancer (Part 2)

Following her first-line recurrence, Diane is switched to FOLFIRI, and bevacizumab is continued.
  • After 3 cycles, her CEA decreased to 19 ng/mL. The patient remained asymptomatic, and her hepatic lesions were stable
In July of 2014, she presents to her oncologist with fatigue, dyspnea, and worsening performance status, and her CEA had increased to 180 ng/mL.
  • CT scan revealed progression of multiple hepatic lesions, with several new nodules noted in the lung right upper lobe
  • Biopsy of the lung and liver lesions was consistent with metastatic disease, and both samples were sent for mutational analysis
Based on results of her mutational analysis, which showed KRAS WT; BRAF negative; RAS WT, the patient is considered eligible for treatment with an anti-EGFR agent, and she is initiated on cetuximab + irinotecan.
  • Cetuximab infusion was delayed after the first cycle for 1 week due to rash
  • After 4 cycles, she shows a response with her CEA decreasing to 32 ng/mL, and a reduction in hepatic lesions and stable lung lesions on CT.
In November of 2014, the patient presents with dyspnea, increasing CEA and worsening performance status.
  • Her CT scan is consistent with progression of lung lesions
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