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

Case Studies: A Continuum of Care for Metastatic CRC

In this case-based interview, John Marshall, MD, describes the case of a 53-year-old man who has newly diagnosed KRAS-mutant metastatic colorectal cancer.

A Continuum of Care for Metastatic CRC

February 2013

  • A 53-year old Caucasian man presented to his gastroenterologist complaining of rectal bleeding and abdominal tenderness
  • PMH includes hypertension, well-controlled on a beta-blocker
  • Family history; mother died from breast cancer
  • He underwent colonoscopy with biopsy
    • Pathology results confirmed poorly-differentiated adenocarcinoma
    • Genetic testing was positive for KRAS exon 2 codon 12 mutation
  • CT scan of the abdomen, pelvis, and chest showed multiple liver lesions and a large nodule in the right lower pulmonary lobe.
  • Diagnosis: Adenocarcinoma of the colon; staging, T4N0M1
  • The patient was started on FOLFOX and bevacizumab, therapy is well-tolerated
  • The second follow-up scan showed a marked decrease in volume of the primary tumor, two of the liver lesions, and the lung lesion.

March 2014

  • The patient complains of intermittent shortness of breath but continues his normal activities
  • Imaging shows slow but steady progression in the plural lesion
  • Bevacizumab therapy was continued; the patient was also started on FOLFIRI
  • Follow-up imaging shows continued regression of the lung lesion; patient continues to tolerate therapy with management of gastrointestinal distress

February 2017

  • The patient complains of abdominal fullness, nausea, and constipation
  • He continues to work full-time but feels sluggish
  • MRI indicated diffuse metastatic disease in the peritoneum, consistent with carcinomatosis
  • The patient was started on regorafenib 80 mg, with a plan to gradually increase to 160 mg if tolerated
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