ONCAlert | 2018 Gastrointestinal Cancers Symposium
Colorectal Cancer Case Studies

Case Studies: Progression of Treatment in Colorectal Cancer

In this case-based interview, Wells Messersmith, MD, discusses the case of a 71-year-old male patient with metastatic colorectal cancer and provides an overview of the treatment options for progression of disease.

Progression of Treatment in Colorectal Cancer

September 2015

  • A 71-year-old Caucasian male presented with severe left lower quadrant pain
    • He sought medical treatment after experiencing bloody diarrhea
  • PMH: hypertension, managed with benazepril
  • He is active and can perform daily activities without restrictions
  • Laboratory findings: remarkable for CEA, 6.0 ng/mL
  • Colonoscopy showed a mass in the descending colon which was biopsied
    • Pathological findings: Moderately differentiated adenocarcinoma
  • NGS mutation testing results were NRAS, KRAS, HRAS, HER2, and BRAF wild-type
    • Microsatellite stable
  • CT of the chest, abdominal, and pelvis showed an 8-cm mass in the sigmoid colon
    • a 2-cm mass in the right lobe of the liver, and a 5-cm in the left lobe adjacent to the left hepatic vein
    • Impression: metastatic disease, borderline resectable
  • Treatment was initiated with FOLFIRI + bevacizumab
  • Imaging at 3 and 6 months showed decreased size of the liver nodules, but was not resectable

July 2016

  • The patient complained of increased fatigue, requiring the need for frequent rest
  • CT scan showed increasing size of the liver nodule (3 cm) and appearance of 3 new small liver lesions (<2 cm)
  • He began therapy with FOLFOX + bevacizumab

February 2017

  • The patient reported weight loss, increasing fatigue, and shortness of breath
  • CT scan revealed progressive disease with no improvement in the primary and metastatic lesion size and/or number
  • A new pulmonary nodule was seen in the right lung
  • He was switched to irinotecan + cetuximab
  • PET/CT at 3 months showed stable disease
  • At 6 months, he reported moderate improvement in fatigue
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