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

Case Studies: Case Presentation in Advanced Colon Cancer

In this case-based interview, Michael Morse, MD, FACP, discusses management of two patients, one with quadruple wild-type unresectable metastatic colon cancer and another with locally advanced disease.

Case Presentation in Advanced Colon Cancer Case: 1

October 2014

  • A 69-year old Caucasian male presented with severe left lower quadrant pain
    • He sought medical treatment after experiencing bloody diarrhea
    • PMH was remarkable for hypertension that was being managed with telmisartan
    • He was active and could perform his daily activities without restrictions or assistance
  • Laboratory evaluation was remarkable for Hb 11.3 and CEA 6.5 ng/mL
  • Colonoscopy revealed a fungating mass in the sigmoid colon which was biopsied
    • Pathological findings: invasive poorly differentiated adenocarcinoma
    • Molecular testing on the primary tumor was requested; no mutations were noted in KRAS, NRAS, BRAF, PIK3CA (quadruple wild type) and the tumor was microsatellite stable (MSS)
  • Chest, abdominal, and pelvic CT scan showed small bilateral lung nodules, a 3-cm mass in the right lobe of the liver, and a mass in the sigmoid colon measuring 10 cm
  • Diagnosis, unresectable metastatic colorectal cancer
  • Treatment was initiated with FOLFIRI + cetuximab and he appeared to respond well
  • CT scans at 3 and 6 months showed decreased size of liver and lung nodules

August 2015

  • The patient complained of increased fatigue, and reported needing frequent breaks while performing daily activities
  • CT scan showed increased size of the liver nodule (to 4 cm) and the appearance of 4 new small liver lesions (<2 cm)
  • He began therapy with FOLFOX + bevacizumab

March 2016

  • The patient complained of severe fatigue
  • 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 then started on trifluridine/tipiracil
  • PET/CT at 3 months showed stable disease
  • At 6-months, he reported less fatigue and some improvement in performing daily tasks
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