ONCAlert | Upfront Therapy for mRCC
Colorectal Cancer Case Studies

Case Studies: A 75-Year-Old Man With Right-Sided mCRC

Bassel F. El-Rayes, MD, discusses his recommendations for managing a patient with stage IV right-sided RAS/BRAF wild-type colorectal cancer.

A 75-Year-Old Man With Right-Sided mCRC

Case: A 75-Year-Old Man With Right-Sided mCRC

Initial presentation

  • A 75-year-old Caucasian man presented to his PCP with rectal bleeding, fatigue, weight loss, and constipation

Clinical workup

  • Colonoscopy: fungating mass in the ascending colon
  • Biopsy: invasive, poorly differentiated adenocarcinoma
  • Imaging: CT scan of the chest/abdomen/pelvis showed multiple small liver lesions including a 3-cm mass in right lobe
  • Molecular testing on tissue biopsy:
    • KRAS, RAS, and BRAF WT
    • Microsatellite-stable
  • ECOG PS 1

Treatment

  • Patient underwent a diverting colostomy without complication
  • He was started on FOLFOX and bevacizumab
  • Follow up imaging at 3, 6, and 9 months showed a partial response
  • He was continued on bevacizumab and underwent capecitabine maintenance
  • Imaging at 12 months showed 2 new liver lesions (1.2 cm and 3.4 cm)
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