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Colorectal Cancer Case Studies

Tanios Bekaii-Saab, MD; Chemotherapy as a Possible Option

Tanios Bekaii-Saab, MD
Published Online:Apr 26, 2016
Scott is a 62-year-old male from Montgomery County, Arkansas who works as a teacher and football coach at a local high school. He was diagnosed with metastatic colon adenocarcinoma in December of 2012.

mCRC with Tanios Bekaii-Saab, MD and Tara Seery, MD: Case 2

Is chemotherapy still an option for this patient?

For this patient, chemotherapy following TAS-102 failure may be an option. This is what we call recycling strategies, meaning you take some of the agents you used initially and you use them again. There is no real, good data supporting this. Unfortunately we find ourselves many times with patients in this setting who are still doing good, they are looking good, and they want to be treated with more chemotherapy.

You may not have identified the target, done tumor-genetic testing where you could match them to another agent. So you're running out of options and in those patients if they are still doing good, and feeling well, this is when you would perhaps consider this recycling strategy depending on how fast the tumor progressed on previous treatments.

Case 2: mCRC

Scott T. is a 62-year-old male from Montgomery County, Arkansas who works as a teacher and football coach at a local high school. He was diagnosed with metastatic colon adenocarcinoma in December of 2012.

  • Medical history is notable for well-controlled hypertension, and hypercholesterolemia, managed with diet and statin therapy
  • Patient underwent a right hemicolectomy in January 2013, which showed stage IIIC disease with several visceral metastases noted and 5 of 14 positive lymph nodes; biopsy showed well-differentiated adenocarcinoma that was KRAS-mutation and BRAF-mutation negative on molecular testing
  • He received initial therapy with FOLFOX and bevacizumab and showed a good response after 6 cycles, with a reduction in several target lesions on CT scan

In October of 2013, the patient returned for a follow-up with increasing fatigue, intermittent dyspnea, and chest pain.

  • Follow-up CT showed marked progression of target lesions, and multiple lung nodules consistent with metastatic disease; performance status at time of recurrence was 0. His chemotherapy was switched to FOLFIRI, and bevacizumab was continued
  • After 5 cycles, the patient’s condition improved and CT scan was consistent with stable disease
  • After 7 cycles, the patient requested to discontinue chemotherapy while traveling, but maintenance bevacizumab was continued

In July of 2014, the patient returned for follow-up with marked fatigue, declining performance status (PS 1), increasing dyspnea and chest pain; CT scan at that time showed marked progression of lung and peritoneal target lesions.

  • Liver and kidney function were within normal limits, and he began treatment with regorafenib at a dose of 160 mg.
  • After 2 weeks, treatment had to be interrupted due to grade 2 hypertension with fatigue and lightheadedness
  • The patient’s condition improved with antihypertensive therapy, and after 10 days treatment was reinitiated at a dose of 120 mg
  • Patient was able to tolerate the reduced dose, with some mild fatigue and diarrhea
  • After 5 cycles at 120 mg, the patient showed a good response, with a reduction in both lung and peritoneal metastases on CT scan; his performance status also improved (PS 0)

The patient’s disease remained stable until August of 2015, at which time his CT scan showed marked progression of the peritoneal lesions, and his CEA levels had increased to 33.5 ng/mL. He was initiated on trifluridine-tipiracil (TAS-102) in September of 2015 and his disease again stabilized. He remains on treatment at last follow-up.

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