ONCAlert | 2018 ASCO Annual Meeting
Colorectal Cancer Case Studies

Marwan G. Fakih, MD: Considering a Second EGFR-directed Therapy

Marwan G. Fakih, MD
Published Online:Jul 07, 2015
Neil H. is a 62-year-old construction manager from Houston, Texas.

Metastatic CRC with Marwan G. Fakih, MD and Tanios Bekaii-Saab, MD: Case 1

Would you consider a second EGFR-directed therapy in this patient?
Dr. Fakih says that it is clear this patient has progressed on first-line chemotherapy. From this, there are several options of treatment. In the second-line treatment of patients with metastatic colorectal cancer with extended RAS wild-type tumors, and BRAF wild-type tumor, the options are to proceed to a second chemotherapy backbone, FOLFIRI, plus an antiangiogenic agent, specifically here bevacizumab, or ramucirumab, or Aflibercept. All of these three antiangiogenic agents are considered options of treatment in the second-line treatment. 

CASE 1: Metastatic Colorectal Cancer (CRC)

Neil H. is a 62-year-old construction manager from Houston, Texas.
  • His prior medical history is notable for obesity, mild hypertension, hyperuricemia, and gout
The patient was diagnosed with colon cancer in February 2011, after reporting to his PCP with symptoms of intermittent nausea, vomiting, and blood in his stool
  • Patient underwent resection of the sigmoid colon with lymph node evaluation (12 nodes examined), which showed adenocarcinoma stage T3N0M0; mutational status showed RAS WT; BRAF negative
In January of 2013, he presented to his oncologist for evaluation after his CEA had increased to 85 ng/mL.
  • The patient was asymptomatic at the time of recurrence
  • CT scan showed multiple unresectable metastatic lesions to the liver and lung; the patient’s ECOG performance status was 0
  • He received initial therapy with FOLFOX and bevacizumab for metastatic disease
  • After 6 cycles the patient experienced a good response but developed grade 3 neuropathy and oxaliplatin was discontinued
  • The patient was continued on 5FU with bevacizumab with eventual improvement of his neuropathy symptoms; his disease continued to be stable
In February of 2015, the patient presents with fatigue, nonexertional dyspnea, and cough, and his CEA had increased to 110 ng/mL.
  • CT scan was consistent with progression of liver and pulmonary lesions
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