ONCAlert | 2018 ASCO Annual Meeting
Colorectal Cancer Case Studies

Tanios Bekaii-Saab, MD: Options for Patients with Recurrent MCRC

Tanios Bekaii-Saab, MD
Published Online:Jul 06, 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

What options are available to prolong survival in patients like Neil with recurrent MCRC?

There are many treatment options for patients with recurrent MCRC. And with someone like Neil who has no mutations in the RAS pathway, that opens up even more options. There are at leasst four lines of therapy – three to four lines of therapy – standard therapies. And one more is coming out soon with an agent called TAS-102.

One option is to continue with bevacizumab to the second-line, move to an EGFR inhibitor plus irinotecan in the third-line. Then TAS-102 or regorafenib. Today regorafenib is the one that’s approved, so it would be regorafenib, and perhaps TAS-102 after that. So right from the get-go we have five, without even thinking about additional clinical trials or anything else or other mutations, there are five lines of therapy for this patient.

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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