ONCAlert | 2018 ASCO Annual Meeting
Saab Metastatic Crc Case Studies

Case Studies: The Therapeutic Management of Metastatic CRC

In this case-based interview, Tanios Bekaii-Saab, MD, FACP, reviews a 62-year-old female patient with metastatic colorectal cancer and provides the options and lines of therapy for her, as well as the impacts of family history and tumor location.

The Therapeutic Management of Metastatic CRC

November 2015

  • A 62-year-old Caucasian female presents with severe crampy right lower quadrant pain
    • 6-month history of occult bleeding and weight loss of 15 pounds in the last 8 months
  • PMHx: tonsillectomy at age 23; hysterectomy at age 55
  • FHx: Mother diagnosed with colon cancer at age 71
  • Laboratory findings: remarkable for Hb, 7.6 g/dL; CEA 5.5 ng/mL
  • Colonoscopy reveals a large mass in the ascending colon, measuring approximately 11 cm
  • Biopsy results: Invasive, poorly differentiated adenocarcinoma
  • Additional pathologic testing
    • KRAS, NRAS, and BRAF wild-type
    • Microsatellite stable
  • CT scan revealed widespread lesions in the left lobe of the liver
  • Performance status: 0
  • Treatment was initiated with FOLFOX + bevacizumab
    • The patient experienced mild neuropathy, significant mucositis, grade 4 neutropenia, and severe diarrhea with the first cycle (suspected DPD deficiency)
    • She subsequently tolerated therapy well with 50% dose reduction of her regimen in addition to dropping the bolus 5-FU and leucovorin. 
  • Follow-up imaging showed reduction in the size of the liver lesions
  • Patient is planned to start maintenance therapy with low-dose capecitabine plus bevacizumab after 8 cycles of FOLFOX

August 2016 

  • Follow-up CT showed progression in the liver with new lesions
  • Performance status: 1
  • She began therapy with mFOLFIRI + bevacizumab
  • CEA levels stabilized

February 2017

  • The patient complained of severe fatigue and additional weight loss. Her performance status remains at 1.
  • CT scan revealed progressive disease with 2 new pulmonary nodules in the left lower lobe of the lung and mild progression in the liver.
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