Metastatic Colorectal Cancer: Part 1 - Episode 11
Should anti-angiogenesis therapy be continued in this patient?
Cathy Eng, MD, FACP, The University of Texas MD Anderson Cancer Center, says anti-angiogenic therapy could definitely be continued in this patient. It’s been demonstrated in prior studies that continuing beyond progression from first-line therapy does benefit patients in regards to the continuation of anti-angiogenic therapy, in combination with chemotherapy. Bevacizumab could be continued. Other antiangiogenic agents could be considered as well, such as ramucirumab and ziv-aflibercept, in combination with irinotecan-based therapy
CASE: Metastatic Colorectal Cancer (Part 1)
Diane B. is a 72-year-old retired elementary school teacher from Chicago, Illinois.
The patient was diagnosed with metastatic colorectal cancer in January of 2013, after presenting to her PCP with progressive fatigue of 3 month’s duration and irregular bowel movements; Patient’s performance status was 1.
Patient was not indicated for surgery due to minimal symptoms and presence of metastatic disease
Biopsy of the sigmoid mass and hepatic lesion showed adenocarcinoma, and mutational testing showed KRAS WT; BRAF negative; RAS status was not determined
Diane underwent initial therapy for metastatic disease with FOLFOX + bevacizumab
Following 6 cycles, patient had a response with a decrease in several stable hepatic lesions the primary mass on CT; her CEA decreased to 25 ng/mL
At 4 months, the patient had developed sensory neuropathy (grade 2), and oxaliplatin was discontinued from her regimen; 5-FU, leucovorin, and bevacizumab were continued
In January of 2014, she presented to her oncologist for evaluation after her CEA had increased to 77 ng/mL.