Cathy Eng, MD, FACP: EGFR-Directed Therapy and Mutational Status

Would you consider an EGFR-directed therapy in this patient, and does her mutational status affect your decision?

CASE: Metastatic Colorectal Cancer (Part 1)

Diane B. is a 72-year-old retired elementary school teacher from Chicago, Illinois.

• Her prior medical history is notable for stage I cervical cancer at age 20 years, treated with cobalt therapy and total hysterectomy

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.

• CT scan revealed a large nonobstructive mass in the sigmoid colon with multiple large hepatic lesions; the patient’s CEA level was 158 ng/mL

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.

• The patient was asymptomatic at the time of recurrence, and her neuropathy had improved to grade 1