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.
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.