Does the occurrence of sensory neuropathy in this patient affect your choice for second-line treatment?
Cathy Eng, MD, FACP, The University of Texas MD Anderson Cancer Center, says the development of sensory neuropathy definitely impacts her decision-making process regarding second-line therapy. In this setting with a rising carcinoembryonic antigen (CEA), Eng would consider starting FOLFIRI. If the patient is opposed to alopecia, she would consider reinitiation of oxaliplatin (FOLFOX) with the consideration of a dose reduction from 85 mg/m2 to 65 mg/m2. Eng would also consider starting treatment with an antineuropathic agent, in order to address the patient's grade 1 neuropathy.
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.