Surgically Unresectable Metastatic Colorectal Cancer Case: 1

December 2014

• A 51-year old Caucasian female presented with severe crampy right lower quadrant pain
  • She had a 4-month history of occult bleeding, and significant weight loss of over 10 pounds in the last 8 months
  • She sought medical treatment after experiencing severe cramping in the abdomen and bloody diarrhea
• Past medical history included GERD, managed with a proton pump inhibitor and appendectomy at age 35
• Laboratory evaluation showed grade 2 anemia (hemoglobin 8.7 g/dL) and carcinoembryonic antigen (CEA) level of 4.5 ng/mL
• Colonoscopy revealed an obstructive lesion in the ascending colon, measuring approximately 15 cm
  • Pathological findings showed invasive and poorly differentiated adenocarcinoma with ulcer
  • 10 of 15 lymph nodes sampled were positive for tumor
  • CT scan revealed widespread lesions in both lobes of the liver, and she was diagnosed with stage IV disease
  • Mutation testing; KRAS-positive (G12D) and BRAF-negative
  • Her ECOG performance status was 0
• She was treated with six cycles of FOLFOX + bevacizumab, and appeared to be responding well to treatment; follow-up imaging showed reduction in the size of the liver lesions

November 2015

• Follow-up CT showed progression in the liver with new lesions and new small masses in the abdomen and pelvis
• Her ECOG performance status was 1
• She began therapy with FOLFIRI + bevacizumab

December 2015

• The patient complained of severe fatigue
• CT scan revealed progressive disease with no improvement in the size and number of the abdominal lesions and the presence of 3 pulmonary nodules in the right lung
• She was then switched to trifluridine/tipiracil (TAS-102)
• PET/CT at 3 months and 6 months showed stable disease
• Her ECOG performance status improved (PS 0)