Marwan G. Fakih, MD: Comorbidity Condition as a Factor in Treatment Decision

Would comorbidity conditions in this patient influence your treatment decisions?

This is a 73-year-old female. She likes to golf, she likes to travel potentially, and she has also comorbidities, she’s diabetic.

Combination chemotherapy may be associated with significant toxicities as far as fatigue, as far as possible diarrhea, and other side effects that are systemic. If the patient wishes to take a break from chemotherapy, then regional therapies to the liver could be a consideration in this patient. The SIRFLOX clinical trial in the first-line setting improves the disease progression in the liver, and delays the progression in the liver by approximately eight months. Results from multiple other clinical trials with radioembolization, including refractory settings, that radioembolization to patients with metastatic colorectal cancer to the liver results in the progression-free survival of a median of approximately five months.

If the patient wishes to forego combination chemotherapy at this point, or wants to delay the combination chemotherapy because of her comorbidities, one option in this setting would be yttrium-90 radioembolization, or SIRT — selective internal radiation therapy with microspheres, specifically with SIRT spheres.

CASE 2: Metastatic Colorectal Cancer (CRC)

Beverly C. is a 73-year-old retired nurse originally from Albany, New York. She and her husband enjoy golf and traveling.

• Her prior medical history is notable for type 2 diabetes mellitus and basal cell carcinoma of the neck, successfully excised in 2009

In 2010, routine colonoscopy revealed a large adenomatous polyp that was subsequently removed endoscopically.

• Patient was advised to return for regular evaluation but subsequently relocated to Florida and was lost to follow-up

In January of 2014, she presented to her PCP with symptoms of irregular bowel movements, fatigue, and unexplained weight loss.

CT scan revealed a large mass in the sigmoid colon and multiple hepatic lesions

Patient was eventually diagnosed with stage IV colorectal cancer with metastasis to the liver

She underwent resection of the sigmoid mass followed by FOLFOX for metastatic disease

After 6 months she developed stage 3 sensory neuropathy and oxaliplatin was discontinued; at that time, hepatic lesions were stable

She is now continuing treatment with 5-FU and leucovorin until disease progression