Treatment Options for Metastatic CRC

February 2013

• A 62-year old man presented to his primary care physician complaining of weight loss and bloody stool.
• PMH includes type 2 diabetes, well controlled on metformin
• He was referred for a colonoscopy:
  • Biopsy of a 6 cm. mass proximal to the sigmoid colon showed moderately differentiated adenocarcinoma
  • Genetic testing was positive forKRASexon 3 mutation
• Imaging of the chest, abdomen, and pelvis showed metastases to inguinal nodes, diffuse hepatic lesions and a 4 cm. nodule in the left lung.
• Diagnosis: stage 4 colorectal adenocarcinoma, unresectable
• After discussion with the patient about his options for systemic therapy, he was started on FOLFIRI and bevacizumab. Moderate nausea and vomiting was managed with ondansetron.
• Follow-up imaging at 6 months showed marked regression in the primary tumor and lung lesion. Subsequent scans showed stable disease.

March 2014

• Thirteen months later, the patient reported weight loss and fatigue; he continued to do household chores but was too tired for exercise.
• CT scan showed increase in size of several of the hepatic lesions.
• Bevacizumab therapy was continued; the patient was also started on FOLFOX.
• Follow up CT showed significant shrinkage of hepatic metastases. The patient continued to tolerate therapy and appeared well.