- 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.
- 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.