Arvind Dasari, MD, MS, explains how to sequence radioligand therapy, cabozantinib, and everolimus in well-differentiated neuroendocrine tumors.
|Videos|June 12, 2017
Case Presentation in Advanced Colon Cancer Case: 1
Case Presentation in Advanced Colon Cancer
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October 2014
- A 69-year old Caucasian male presented with severe left lower quadrant pain
- He sought medical treatment after experiencing bloody diarrhea
- PMH was remarkable for hypertension that was being managed with telmisartan
- He was active and could perform his daily activities without restrictions or assistance
- Laboratory evaluation was remarkable for Hb 11.3 and CEA 6.5 ng/mL
- Colonoscopy revealed a fungating mass in the sigmoid colon which was biopsied
- Pathological findings: invasive poorly differentiated adenocarcinoma
- Molecular testing on the primary tumor was requested; no mutations were noted in KRAS, NRAS, BRAF, PIK3CA (quadruple wild type) and the tumor was microsatellite stable (MSS)
- Chest, abdominal, and pelvic CT scan showed small bilateral lung nodules, a 3-cm mass in the right lobe of the liver, and a mass in the sigmoid colon measuring 10 cm
- Diagnosis, unresectable metastatic colorectal cancer
- Treatment was initiated with FOLFIRI + cetuximab and he appeared to respond well
- CT scans at 3 and 6 months showed decreased size of liver and lung nodules
August 2015
- The patient complained of increased fatigue, and reported needing frequent breaks while performing daily activities
- CT scan showed increased size of the liver nodule (to 4 cm) and the appearance of 4 new small liver lesions (<2 cm)
- He began therapy with FOLFOX + bevacizumab
March 2016
- The patient complained of severe fatigue
- CT scan revealed progressive disease with no improvement in the primary and metastatic lesion size and/or number
- A new pulmonary nodule was seen in the right lung
- He was then started on trifluridine/tipiracil
- PET/CT at 3 months showed stable disease
- At 6-months, he reported less fatigue and some improvement in performing daily tasks
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