Case Presentation in Advanced Colon Cancer Case: 1

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