Optimal Treatment of Chemoresistant mCRC

March 13, 2019

Optimal Treatment of Chemoresistant mCRC


Case: A 60-Year-Old Male With mCRC

Initial presentation

April 2015

  • A 60-year—old man was referred to gastroenterology after complaining of general malaise and alternating constipation with bloody diarrhea.
  • PE: Showed left-sided lower abdominal pain
  • Carcinoembryonic antigen (CEA); 8.1 mg/L
  • Colonoscopy revealed a left-sided adenocarcinoma of the colon
  • Surgery: left hemicolectomy
  • Pathology: well-differentiated adenocarcinoma
  • PET/CT: 15/15 lymph nodes tested negative
  • Staging: IIIA
  • ECOG PS 0
  • Patient received adjuvant mFOLFOX4

April 2018

  • 24 months later, the patient complained of mild abdominal distension and his stools were pencil-shaped with some presence of blood
  • PET/CT scan showed widespread small liver lesions
  • CEA; 14.7 mg/L
  • Biopsy was CK2-positive
  • Molecular testing; allRAS&BRAFWT
  • ECOG PS 1
  • Patient began treatment with FOLFIRI + bevacizumab

February 2019

  • PET/CT scan showed evidence of new liver lesions and a 2-cm mass in the right lung
  • CEA; 31.7 mg/L
  • Patient started on regorafenib 80 mg/day