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