The Therapeutic Management of Metastatic CRC

October 3, 2017

The Therapeutic Management of Metastatic CRC

November 2015

  • A 62-year-old Caucasian female presents with severe crampy right lower quadrant pain
    • 6-month history of occult bleeding and weight loss of 15 pounds in the last 8 months
  • PMHx: tonsillectomy at age 23; hysterectomy at age 55
  • FHx: Mother diagnosed with colon cancer at age 71
  • Laboratory findings: remarkable for Hb, 7.6 g/dL; CEA 5.5 ng/mL
  • Colonoscopy reveals a large mass in the ascending colon, measuring approximately 11 cm
  • Biopsy results: Invasive, poorly differentiated adenocarcinoma
  • Additional pathologic testing
    • KRAS,NRAS, andBRAFwild-type
    • Microsatellite stable
  • CT scan revealed widespread lesions in the left lobe of the liver
  • Performance status: 0
  • Treatment was initiated with FOLFOX + bevacizumab
    • The patient experienced mild neuropathy, significant mucositis, grade 4 neutropenia, and severe diarrhea with the first cycle (suspected DPD deficiency)
    • She subsequently tolerated therapy well with 50% dose reduction of her regimen in addition to dropping the bolus 5-FU and leucovorin.
  • Follow-up imaging showed reduction in the size of the liver lesions
  • Patient is planned to start maintenance therapy with low-dose capecitabine plus bevacizumab after 8 cycles of FOLFOX

August 2016

  • Follow-up CT showed progression in the liver with new lesions
  • Performance status: 1
  • She began therapy with mFOLFIRI + bevacizumab
  • CEA levels stabilized

February 2017

  • The patient complained of severe fatigue and additional weight loss. Her performance status remains at 1.
  • CT scan revealed progressive disease with 2 new pulmonary nodules in the left lower lobe of the lung and mild progression in the liver.