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