Colorectal Cancer: Managing Recurrent Disease

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Colorectal Cancer: Managing Recurrent Disease

January 2017

A 62-year-old African-American man presented with recurrent CRC

  • Diagnosed at age 55 with stage 3 CRC, treated with surgery and adjuvant FOLFOX
  • He underwent colonoscopy with biopsy
    • 6-cm ulcerated non-obstructive mass noted in the right colon
    • Pathology confirmed poorly-differentiated adenocarcinoma
    • Staging; T3N1M0
  • History
    • Former smoker, 1 pack a day; quit 20 years ago
    • Obese, BMI = 30.2 kg/m2
    • Mother had inflammatory bowel disease, died at age 70
    • Other medications: metoprolol for hypertension, omeprazole, regular NSAID use
  • PET/CT scan showed recurrent disease with multiple metastases in liver
    • CEA, 28.4 ng/mL
    • Biopsy of liver lesions suggests poorly-differentiated with colon primary
    • Mutation analysis;KRASandNRAS,WT;BRAF-wild-type; microsatellite-stable
  • He was started on FOLFIRI with bevacizumab and achieved partial response

January 2018

  • The patient reports feeling short of breath.
  • PET/CT showed progressive disease in the liver and multiple metastases in both lung fields
  • Therapy options were discussed with the patient; he preferred an oral therapy
  • He was started on regorafenib, 80 mg once daily
    • He experienced grade 2 dermatologic toxicity on his hands and feet (palmar-plantar erythrodysesthesia syndrome [PPES]), which was managed with dose escalation from 80 mg to 120 mg to 160 mg. With recovery, he resumed regorafenib at 120 mg/day
    • At present,he remains on regorafenib 120 mg/day with evidence of stable disease at 6-month follow-up
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