Metastatic CRC with Marwan G. Fakih, MD and Tanios Bekaii-Saab, MD: Case 1 - Episode 2

Tanios Bekaii-Saab, MD: Age and Performance Status Issue in Determining Therapy

Is age or performance status an issue for this patient in determining subsequent therapy?

Dr. Bekaii-Saab would not say that age is an issue in this patient, considering 62 to still be relatively young. The patient also doesn’t have many comorbidities. So in many ways this patient has, in this particular patient at least, there are no contraindications for any further aggressive therapy so we continue through aggressive therapy. Age, and more importantly, comorbidities and performance status more than age are actually very important determinants are whether we use an aggressive combination approach versus a single agent plus/minus biologic approach.

So these are important factors and actually more important than age. Patients up to age 80 have been treated with very aggressive regimens. They’re relatively safe. And the literature suggests that at least until age 75 these patients continue to benefit from more aggressive therapy. And you can argue even higher than that, if the patient has a good performance status and no significant comorbidities.

CASE 1: Metastatic Colorectal Cancer (CRC)

Neil H. is a 62-year-old construction manager from Houston, Texas.

  • His prior medical history is notable for obesity, mild hypertension, hyperuricemia, and gout

The patient was diagnosed with colon cancer in February 2011, after reporting to his PCP with symptoms of intermittent nausea, vomiting, and blood in his stool

  • Patient underwent resection of the sigmoid colon with lymph node evaluation (12 nodes examined), which showed adenocarcinoma stage T3N0M0; mutational status showed RAS WT; BRAF negative

In January of 2013, he presented to his oncologist for evaluation after his CEA had increased to 85 ng/mL.

The patient was asymptomatic at the time of recurrence

CT scan showed multiple unresectable metastatic lesions to the liver and lung; the patient’s ECOG performance status was 0

He received initial therapy with FOLFOX and bevacizumab for metastatic disease

After 6 cycles the patient experienced a good response but developed grade 3 neuropathy and oxaliplatin was discontinued

The patient was continued on 5FU with bevacizumab with eventual improvement of his neuropathy symptoms; his disease continued to be stable

In February of 2015, the patient presents with fatigue, nonexertional dyspnea, and cough, and his CEA had increased to 110 ng/mL.

  • CT scan was consistent with progression of liver and pulmonary lesions