Metastatic CRC with Marwan G. Fakih, MD and Tanios Bekaii-Saab, MD: Case 2 - Episode 3

Tanios Bekaii-Saab, MD: Comorbidity Condition as a Factor in Treatment Decision

Would comorbidity conditions in this patient influence your treatment decisions?

Dr. Bekaii-Saab think that this patient is more likely than not to be able to tolerate these types of treatments. Again, very few comorbidities, if any, and then a good performance status. Age itself is only a minor determinant. Of course a patient above 80, you really need to think hard about being too aggressive. But under 80, and in some would cut the mark at 75, still you should be equally aggressive across these patients unless significant comorbidities coexist, or a poor performance status.


CASE 2: Metastatic Colorectal Cancer (CRC)

Beverly C. is a 73-year-old retired nurse originally from Albany, New York. She and her husband enjoy golf and traveling.

  • Her prior medical history is notable for type 2 diabetes mellitus and basal cell carcinoma of the neck, successfully excised in 2009

In 2010, routine colonoscopy revealed a large adenomatous polyp that was subsequently removed endoscopically.

  • Patient was advised to return for regular evaluation but subsequently relocated to Florida and was lost to follow-up

In January of 2014, she presented to her PCP with symptoms of irregular bowel movements, fatigue, and unexplained weight loss.

CT scan revealed a large mass in the sigmoid colon and multiple hepatic lesions

Patient was eventually diagnosed with stage IV colorectal cancer with metastasis to the liver

She underwent resection of the sigmoid mass followed by FOLFOX for metastatic disease

After 6 months she developed stage 3 sensory neuropathy and oxaliplatin was discontinued; at that time, hepatic lesions were stable

She is now continuing treatment with 5-FU and leucovorin until disease progression