Metastatic CRC with Marwan G. Fakih, MD and Tanios Bekaii-Saab, MD: Case 1 - Episode 4

Tanios Bekaii-Saab, MD: Options for Patients with Recurrent MCRC

What options are available to prolong survival in patients like Neil with recurrent MCRC?

There are many treatment options for patients with recurrent MCRC. And with someone like Neil who has no mutations in the RAS pathway, that opens up even more options. There are at leasst four lines of therapy — three to four lines of therapy – standard therapies. And one more is coming out soon with an agent called TAS-102.


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