Cathy Eng, MD, FACP: Impact of Sensory Neuropathy on Second-Line Treatment

Does the occurrence of sensory neuropathy in this patient affect your choice for second-line treatment?

Cathy Eng, MD, FACP, The University of Texas MD Anderson Cancer Center, says the development of sensory neuropathy definitely impacts her decision-making process regarding second-line therapy. In this setting with a rising carcinoembryonic antigen (CEA), Eng would consider starting FOLFIRI. If the patient is opposed to alopecia, she would consider reinitiation of oxaliplatin (FOLFOX) with the consideration of a dose reduction from 85 mg/m2 to 65 mg/m2. Eng would also consider starting treatment with an antineuropathic agent, in order to address the patient's grade 1 neuropathy.

CASE: Metastatic Colorectal Cancer (Part 1)

Diane B. is a 72-year-old retired elementary school teacher from Chicago, Illinois.

• Her prior medical history is notable for stage I cervical cancer at age 20 years, treated with cobalt therapy and total hysterectomy

The patient was diagnosed with metastatic colorectal cancer in January of 2013, after presenting to her PCP with progressive fatigue of 3 month’s duration and irregular bowel movements; Patient’s performance status was 1.

• CT scan revealed a large nonobstructive mass in the sigmoid colon with multiple large hepatic lesions; the patient’s CEA level was 158 ng/mL

Patient was not indicated for surgery due to minimal symptoms and presence of metastatic disease

Biopsy of the sigmoid mass and hepatic lesion showed adenocarcinoma, and mutational testing showed KRAS WT; BRAF negative; RAS status was not determined

Diane underwent initial therapy for metastatic disease with FOLFOX + bevacizumab

Following 6 cycles, patient had a response with a decrease in several stable hepatic lesions the primary mass on CT; her CEA decreased to 25 ng/mL

At 4 months, the patient had developed sensory neuropathy (grade 2), and oxaliplatin was discontinued from her regimen; 5-FU, leucovorin, and bevacizumab were continued

In January of 2014, she presented to her oncologist for evaluation after her CEA had increased to 77 ng/mL.

• The patient was asymptomatic at the time of recurrence, and her neuropathy had improved to grade 1