A Continuum of Care for Metastatic CRC

February 2013

• A 53-year old Caucasian man presented to his gastroenterologist complaining of rectal bleeding and abdominal tenderness
• PMH includes hypertension, well-controlled on a beta-blocker
• Family history; mother died from breast cancer
• He underwent colonoscopy with biopsy
  • Pathology results confirmed poorly-differentiated adenocarcinoma
  • Genetic testing was positive forKRASexon 2 codon 12 mutation
• CT scan of the abdomen, pelvis, and chest showed multiple liver lesions and a large nodule in the right lower pulmonary lobe.
• Diagnosis: Adenocarcinoma of the colon; staging, T4N0M1
• The patient was started on FOLFOX and bevacizumab, therapy is well-tolerated
• The second follow-up scan showed a marked decrease in volume of the primary tumor, two of the liver lesions, and the lung lesion.

March 2014

• The patient complains of intermittent shortness of breath but continues his normal activities
• Imaging shows slow but steady progression in the plural lesion
• Bevacizumab therapy was continued; the patient was also started on FOLFIRI
• Follow-up imaging shows continued regression of the lung lesion; patient continues to tolerate therapy with management of gastrointestinal distress

February 2017

• The patient complains of abdominal fullness, nausea, and constipation
• He continues to work full-time but feels sluggish
• MRI indicated diffuse metastatic disease in the peritoneum, consistent with carcinomatosis
• The patient was started on regorafenib 80 mg, with a plan to gradually increase to 160 mg if tolerated