Colorectal Cancer: Managing Recurrent Disease
Colorectal Cancer: Managing Recurrent Disease
January 2017
A 62-year-old African-American man presented with recurrent CRC
- Diagnosed at age 55 with stage 3 CRC, treated with surgery and adjuvant FOLFOX
- He underwent colonoscopy with biopsy
- 6-cm ulcerated non-obstructive mass noted in the right colon
- Pathology confirmed poorly-differentiated adenocarcinoma
- Staging; T3N1M0
- History
- Former smoker, 1 pack a day; quit 20 years ago
- Obese, BMI = 30.2 kg/m2
- Mother had inflammatory bowel disease, died at age 70
- Other medications: metoprolol for hypertension, omeprazole, regular NSAID use
- PET/CT scan showed recurrent disease with multiple metastases in liver
- CEA, 28.4 ng/mL
- Biopsy of liver lesions suggests poorly-differentiated with colon primary
- Mutation analysis;KRASandNRAS,WT;BRAF-wild-type; microsatellite-stable
- He was started on FOLFIRI with bevacizumab and achieved partial response
January 2018
- The patient reports feeling short of breath.
- PET/CT showed progressive disease in the liver and multiple metastases in both lung fields
- Therapy options were discussed with the patient; he preferred an oral therapy
- He was started on regorafenib, 80 mg once daily
- He experienced grade 2 dermatologic toxicity on his hands and feet (palmar-plantar erythrodysesthesia syndrome [PPES]), which was managed with dose escalation from 80 mg to 120 mg to 160 mg. With recovery, he resumed regorafenib at 120 mg/day
- At present,he remains on regorafenib 120 mg/day with evidence of stable disease at 6-month follow-up
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