A Case of Rectal Cancer with Unresectable Liver Metastasis Responding to Rechallenge with FOLFIRI

• Published in: Gan to kagaku ryoho Vol. 43; no. 12; p. 2277
• Main Authors: Kamiya, Mariko, Yoneyama, Katsuya, Doi, Yuki, Shirai, Junya, Suzuki, Yoshihiro, Hatori, Shinsuke, Yamada, Takanobu, Sato, Tsutomu, Yamamoto, Naoto, Oshima, Takashi, Yukawa, Norio, Yoshikawa, Takaki, Rino, Yasushi, Masuda, Munetaka
• Format: Journal Article
• Language: Japanese
• Published: Japan 01.11.2016
• Subjects: Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bevacizumab - administration & dosage; Camptothecin - administration & dosage; Camptothecin - analogs & derivatives; Cetuximab - administration & dosage; Fluorouracil - administration & dosage; Humans; Leucovorin - administration & dosage; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - drug therapy; Liver Neoplasms - secondary; Male; Middle Aged; Rectal Neoplasms - diagnostic imaging; Rectal Neoplasms - drug therapy; Rectal Neoplasms - pathology; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 0385-0684

A 63-year-old man underwent low anterior resection for rectal cancer.A synchronous liver metastasis located in segment 8 was 12 cm in diameter and unresectable due to its proximity to the inferior vena cava(IVC).The postoperative pathological findings revealed a T3(SS), N0, M1(liver)Stage IV tumor, and wild type K-RAS was expressed.We chose FOLFIRI plus cetuximab(Cmab)for first-line chemotherapy.After 6 courses, we changed the molecular target drug from Cmab to bevacizumab( Bmab)because the liver metastasis remained unresectable.The patient had long-term stable disease(SD)for approximately 30 months with the FOLFIRI-based regimen.We then changed the regimen to mFOLFOX6 plus Bmab for second-line, Cmab for third-line, and trifluridine/tipiracil hydrochloride for fourth-line chemotherapy to treat progressive disease(PD).After treatment with these chemotherapies, the patient wished to continue treatment.We restarted FOLFIRI plus Bmab for fifth-line chemotherapy as his general condition was still good.Consequently, his tumor markers levels decreased with stabilization of the disease on CT scans, and he continued therapy for 6 months while maintaining a good quality of life.This case suggested that rechallenge with anti-cancer agents could be effective and improve the prognosis of colorectal cancer patients after using all key drugs.