Klin Onkol 2011; 24(6): 465-469. DOI: 10.14735/amko2011465.
Summary
Backgrounds: Colorectal cancer (CRC) is the second most frequent malignancy in the Czech Republic. Treatment of a metastatic disease is based on application of palliative chemotherapy (fluorouracil, leucovorin, irinotecan, oxaliplatin). When combined with targeted agents against vascular endothelial growth factor (VEGF) and epidermal growth factor receptor (EGFR), it can result in significant and long-term response. Case: We present a case of a 34-years old man with adenocarcinoma of sigmoid colon (Dukes C) with 5 years disease-free survival (DFS) after primary surgery (in 2002) and adjuvant chemotherapy with FOLFIRI (12 cycles). A solitary relapse in retroperitoneal lymph nodes in November 2007 was treated with retroperiotoneal dissection followed by adjuvant chemotherapy with FOLFOX 4 (12 cycles) and targeted radiotherapy of retroperitoneal area (completed in May 2008). An early relapse occurred one month later (June 2008 – infraclavicular area, thoracic wall and retroperitoneal lymph nodes), patient underwent first line palliative chemotherapy with XELIRI + bevacizumab leading to partial remission (PR) after 3 months and complete remission (CR) after 6 months of treatment. Bevacizumab monotherapy was continued for the next 8 months up to March 2010, when a progression in the lung occurred. After wild-type status was confirmed, KRAS treatment was changed to the second line combination of irinotecan and cetuximab that resulted in nearly complete remission after 6 months and preservation of this remission after the next 6 months of cetuximab monotherapy. All treatments were well tolerated with good quality of life. Conclusion: Our case demonstrates the current options in the treatment of metastatic CRC. There is a trend to gradually use all the above listed cytostatics in combination with anti-VEGF and anti-EGFR monoclonal antibodies. When administered early, it may provide a significant and long-term treatment response.
