Summary
We report on a 42-year-old woman with colorectal cancer of the sigmoid colon with synchronous pulmonary metastases being treated since June of 2016. With a poorly differentiated, KRAS, NRAS and BRAF wildtype cancer and an advanced stage of the disease we look back to almost four years of treatment and a sequence consisting of four lines of polychemotherapy. Dynamic treatment without achieving relevant treatment-free periods resulted in a satisfying quality of life and prolonged overall survival. Exceptional cases in young and very fit patients support the benefit of a more aggressive treatment strategy.
References
Ferlay J, et al. Cancer incidence and mortality patterns in Europe: Estimates for 40 countries and 25 major cancers in 2018. Eur J Cancer. 2018;103:356–87.
Araghi M, et al. Global trends in colorectal cancer mortality: projections to the year 2035. Int J Cancer. 2019;144:2992–3000.
Siegel RL, et al. Colorectal cancer statistics. CA Cancer J Clin. 2020;64(2):104–17.
The American Cancer Society medical and editorial content team. Survival rates for colorectal cancer. 2020. https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/survival-rates.html. Accessed 13 March 2020.
Lim HJ, et al. Impact of irinotecan and oxaliplatin on overall survival in patients with metastatic colorectal cancer: a population-based study. J Oncol Pract. 2009;5:153–8.
Meulenbeld HJ, van Steenbergen LN, Janssen-Heijnen MLG, Lemmens VEPP, Creemers GJ. Significant improvement in survival of patients presenting with metastatic colon cancer in the south of The Netherlands from 1990 to 2004. Ann Oncol. 2008;19:1600–4.
Aljehani MA, et al. Association of primary tumor site with mortality in patients receiving bevacizumab and cetuximab for metastatic colorectal cancer. JAMA Surg. 2018;153:60–7.
Tournigand C, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol. 2004;22:229–37.
Colucci G, et al. Phase III randomized trial of FOLFIRI versus FOLFOX4 in the treatment of advanced colorectal cancer: a multicenter study of the Gruppo Oncologico Dell’Italia Meridionale. J Clin Oncol. 2005;23:4866–75.
Kalofonos HP, et al. Irinotecan or oxaliplatin combined with leucovorin and 5‑fluorouracil as first-line treatment in advanced colorectal cancer: a multicenter, randomized, phase II study. Ann Oncol. 2005;16:869–77.
CALGB/SWOG C80405. A phase III trial of FOLFIRI or FOLFOX with bevacizumab or cetuximab or both for untreated metastatic adenocarcinoma of the colon or rectum. Clin Adv Hematol Oncol. 2006;4:452–3.
Venook AP, et al. CALGB/SWOG 80405: Phase III trial of irinotecan/5-FU/leucovorin (FOLFIRI) or oxaliplatin/5-FU/leucovorin (mFOLFOX6) with bevacizumab (BV) or cetuximab (CET) for patients (pts) with KRAS wild-type (wt) untreated metastatic adenocarcinoma of the colon or rectum (MCRC). J Clin Oncol. 2014;32:LBA3–LBA3.
Heinemann V, et al. FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomised, open-label, phase 3 trial. Lancet Oncol. 2014;15:1065–75.
Giantonio BJ, et al. Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: results from the Eastern Cooperative Oncology Group Study E3200. J Clin Oncol. 2007;25:1539–44.
Cremolini C, Antoniotti C, Moretto R, Masi G, Falcone A. First-line therapy for mCRC—the influence of primary tumour location on the therapeutic algorithm. Nat Rev Clin Oncol. 2017;14:113.
Holch JW, Ricard I, Stintzing S, Modest DP, Heinemann V. The relevance of primary tumour location in patients with metastatic colorectal cancer: A meta-analysis of first-line clinical trials. Eur J Cancer. 2017;70:87–98.
Santini D, et al. Cetuximab rechallenge in metastatic colorectal cancer patients: how to come away from acquired resistance? Ann Oncol. 2012;23:2313–8.
Cremolini C, et al. Rechallenge for patients with RAS and BRAF wild-type metastatic colorectal cancer with acquired resistance to first-line cetuximab and irinotecan: a phase 2 single-arm clinical trial. JAMA Oncol. 2019;5:343–50.
U.S. National Library of Medicine. Metastatic colorectal cancer (RAS-wildtype) after response to first-line treatment with FOLFIR plus Cetuximab—full text view—clinicaltrials.gov. 2016. https://clinicaltrials.gov/ct2/show/NCT02934529. Accessed 18 March 2020.
Anonymous. Zaltrap. European Medicines Agenc. 2018. https://www.ema.europa.eu/en/medicines/human/EPAR/zaltrap. Accessed 19 April 2020.
Van Cutsem E, et al. Addition of aflibercept to fluorouracil, leucovorin, and irinotecan improves survival in a phase III randomized trial in patients with metastatic colorectal cancer previously treated with an oxaliplatin-based regimen. J Clin Oncol. 2012;30:3499–506.
Scartozzi M, Vincent L, Chiron M, Cascinu S. Aflibercept, a new way to target angiogenesis in the second line treatment of metastatic colorectal cancer (mCRC). Target Oncol. 2016;11:489–500.
Dhillon S. Regorafenib: a review in metastatic colorectal cancer. Drugs. 2018;78:1133–44.
Pfeiffer P, et al. Randomized study evaluating trifluridine/tipiracil (TAS-102) versus + trifluridine/tipiracil + bevacizumab as last-line therapy in patients with chemorefractory unresectable metastatic colorectal cancer (mCRC). J Clin Oncol. 2019;37:637–637.
Arnold M, et al. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66:683–91.
Center MM, Jemal A, Smith RA, Ward E. Worldwide variations in colorectal cancer. CA Cancer J Clin. 2009;59:366–78.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
F.H. Witte, W. Hilbe and E. Müldür declare that they haves no competing interests.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Witte, F.H., Hilbe, W. & Müldür, E. Four lines of immunochemotherapy combinations in a young patient with an aggressive metastatic colorectal cancer. memo 13, 337–340 (2020). https://doi.org/10.1007/s12254-020-00627-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12254-020-00627-8