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Four lines of immunochemotherapy combinations in a young patient with an aggressive metastatic colorectal cancer

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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.

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References

  1. 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.

    Article  CAS  Google Scholar 

  2. Araghi M, et al. Global trends in colorectal cancer mortality: projections to the year 2035. Int J Cancer. 2019;144:2992–3000.

    Article  CAS  Google Scholar 

  3. Siegel RL, et al. Colorectal cancer statistics. CA Cancer J Clin. 2020;64(2):104–17.

    Article  Google Scholar 

  4. 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.

  5. 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.

    Article  Google Scholar 

  6. 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.

    Article  CAS  Google Scholar 

  7. 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.

    Article  Google Scholar 

  8. 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.

    Article  CAS  Google Scholar 

  9. 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.

    Article  CAS  Google Scholar 

  10. 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.

    Article  CAS  Google Scholar 

  11. 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.

    Google Scholar 

  12. 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.

    Article  Google Scholar 

  13. 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.

    Article  CAS  Google Scholar 

  14. 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.

    Article  CAS  Google Scholar 

  15. 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.

    Article  Google Scholar 

  16. 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.

    Article  Google Scholar 

  17. Santini D, et al. Cetuximab rechallenge in metastatic colorectal cancer patients: how to come away from acquired resistance? Ann Oncol. 2012;23:2313–8.

    Article  CAS  Google Scholar 

  18. 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.

    Article  Google Scholar 

  19. 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.

  20. Anonymous. Zaltrap. European Medicines Agenc. 2018. https://www.ema.europa.eu/en/medicines/human/EPAR/zaltrap. Accessed 19 April 2020.

  21. 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.

    Article  Google Scholar 

  22. 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.

    Article  Google Scholar 

  23. Dhillon S. Regorafenib: a review in metastatic colorectal cancer. Drugs. 2018;78:1133–44.

    Article  CAS  Google Scholar 

  24. 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.

    Article  Google Scholar 

  25. Arnold M, et al. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66:683–91.

    Article  Google Scholar 

  26. Center MM, Jemal A, Smith RA, Ward E. Worldwide variations in colorectal cancer. CA Cancer J Clin. 2009;59:366–78.

    Article  Google Scholar 

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Correspondence to Frédéric H. Witte.

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F.H. Witte, W. Hilbe and E. Müldür declare that they haves no competing interests.

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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

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  • DOI: https://doi.org/10.1007/s12254-020-00627-8

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