4 cases of metastatic colorectal cancer treated by FOLFIRI+Aflibercept (FOLFIRI+AFL) after 3rd line

Abstract

Abstract The efficacy of FOLFIRI+AFL therapy in the 2nd line for metastatic colorectal cancer was proved in VELOUR study. In Japan, Aflibercept (AFL) was permitted by health insurance medical treatment in 2017. But at that time, many patients had finished the strong chemotherapy or treated after 3rd line chemotherapy. So some patients hoped for the treatment of FOLFIRI+AFL. We study of 4 cases of metastatic colorectal cancer treated by FOLFIRI+AFL after 3rd line in our hospital. Case 1 38 y.o male contracted multiple lung and liver metastases of rectal cancer. He was treated by the following chemotherapies [CAPOX+BEV, FOLFIRI+BEV, FOLFOX+BEV, FTD/TPI] and ALF was introduced in 5th line. 14 courses of FOLFIRI+AFL were performed and the tumors temporarily reduced. Case 2 72 y.o female contracted multiple lymphnode metastases and peritoneal dissemination of sigmoid colon cancer. She was treated by the following chemotherapies [FOLFOX+CET, FOLFIRI+BEV] and ALF was introduced in 3rd line. 3 courses of FOLFIRI+AFL were performed but the tumors were increased (PD). Case 3 67 y.o female contracted unresectable rectal cancer and multiple lymphnode metastases. She was treated by the following chemotherapies [CAPOX+BEV, FOLFIRI+RAM] and ALF was introduced in 3rd line. 1 course of FOLFIRI+AFL was performed, but she deteriorated into bad condition and this therapy was stopped. Case 4 64 y.o female contracted paraaortic lymphnode metastases of rectal cancer . He was treated by the following chemotherapies [FOLFOX+CET, FOLFIRI+BEV, FOLFIRI+PANI] and ALF was introduced in 4th line. 3 courses of FOLFIRI+AFL were performed but the tumors were increased (PD). Conclusion Only Case1 showed tumor regression. But the other 3 cases those were treated by FOLFIRI + molecularly targeted agents except AFL in previous line, showed no efficacy. It is suggested that only exchange of molecularly targeted agents to AFL in FOLFIRI therapy dose not show the enough antitumor effect in colorectal cancer.