P3-067 - A case of liver metastases with hyperbilirubinemia that was safely treated with chemotherapy (FOLFOX plus Cetuximab)

Abstract

The liver and lungs are the most common sites of metastasis from colorectal cancer. Multiple liver metastases from colorectal cancer may result in severe liver dysfunction. The systemic chemotherapy for cases with severe liver dysfunction with hyperbilirubinemia and ascites is challenging. A 48-year-old man presented to our hospital with a complaint of anorexia and defecation difficulty for approximately two months' duration. Physical examination revealed jaundice and apparently enlarged liver within the right upper quadrant that extended 6 cm below the right costal margin. Laboratory data showed increased serum liver enzymes (AST 160 IU/L, ALT 38 IU/L, ALP 3674 IU/L, LDH 1347 IU/L), a total bilirubin level of 6.2 mg/dL and increased tumor markers (CEA 4536 ng/mL, CA 19-9 4363 U/mL). A CT scan revealed multiple liver metastases and moderate ascites. Endoscopic examination revealed sigmoid colon adenocarcinoma harboring with wild-type RAS. FOLFOX (folinic acid/5-FU/oxaliplatin) was started at full standard doses. We started Cetuximab after 1 week and then FOLFOX plus Cetuximab therapy was given every two weeks (Cetuximab was given weekly). Five weeks after the start of treatment, a CT scan showed that liver metastases were reduced in size and ascites disappeared. Laboratory date showed a decrease in serum liver enzymes (AST 30 IU/L, ALT 12 IU/L, ALP 785 IU/L, LDH 247 IU/L) and a total bilirubin level of 1.1 mg/dL. Serious adverse events didńt occur except for grade 3 skin reaction. The Systemic chemotherapy has been administered on an outpatient basis for seven months since the treatment initiation. FOLFOX plus Cetuximab therapy was effective and safe even in the patient with severe liver dysfunction.