Abstract
Introduction. Pathological complete remission of liver metastases is a rare colon cancer treatment outcome with increased 5-year survival of 76%. Case report. Metastatic colorectal cancer patient with pathological complete remission of large hepatic metastasis after palliative chemotherapy in combination with bevacizumab is presented. Solitary liver metastasis measuring 8 cm was observed in computed tomography (CT) scan before combined treatment. The best radiological response during treatment with FOLFOX-4 and bevacizumab therapy was partial remission and patient underwent partial hepatectomy. Since the operation material was free of viable adenocarcinoma cells the effect of FOLFOX-4 in combination with bevacizumab treatment was interpreted as the pathological complete remission. Conclusion. Use of combination chemotherapy and targeted therapy with the aim to reduce initially unresectable liver metastasis is the best option to achieve complete pathological remission and significantly prolong survival.
Highlights
Pathological complete remission of liver metastases is a rare colon cancer treatment outcome with increased 5-year survival of 76%
Since the operation material was free of viable adenocarcinoma cells the effect of FOLFOX-4 in combination with bevacizumab treatment was interpreted as the pathological complete remission
25% present with metastases at initial diagnosis and almost 50% of patients with CRC will develop metastases, contributing to the high mortality rates reported for metastatic colorectal cancer [1]
Summary
There are about 410,000 new cases of colorectal cancer in Europe every year. Most of patients with colorectal cancer (CRC) are over 65 years of age and the disease is rare before the age of 45 (2 per 100,000/year). About 13% of patients with initially unresectable metastases can become resectable after multidrug chemotherapy [3], that can improve progression free and overall survival: 5-year survival rates are in the range of 21% to 58% in patients with colorectal cancer liver metastases after surgical resection [4]. The addition of monoclonal antibodies (bevacizumab or cetuximab) to cytotoxic chemotherapy has increased the rate of tumor response, suggesting that the addition of these agents could improve resectability rate [5,6]. Several studies have been performed to find markers to predict the probability of patients achieving pathologic complete remission, including routine clinical and pathological characteristics, biomarkers, gene expression profiling and imaging techniques [6,7]. The objective of the research is to analyze the results of a clinical case and to identify possible predictive and prognostic factors which might affect treatment outcome
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