Abstract
A 31-year-old man with sigmoid colon cancer with concomitant simultaneous multiple liver metastases had received FOLFIRI (leucovorin, fluorouracil and irinotecan) and FOLFOX6 (leucovorin, fluorouracil and oxaliplatin) after an ordinary sigmoidectomy. However, his serum carcinoembryonic antigen (CEA) level increased rapidly during the fifteen months after the operation while he was on FOLFOX6. Abdominal computed tomography revealed expanding multiple liver tumors. As the third line chemotherapy, a combination therapy of cetuximab with irinotecan was given, which markedly reduced his levels of serum CEA, and the size and number of liver tumors. He underwent lateral segmentectomy of the liver and microwave coagulation of the liver metastases in the remnant liver. Thereafter, a good quality of life with tumor dormancy was obtained for 6 months. However, his serum CEA started to rise again in the absence of liver tumors. Therefore, FOLFOX6 with bevacizumab was chosen as the fourth line chemotherapy, and the serum CEA was reduced with tumor dormancy. A good quality of life was obtained again at 3 years after the first surgery. This report indicates the effectiveness of sandwiched liver surgery with the molecular targeting drugs cetuximab and bevacizumab on multiple liver metastases of colon cancer, and suggests the possibility of a regimen consisting of bevacizumab following cetuximab.
Highlights
Various molecular targeting drugs have appeared through developing biotechnology [1]
The patient underwent conventional neoadjuvant chemotherapy, first with leucovorin fluorouracil and irinotecan (FOLFIRI) (5-fluorocil (FU) 400 mg/m2 bolus injection; LV 400 mg/m2/2 hours; 5FU 2,400 to 3,000 mg/m2/46 hours continuous infusion with irinotecan 180 mg/m2/1.5 hours, every 2 weeks for twenty courses). He was commenced on FOLFOX6 (Day 1: 5FU 400 mg/m2 bolus injection; LV 200 mg/m2/ 2 hours; 5FU 600 mg/m2/22 hours continuous infusion with oxaliplatin (L-OHP) 85 mg/m2/2 hours; Day 2: same menu without L-OHP, every 2 weeks for eight courses) because abdominal enhanced computed tomography (CT) demonstrated enlargement of the cancer liver metastases (CCLM) according to Response Evaluation Criteria in Solid Tumors (RECIST) (Figure 1)
A European randomized trial suggested that cetuximab with or without irinotecan was effective in patients with irinotecan-refractory CCLM [3]
Summary
Various molecular targeting drugs have appeared through developing biotechnology [1]. The patient underwent conventional neoadjuvant chemotherapy, first with FOLFIRI (5-fluorocil (FU) 400 mg/m2 bolus injection; LV 400 mg/m2/2 hours; 5FU 2,400 to 3,000 mg/m2/46 hours continuous infusion with irinotecan 180 mg/m2/1.5 hours, every 2 weeks for twenty courses) He was commenced on FOLFOX6 (Day 1: 5FU 400 mg/m2 bolus injection; LV 200 mg/m2/ 2 hours; 5FU 600 mg/m2/22 hours continuous infusion with oxaliplatin (L-OHP) 85 mg/m2/2 hours; Day 2: same menu without L-OHP, every 2 weeks for eight courses) because abdominal enhanced CT demonstrated enlargement of the CCLM according to Response Evaluation Criteria in Solid Tumors (RECIST) (Figure 1). The patient obtained good quality of life (QOL) with tumor dormancy by addition of the third line chemotherapy during the 6 months after the second operation His serum CEA level gradually re-increased even though the third line chemotherapy with the combination of cetuximab and irinotecan was performed (Figure 2). A combination of FOLFOX6 with bevacizumab was chosen as the fourth line chemotherapy His serum CEA level again decreased significantly without any new lesions in the remnant liver. The patient has kept a good QOL with tumor dormancy as of 3 years after the first operation
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