Systemic chemotherapy for metastatic non-mucinous appendiceal adenocarcinoma: a case report and literature review

Abstract

Non-mucinous appendiceal adenocarcinoma is rare and shows poor prognosis due to the high frequency of metastases to lymph nodes and distant organs. A 53-year-old male first presented complaining of distention of his abdomen. An abdominal computed tomography scan revealed significant ascites, swelling of thoracic lymph nodes, pleural effusion, and thickening of the cecum and appendix walls. A colorectal endoscopic examination revealed a cecal tumor with ulceration. Finally, the patient was diagnosed with metastatic, poorly differentiated adenocarcinoma with signet ring cells and goblet cell-like features of the appendix. mFOLFOX6 chemotherapy showed dramatic effects and, after 10 cycles, the patient achieved nearly complete response. Subsequently, owing to sensory neuropathy, oxaliplatin was discontinued and sLV5FU2 treatment was maintained for a further 25 cycles. In total, mFOLFOX6 and sLV5FU2 were administered over 20 months. Although some reports have examined the efficacy of chemotherapy regimens in colorectal cancer for the treatment of metastatic non-mucinous adenocarcinoma, a standard regimen has not been established to date. mFOLFOX6 could become a candidate for standard therapy and, to this end, prospective clinical studies are needed.