Cancer of Colon with Metastases
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70-year-old-male was diagnosed with colon cancer. After undergoing a right hemicolectomy, hepatic lesions were revealed. Three months after starting chemotherapy a CT revealed recurrent hepatic disease and celiac lymphadenopathy. He underwent directed therapy with radiofrequency ablation and stereotactic radiation, but unfortunately a repeat CT showed progressive disease in the liver and new pulmonary disease. Upon surgical exploration, his liver disease was deemed too extensive for surgical resection.
The patient was also inquiring about SIRTeX yttrium-90 microspheres.
Age: 70 years, Sex: Male
- The results of a PET scan were as follows: No high metabolic activity pathology.
- The results of a CAT scan of the patient’s abdomen were as follows:Hepatic recurrence at segment III.
- The results of a PET scan were as follows: Confirmation of the secondary hepatic lesion: Suspected secondary adenopathy of celiac tripod.
- RF-thermoablation treatment of hepatic lesion at segment III of liver.
- A CAT scan showed that good results were achieved with thermoablation procedure.
- Stereotaxic radiotherapy was carried out on celiac tripod lymphadenopathy.
- A CAT scan showed three small localized secondary lesions in the patient’s lungs: Hepatic PD: PR on celiac adenopathies.
- The patient began FOLFIRI regime chemotherapy which was completed on 03/2005 after 16 cycles.
- Primary lesion EGFR: negative.
- A CAT scan showed that the patient’s condition was stable.
- The patient began chemotherapy with FOLFIRI + Cetuximab regime, which was completed.
- A CAT scan showed that the patient’s condition was stable.
- The patient was in weekly therapy with Cetuximab alone.
- A CAT scan showed pulmonary and hepatic PD.
- The patient has been having 4 cycles of FOLFOX regime chemotherapy.
- A CAT scan showed further PD of pulmonary lesions and a small volumetric decrease of known secondary hepatic lesions.
GB: 7.88
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Plts: 264
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Glu: 90
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K+: 4
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AST: 24
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GR: 3.85
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INR: 1.07
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Urea: 24
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Amil.: 3
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ALT: 50
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Hb: 11.5
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PTT: 34.5
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Creat: 0.6
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Tot. prot.: 6.9
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Tot. bili.: 0.6
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Hct: 34.9
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Fibr: 738
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Na+: 137
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The patient is inquiring about laser resection of his metastatic lung lesions in conjunction with selective internal radiation therapy for his liver lesions. The patient should be aware that neither technique has been shown to provide “curative” treatment, and it is clear from his recent hospitalization that his liver disease is too extensive for surgical resection, the only known method of providing long-term cure. My main concern is that pursing directed treatment to either the lungs or liver or both will delay the ability to treat with systemic chemotherapy. While the patient has been heavily pretreated with chemotherapy in the past, he has not yet received Avastin (bevacizumab), one of the 5 active drugs for metastatic colon cancer, the others being 5-fluorouracil, oxaliplatin, irinotecan and cetuximab. While bevacizumab is not active as a single agent, it is active with chemotherapy. I agree with Dr. X that the patient’s best option at the present would be to pursue additional chemotherapy with bevacizumab.
With respect to clinical trials, I would recommend, prior to enrolling in any phase of clinical trial, treatment with bevacizumab plus chemotherapy.