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Chemotherapy rechallenge in metastatic colon cancer:A case report and literature review

查看全文 作　　者：Tejaswini Parlapalle [1]Reddy;Usman [2]Khan;Ethan Alexander [2]Burns;Maen [2,3]Abdelrahim 高影响力作者 机构地区：[1]College of Medicine,Texas A&M University Health Science Center,Bryan,TX 77807,United States;[2]Department of Medical Oncology,Houston Methodist Hospital Cancer Center,Houston,TX 77030,United States;[3]Section of GI Oncology,Department of Medical Oncology,Houston Methodist Cancer Center.Cockrell Center of Advanced Therapeutics Phase I Program,Houston Methodist Research Institute and Weill Cornell Medical College,Houston,TX 77030,United States高影响力机构 出　　处：《World Journal of Clinical Oncology》索引2020年第11卷第11期,共9页高影响力期刊 摘　　要：BACKGROUND Colorectal cancer(CRC)is the third leading cause of cancer-related death in males and females in the United States.Approximately,20%-22%of patients have metastatic disease at the time of presentation,and 50%-60%will develop metastasis over the course of their disease.Despite advances in systemic therapies,there remains a paucity of effective third-and later-line therapies for patients with ongoing disease progression.However,rechallenging chemoresistant CRC tumors with previously administered therapies is an emerging concept that may be a life-prolonging option for heavily treated metastatic colorectal cancer(mCRC).CASE SUMMARY A 41-year-old man with no previous medical history initially presented with worsening diffuse abdominal tenderness.Computed tomography was significant for a splenic flexure mass and hepatic lesions concerning for metastatic disease.He underwent a colectomy with anastomosis.Postoperative pathology was diagnostic for moderately to well-differentiated adenocarcinoma(T4bN1bM1a).He received adjuvant 5-fluorouracil,leucovorin,and oxaliplatin(FOLFOX),but therapy was discontinued due to the development of atrial fibrillation.Additional workup indicated a carcinoembryonic antigen level of 508.2 ng/mL,and mutational analysis found that the tumor was microsatellite instability-high and KRAS/BRAF wild-type.He was started on irinotecan with oxaliplatin(IROX),and bevacizumab(14 cycles),developed disease progression,was transitioned to FOLFOX and cetuximab,and then eventually three cycles of pembrolizumab.Following disease progression,he was rechallenged with IROX therapy,as he previously responded well to oxaliplatin-based therapy.The IROX rechallenge provided this patient with a ten-month survival benefit,decreased metastatic burden,and marked improvement in his clinical condition.CONCLUSION Rechallenge of previous lines of well-tolerated systemic chemotherapy regimens may be a valuable therapeutic strategy in patients with heavily-treated mCRC. 关 键 词：Metastatic colorectal cancer Rechallenge therapy Treatment holiday OXALIPLATIN IRINOTECAN Case report CHEMORESISTANCE Palliative option
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