Meet The Professors: Volume 3, Issue 1
A case-based discussion on the management
of colorectal cancer in the adjuvant and metastatic settings
|Neil Love, MD|
|Alan P Venook, MD||Daniel G Haller, MD|
|Axel Grothey, MD|
Case 1 from the practice of Samuel N Bobrow, MD: A 53-year-old man who underwent resection of a 9-cm, well-differentiated colon tumor in 1999. Twenty-five of 43 nodes were positive, and he received adjuvant 5-FU/leucovorin. In 2008, he presented with a ureteral obstruction and lymphadenopathy. A lymph node biopsy revealed an adenocarcinoma consistent with colon cancer, which tested CDX2-positive, CK20-positive and CK7-negative. He is currently receiving FOLFOX4/bevacizumab (presented to Dr Venook).
Case 2 from the practice of William N Harwin, MD: An 84-year-old woman receiving digoxin with a history of cardiac arrhythmia and hypertension who underwent resection of a 6.5-cm, high-grade, poorly differentiated adenocarcinoma. The mass perforated the lateral wall of the rectum. Lymphatic invasion was present, and seven of eight nodes were positive. The patient received capecitabine postoperatively (presented to Dr Venook).
Case 3 from the practice of Kenneth R Hoffman, MD, MPH: A 90-year-old man with PS 1 and controlled hypertension, hypercholesterolemia and coronary artery disease who presented in June 2008 with a ruptured appendix, a cecal mass and multiple matted nodes. The mass was resected and pathology revealed a well-differentiated adenocarcinoma, but the nodes have not yet been identified as metastatic disease versus gross inflammation (presented to Dr Venook).
Case 4 from the practice of Steven P Kanner, MD: A 52-year-old man who presented with a rectal adenocarcinoma and multiple hepatic metastases considered unresectable. He was treated with modified FOLFOX6 (presented to Dr Venook).
Case 5 from the practice of Malek Safa, MD: A 60-year-old woman who presented in 2003 with rectal cancer and multiple hepatic and bilateral lung metastases. After six months of FOLFOX, she experienced resolution of the tumor and metastases, but seven months later progressive disease was detected in the liver and lungs, and she began FOLFOX/bevacizumab. After her second cycle, she developed thrombocytopenia and was switched to FOLFIRI/bevacizumab and received cetuximab after disease progression (presented to Dr Grothey).
Case 6 from the practice of Michael A Schwartz, MD: A 57-year-old woman who underwent a hemicolectomy for a moderately well-differentiated adenocarcinoma. Three of 65 nodes were involved. Postoperatively she received FOLFOX6, but after nine cycles she developed herpes encephalitis (presented to Dr Grothey).
Case 7 from the practice of Dr Schwartz: A 56-year-old man who in 2003 underwent resection, followed by 5-FU/leucovorin and radiation therapy, for T3 rectal cancer with three positive nodes. In 2005, a single hepatic metastasis was treated by resection and ablation, followed by FOLFOX/bevacizumab. In 2007, he received FOLFIRI for metastasis in a supraclavicular node and periaortic and pelvic lymphadenopathy on CT. In 2008, he received FOLFIRI/cetuximab for progression of nodal and small-volume liver disease. The tumor tested positive for K-ras wild type, and he continues on maintenance cetuximab (presented to Dr Haller).
Case 8 from the practice of Dr Hoffman: A 68-year-old woman who in 2005 underwent resection of a T3N0M0 adenocarcinoma of the colon but declined adjuvant therapy. In 2008, metastatic colon cancer was confirmed in the liver and she received modified FOLFOX/bevacizumab, followed by resection of two masses — 1.1 and 1.2 centimeters (presented to Dr Haller).
Case 9 from the practice of Lowell Hart, MD: A 58-year-old man who underwent resection of a 3.5-cm, moderately differentiated rectal adenocarcinoma. One of 18 pericolonic nodes was positive. He was enrolled in a Phase II trial and received three cycles of 5-FU/bevacizumab and radiation therapy, followed by modified FOLFOX/ bevacizumab (presented to Dr Haller).
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