Pathological Complete Remission in Young Colon Cancer Patient with a Large Liver Metastasis after FOLFOX-4/Bevacizumab Treatment – A Case Report

Abstract

Introduction. Pathological complete remission of liver metastases is a rare colon cancer treatment outcome with increased 5-year survival of 76%. Case report. Metastatic colorectal cancer patient with pathological complete remission of large hepatic metastasis after palliative chemotherapy in combination with bevacizumab is presented. Solitary liver metastasis measuring 8 cm was observed in computed tomography (CT) scan before combined treatment. The best radiological response during treatment with FOLFOX-4 and bevacizumab therapy was partial remission and patient underwent partial hepatectomy. Since the operation material was free of viable adenocarcinoma cells the effect of FOLFOX-4 in combination with bevacizumab treatment was interpreted as the pathological complete remission. Conclusion. Use of combination chemotherapy and targeted therapy with the aim to reduce initially unresectable liver metastasis is the best option to achieve complete pathological remission and significantly prolong survival

Multimodality Treatment of a Colorectal Cancer Stage IV Patient with FOLFOX-4, Bevacizumab, Rigvir Oncolytic Virus, and Surgery

“…The patient also underwent genetic screening for predominant somatic mutations in KRAS codons 12, 13, 61, BRAF V600E, TP53 exon 5, 6, 7, 8, PIK3CA exon 9, 10, and PTEN whole coding sequence. The screening showed 1 mutation Q61H located in the KRAS codon 61 [ 12 ]. (While those authors write G61H, the correct codon appears to be Q61H [ 13 ].)…”

“…The patient was treated with FOLFOX-4 palliative chemotherapy (8 infusions) plus the biological agent bevacizumab (4 infusions). The administration frequency was every 2 weeks for 4 months [ 12 ]. In addition, considering the grave prognosis, starting December 2010, the patient also received Rigvir therapy; 11 intramuscular administrations (2 mL solution containing > 10 6 TCID 50 /mL in 0.9% sodium chloride) during 13 months intermittently between the chemotherapy cycles.…”

“…In March 2011, the patient underwent a partial hepatectomy; segment 8 of the liver was resected. After the surgery, in April 2011, the patient started an adjuvant postoperative chemotherapy with 4 infusions of FOLFOX-4 for a 2-month period [ 12 ].…”

“…The partially calcinated structure located in the pelvis or hypogastrium could be a granuloma, which is mostly constant in all CT scans. In conclusion, the radiological findings (repeated CT scans) and pathological findings (from the removed liver metastasis [ 12 ]) show that the patient has reached complete response to the applied therapies.…”

“…The aim of this report is to show the positive effect of Rigvir oncolytic virus treatment in combination with FOLFOX-4, anti-VEGF-A antibody therapy (bevacizumab), and surgery of a colorectal cancer stage IV patient. A preliminary report has been published [ 12 ].…”