LETTERS TO THE EDITOR

 

Long survival in a patient with metastatic colorrectal carcinoma: reality or utopia?

Larga supervivencia en paciente con carcinoma colorrectal metastásico: ¿realidad o utopía?

 

 

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Key words: Colorectal cancer. Metastasis. Long survivor.

Palabras clave: Carcinoma colorrectal. Metástasis. Largo superviviente.

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Dear Editor,

We report the case of a 42 year old male patient with a diagnosis of mucinous-type colorectal adenocarcinoma treated with surgery and adjuvant chemotherapy. After an 18 month progression free interval (ILP), he presented with a soft tissue metastatic relapse. The RAS gene was wildtype. He underwent several metastasectomies and several lines of cytostatic treatment such as FOLFIRI + cetuximab, FOLFOX + bevacizumab, CPT-11 + gemcitabine + cetuximab, tomudex-cetuximab, capecitabin + bevacizumab. The patient experienced grade I thrombopenia and grade II anemia and thus, capecitabine treatment was stopped and maintenance therapy with bevacizumab was administered for 27 months with a good tolerance. Due to new pulmonary, adenopathic, muscular and locoregional progression, he was treated in several treatment lines with panitumumab, external palliative radiotherapy (TRE) of the retroperitoneal and right iliac adenopathies, regorafenib and raltitrexed.

 

Discussion

About 50% of patients with CCR will develop metastases during the evolution of the disease. At present, the overall survival of patients with metastatic colon cancer under cytostatic treatment is around 24 months. However, a small subset of patients may have a prolonged survival of 5 to 10 years after diagnosis, highlighting the heterogeneity of tumor behavior and response to treatment.

The development of specific biological agents in combination with cytotoxic chemotherapy regimens has improved clinical efficacy. Determining RAS status is essential in order to identify patients who will benefit from anti-EGFR therapy. In addition, the presence of a BRAF mutation is associated with a negative prognostic value. It is essential in clinical practice to use all drugs available to achieve a longer progression-free survival and overall survival, without impairing the quality of life of the patient.

 

Andrea Illán, Jonathan Aires and Laura Quintana
Medical Oncology Service. Hospital San Pedro de Alcántara. Cáceres, Spain

 

References

1. Van Cutsem E, Cervantes A, Adam R, et al. ESMO consensus guidelines for the Management of Patients with Metastatic Colorectal Cancer. Ann Oncol 2016;27:1386-422. DOI: 10.1093/annonc/mdw235.         [ Links ]

2. Dy GK, Hobday TJ, Nelson G, et al. Long-term survivors of metastatic colorectal cancer treated with systemic chemotherapy alone: A North Central Cancer Treatment Group Review of 3811 Patients, N0144. Clin Colorectal Cancer 2009;8(2):88-93. DOI: 10.3816/CCC.2009.n.014.         [ Links ]

3. Soerjomataram I, Thong MS, Ezzati M, et al. Colorectal cancer survivors live a large proportion of their remaining life in good health. Cancer Causes Control 2012;23:1421-8. DOI: 10.1007/s10552-012-0010-2.         [ Links ]