ESMO Preceptorship Programme

Stage IV Rectal Cancer with CR

Matthaiou Christiana MD, MSc

Specialist Registrar in Medical Oncology

Cyprus Oncology Center

Colorectal Cancer– Barcelona– 25/26 November 2016

ESMO PRECEPTORSHIP PROGRAM

Case report(1)� 70 yo woman

� Weakness, fatigue, one episode of

rectal bleeding

� 5/2011:CT abdomen-pelvis:

multiple liver metastases

� 5/2011:liver biopsy:

adenocarcinoma grade II,GI tract

origin

� 6/2011:colonoscopy:

fungating tumour present on the

proximal rectum 10cm distance

from the anal verge

� 6/2011:CT chest (-) STAGE IV

ADENOCARCINOMA OF

RECTUM

ESMO PRECEPTORSHIP PROGRAM

Case report(2)

� PMH:TAH-BSO

� FAMILY HISTORY:

� Father 70 yo with lung cancer

� Two sisters(51yo and 38yo) with breast cancer

� 6/2011: CEA 93,2 ng/ml CA 19.9=510U/ml

� K-ras: wild type

ESMO PRECEPTORSHIP PROGRAM

Initial management

� 8xFolfiri+Cetuximab biweekly

� 10/2011:CT restaging: PR >50%decrease

� 10/2011:CEA:5ng/ml,

CA 19-9:25.8 U/ml

� 11/2011:

right hepatectomy and metastasectomy from the segment III of the liver

ESMO PRECEPTORSHIP PROGRAM

The next steps after hepatectomy…

� Postoperative CT: 7xFolfiri+Cetuximab biweekly

� 4/2012: CT restaging (-)

� 4/2012: MRI pelvis: cT4aN0 (stage IIB), CRM(-)

� Neoadjuvant RT: 500cGYX5

� 05/2012: low anterior resection: pT3N0 gr II

� Adjuvant CT: 4xMdG

� 10/2012: obstruction of ureter: no recurrence�ureteral stent

ESMO PRECEPTORSHIP PROGRAM

Recurrence

� 7/2015:liver recurrence

segment I near the IVC

� CEA:5,8 ng/ml

� CA 19-9:25,2 U/ml

� GI meeting:

no possibilities for topical

treatment

� 12x Folfiri+Cetuximab

ESMO PRECEPTORSHIP PROGRAM

Complete Response� Follow up restaging:

� 2/2016 CT: CR

� 5/2016 CT: CR

� 11/2016 CT: CR

� Questions:� Do we need further imaging?

� Is there micrometastatic disease?

� Which is the role of maintenance therapy?

� What is the best chemotherapy-regimen for a new recurrence?

Thanks for your attention