The prognosis for patients diagnosed with advanced
colorectal cancer with liver
metastases is poor.
Chemotherapy should be administered with caution in such patients because of complications due to severe
liver dysfunction. We report here the successful management of a case of advanced
sigmoid colon cancer, with
icterus due to severe liver
metastases, treated with
cetuximab as first-line
therapy. A 72-year-old man presented at our institution with complaints of severe general
fatigue, tarry stools, and abdominal distention. He was diagnosed with advanced
sigmoid colon cancer with multiple liver
metastases. Clinical examination revealed the presence of
ascites. The patient had an Eastern Cooperative Oncology Group(ECOG) performance status(PS)score of 3. A biopsy specimen of the primary
tumor showed well-moderately differentiated
adenocarcinoma without KRAS mutation. He was diagnosed with advanced
sigmoid colon cancer with multiple hepatic
metastases.
Cetuximab monotherapy was initiated as first-line treatment. After 4 courses of
cetuximab monotherapy, results of laboratory tests showed an improvement, and a computed tomography(CT)scan revealed a regression in the size of the liver
metastases. Because the results of liver function tests and the ECOG PS scores improved, we initiated
combination chemotherapy with
5-fluorouracil,
Leucovorin,
oxaliplatin(FOLFOX), and
cetuximab. This regimen was well tolerated up to 14 courses, during which the only adverse reaction reported was a
rash of grade 2 toxicity. Thereafter,
disease progression in the form of liver
metastases resulted in a change in the combination
therapy to
irinotecan and S-1(IRIS)as second-line
chemotherapy. Thereafter,
irinotecan and
panitumumab were administered as third-line
therapy. The patient continued
chemotherapy on an outpatient basis; however, he died due to
disease progression 18 months after his first visit.