Abstract

COMPLETE RESPONSE TO LONSURF IN A STAGE IV RIGHT SIDED COLON CANCER PATIENT WITH PERITONEAL METASTASIS

Aref Chehal, Ashraf Alakkad*, Ashok Uttamchandani and Sonia Otsmane

Abstract

Background: Right-sided colon cancer continues to be the third most frequently occurring cancer and a primary cause of cancer-related deaths globally. The 5-year relative survival rate for patients diagnosed with stage IV Right-sided colon cancer is only 14 percent. Case Report: A 53-year-old non-diabetic non-alcoholic, nonsmoker, male patient was diagnosed with stage IV right-sided colon cancer with ascites, and peritoneal metastasis. The patient has no significant past medical history. The patient presented to the emergency department with major complaints of generalized abdominal pain associated with persistent nausea and vomiting. According to the esophageal-gastroduodenoscopy report, the gastric outlet was partially obstructed by compression from outside. The patient presented to emergency department at Mafraq Hospital Abu Dhabi on 25/4/2019. CT scan showed multiple peritoneal deposits with ascites. CT-guided peritoneal biopsy reported as metastatic mucinous adenocarcinoma. Tumor cells were negative for CK7, Calretinin, and WT1. However, the other biomarkers CK20, BerEP4, MOC31, and CDX2 were found to be positive. On 26/8/2019, he underwent exploratory laparotomy, cytoreductive surgery, and Hyperthermic intraperitoneal chemotherapy with Mitomycin C. After the surgery, tumor marker carcinoembryonic antigen (CEA) was found to be persistently high 11.80 mcg/L. The patient was given 6 cycles of Folfox and Avastin as firstline palliative chemotherapy. He responded to this treatment plan initially but the tumor progressed, then he was switched to second-line therapy FOLFIRI and Ramucirumab. He also responded to this therapy initially but later his condition worsened. Then, he received Lonsurf as third-line palliative therapy. Lonsurf was found to be very effective in this case. The amazing thing about this treatment approach was that his disease was completely cleared up and he had been in complete remission for almost 2 years. Conclusion: Our case report demonstrated a full response to Lonsurf in a patient with stage IV right-sided colon cancer, ascites, and peritoneal metastasis.

Keywords: Trifluridine-tipiracil, Lonsurf, Stage IV colon cancer, Colorectal cancer, ascites, Peritoneal metastasis.