Zhang Ying, Zou Jia-Yun, Xu Yan-Yan, He Jing-Ni
Department of Clinical Oncology, Shengjing Hospital of China Medical University, Shenyang 110022, Liaoning Province, China.
Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110022, Liaoning Province, China.
World J Clin Cases. 2021 Jul 26;9(21):6170-6177. doi: 10.12998/wjcc.v9.i21.6170.
Neoplastic pericardial effusion (NPE) is a rare consequence of rectal cancer and carries a poor prognosis. Optimal management has yet to be determined. Fruquintinib is an oral anti-vascular endothelial growth factor receptor tyrosine kinase inhibitor approved by the China Food and Drug Administration in September 2018 as third-line treatment of metastatic colorectal cancer.
Herein, we report an elderly patient with NPE from rectal cancer who responded to the use of fruquintinib. In March 2015, a 65-year-old Chinese woman diagnosed with KRAS-mutated adenocarcinoma of the rectum was subjected to proctectomy, adjuvant concurrent chemoradiotherapy, and adjuvant chemotherapy. By October 2018, a mediastinal mass was detected computed tomography. The growth had invaded parietal pericardium and left hilum, displaying features of rectal adenocarcinoma in a bronchial biopsy. FOLFIRI and FOLFOX chemotherapeutic regimens were administered as first- and second-line treatments. After two cycles of second-line agents, a sizeable pericardial effusion resulting in tamponade was drained by pericardial puncture. Fluid cytology showed cells consistent with rectal adenocarcinoma. Single-agent fruquintinib was initiated on January 3, 2019, as a third-line therapeutic. Ten cycles were delivered before the NPE recurred and other lesions progressed. The recurrence-free interval for NPE was 9.2 mo, attesting to the efficacy of fruquintinib. Ultimately, the patient entered a palliative care unit for best supportive care.
Fruquintinib may confer good survival benefit in elderly patients with NPEs due to rectal cancer.
肿瘤性心包积液（NPE）是直肠癌罕见的并发症，预后较差。最佳治疗方案尚未确定。呋喹替尼是一种口服抗血管内皮生长因子受体酪氨酸激酶抑制剂，于2018年9月被中国国家食品药品监督管理总局批准作为转移性结直肠癌的三线治疗药物。
在此，我们报告一例老年直肠癌合并NPE患者，其使用呋喹替尼后有反应。2015年3月，一名65岁中国女性被诊断为KRAS突变的直肠腺癌，接受了直肠切除术、辅助同步放化疗及辅助化疗。到2018年10月，计算机断层扫描发现纵隔肿块。肿瘤已侵犯心包壁层和左肺门，支气管活检显示为直肠腺癌特征。一线和二线治疗分别采用FOLFIRI和FOLFOX化疗方案。二线治疗两个周期后，通过心包穿刺引流了大量导致心脏压塞的心包积液。积液细胞学检查显示细胞与直肠腺癌一致。2019年1月3日开始使用单药呋喹替尼作为三线治疗。在NPE复发和其他病灶进展前共进行了10个周期的治疗。NPE的无复发生存期为9.2个月，证明了呋喹替尼的疗效。最终，患者进入姑息治疗病房接受最佳支持治疗。
呋喹替尼可能为老年直肠癌合并NPE患者带来良好的生存获益。
