Baik Hyungjoo, Lee Hee Ju, Park Jueun, Park Ha Young, Park Jinyoung, Lee Sunseong, Bae Ki Beom
Department of Surgery, Inje University, College of Medicine, Busan Paik Hospital, Busan 47392, Republic of Korea.
Department of Pathology, Inje University, College of Medicine, Busan Paik Hospital, Busan 47392, Republic of Korea.
Mol Clin Oncol. 2021 Nov;15(5):243. doi: 10.3892/mco.2021.2405. Epub 2021 Sep 24.
Regorafenib has been demonstrated to prolong survival in patients with metastatic colorectal cancer refractory to standard chemotherapy. However, overall survival is limited to 2.5 months. The present report describes a unique case of metastatic colon cancer, which showed a complete response to regorafenib. A 54-year-old woman was diagnosed with right colon cancer obstruction with peritoneal seeding. The patient underwent laparoscopic right hemicolectomy, and the pathology was T4aN2bM1, moderately differentiated adenocarcinoma with high microsatellite instability (MSI-H) and wild-type KRAS/NRAS. The first-line chemotherapy was fluorouracil, leucovorin and irinotecan with cetuximab. After 12 cycles, recurrence at the anastomotic site was identified. The patient underwent palliative colectomy, and superior mesenteric artery (SMA) lymph node metastases were evident. The patient received second-line chemotherapy of fluorouracil, leucovorin and oxaliplatin with bevacizumab. Progression of metastasis to the right common iliac lymph nodes was detected after only four cycles of therapy. Thereafter, the patient received regorafenib as third-line therapy, starting with 160 mg for two cycles and reducing the dose thereafter, for a total of 17 cycles. The previously confirmed SMA lymph node metastasis had disappeared after the seventh cycle, and the right common iliac lymph node metastasis was not visible on CT after the 16th cycle. The patient decided to terminate regorafenib and has not experienced recurrence 2 years since treatment cessation. This is the first report of refractory metastatic colon cancer with MSI-H showing a complete response to regorafenib. Further studies are required to investigate the efficacy of regorafenib in refractory metastatic colon cancer with MSI-H and to elucidate the mechanism of remission.
瑞戈非尼已被证明可延长对标准化疗难治的转移性结直肠癌患者的生存期。然而，总生存期仅为2.5个月。本报告描述了一例独特的转移性结肠癌病例，该病例对瑞戈非尼表现出完全缓解。一名54岁女性被诊断为右结肠癌伴腹膜种植梗阻。患者接受了腹腔镜右半结肠切除术，病理结果为T4aN2bM1，中分化腺癌，微卫星高度不稳定（MSI-H）且KRAS/NRAS野生型。一线化疗方案为氟尿嘧啶、亚叶酸钙和伊立替康联合西妥昔单抗。12个周期后，发现吻合口处复发。患者接受了姑息性结肠切除术，可见肠系膜上动脉（SMA）淋巴结转移。患者接受了二线化疗，方案为氟尿嘧啶、亚叶酸钙和奥沙利铂联合贝伐单抗。仅4个周期的治疗后，检测到转移进展至右髂总淋巴结。此后，患者接受瑞戈非尼作为三线治疗，开始时160 mg服用两个周期，之后减量，共进行了17个周期。先前确诊的SMA淋巴结转移在第7个周期后消失，第16个周期后CT显示右髂总淋巴结转移不可见。患者决定停用瑞戈非尼，自停药以来2年未出现复发。这是首例MSI-H难治性转移性结肠癌对瑞戈非尼表现出完全缓解的报告。需要进一步研究来调查瑞戈非尼在MSI-H难治性转移性结肠癌中的疗效，并阐明缓解机制。
