Wang Yi, Li Jianjiong, Xu Qiyang, Li Kai, Zhang Chen, Chen Ping
Department of Radiotherapy and Chemotherapy, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.
Department of Anus and Intestine Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.
J Gastrointest Oncol. 2022 Oct;13(5):2667-2671. doi: 10.21037/jgo-22-841.
Chemotherapy was recommended as the 1 or 2 line standard of care for patients with refractory or metastatic colorectal cancer (mCRC). Extra cautions are needed for elderly patients, because cytotoxic regimens may induce unexpected adverse effects due to their impaired physical condition and tolerability. Currently, there is no evidence for the treatment in elderly patients. This case reports a new ideas to the treatment of elderly mCRC patients.
An 82-year-old man was diagnosed with descending colon cancer and underwent radical operation revealed stage IIIB cancer (pT4aN1cM0) in June 2016, followed by adjuvant chemotherapy (6 cycles of XELOX). The disease relapsed in June 2018, and the patient was prescribed Tegafur for 6 months. In December 2018, he was admitted to hospital due to intestinal obstruction with performance status (PS) score of 3 and nutrition score (NRS2002) of 5. According to a multidisciplinary team (MDT) meeting: considering that the adverse effects of front-line treatment are dominated by myelosuppression, the general condition of the patient is currently poor. The patient received fruquintinib as the second-line treatment which was interrupted for one month due to grade 3 hypertension and proteinuria. The restarted dose was reduced from 5 to 3 mg/day and continued until the last follow-up. The disease did not progress during 25-months of Fruquintinib treatment. Unfortunately, the patient was bedridden for a long time after an accidental fall resulting in a pulmonary infection and finally died of respiratory failure in January 2021.
CRC patients with advanced age and poor general condition require MDT meetings and individualized treatment. Despite of an advanced age, poor physical condition, and intense tumor burden, Fruquintinib as the second-line treatment achieved satisfactory disease control in this case. Adverse events could be relieved by dose reduction. Thus, fruquintinib could be a treatment option in refractory elderly CRC patients.
化疗被推荐为难治性或转移性结直肠癌（mCRC）患者的一线或二线标准治疗方案。老年患者需要格外谨慎，因为细胞毒性治疗方案可能因其身体状况受损和耐受性差而引发意外的不良反应。目前，尚无针对老年患者治疗的证据。本病例报告了老年mCRC患者治疗的新思路。
一名82岁男性被诊断为降结肠癌，于2016年6月接受根治性手术，术后病理显示为IIIB期癌症（pT4aN1cM0），随后接受辅助化疗（6个周期的XELOX方案）。2018年6月疾病复发，患者接受替加氟治疗6个月。2018年12月，他因肠梗阻入院，体能状态（PS）评分为3分，营养评分（NRS2002）为5分。根据多学科团队（MDT）会议意见：考虑到一线治疗的不良反应以骨髓抑制为主，患者目前一般状况较差。患者接受呋喹替尼作为二线治疗，因3级高血压和蛋白尿中断治疗1个月。重新开始治疗时剂量从5毫克/天减至3毫克/天，并持续至最后一次随访。在呋喹替尼治疗的25个月期间疾病未进展。不幸的是，患者在一次意外跌倒后长期卧床，导致肺部感染，最终于2021年1月死于呼吸衰竭。
高龄且一般状况较差的CRC患者需要MDT会议和个体化治疗。尽管年龄较大、身体状况差且肿瘤负荷高，但在本病例中呋喹替尼作为二线治疗取得了令人满意的疾病控制效果。不良反应可通过减量缓解。因此，呋喹替尼可能是难治性老年CRC患者的一种治疗选择。
