RAS突变型横结肠癌伴多发肝转移经阿柏西普联合FOLFIRI术后维持治疗及四次重复根治性切除实现长期无病生存：一例报告

RAS mutant transverse colon cancer with multiple liver metastases achieving long-term disease-free survival with postoperative maintenance therapy with aflibercept + FOLFIRI and four repeated radical resections: a case report.

作者信息

Tanaka Yasushi, Nakanishi Ryota, Sato Shota, Otake Akihiko, Ryujin Keiichiro, Ikeda Shinichiro, Ebata Yuho, Harima Tomoya, Natsugoe Keita, Yoshiyama Takayuki, Shin Yuki, Kawazoe Tetsuro, Kudo Kensuke, Zaitsu Yoko, Hisamatsu Yuichi, Ando Koji, Nakashima Yuichiro, Itoh Shinji, Oki Eiji, Oda Yoshinao, Yoshizumi Tomoharu

机构信息

Department of Surgery and Science, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.

Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.

出版信息

Surg Case Rep. 2024 Oct 8;10(1):231. doi: 10.1186/s40792-024-02033-2.

BACKGROUND

Management of patients with colorectal liver metastases (CRLMs) requires a multidisciplinary approach. For patients with progression of RAS mutant tumors, the choice of angiogenesis inhibitors can be controversial. Here, we report a patient with RAS mutant CRLMs achieving long-term disease-free survival with repeated R0 resections and perioperative treatment, especially aflibercept + FOLFIRI (5-fluorouracil, levofolinate, irinotecan), which may have prevented long-term recurrence.

CASE PRESENTATION

The patient was a 37 year-old woman diagnosed with RAS mutant transverse colon cancer with 19 LMs. As the metastases were limited to the liver, we introduced systemic chemotherapy aiming at conversion surgery. After six cycles of bevacizumab + FOLFOXIRI (5-fluorouracil, levofolinate, oxaliplatin, irinotecan), we performed partial hepatectomy for all LMs, and left hemicolectomy for the primary tumor after another four cycles of bevacizumab + FOLFIRI. Three months after surgery, the patient presented with massive ovarian metastases with carcinomatous ascites. We conducted bilateral oophorectomy, and initiated aflibercept + FOLFIRI therapy considering the possibility of resistance to bevacizumab. The patient was recurrence-free for 2 years during aflibercept + FOLFIRI treatment. After its discontinuation, two distant metastases developed. Both were resectable and the patient achieved recurrence-free survival of 2 years and 3 months after the last operation (6 years since initiation of treatment), without additional chemotherapy.

CONCLUSIONS

We believe that multidisciplinary treatment aimed at complete resection could lead to long-term survival even in patients with repeated recurrence of CRLMs. Aflibercept + FOLFIRI could be effective in controlling metastasis of RAS mutant colon cancer even after treatment with bevacizumab.

背景

结直肠癌肝转移（CRLMs）患者的管理需要多学科方法。对于RAS突变肿瘤进展的患者，血管生成抑制剂的选择可能存在争议。在此，我们报告1例RAS突变的CRLMs患者通过重复R0切除和围手术期治疗，尤其是阿柏西普联合FOLFIRI（5-氟尿嘧啶、亚叶酸钙、伊立替康）实现了长期无病生存，这可能预防了长期复发。

病例介绍

该患者为一名37岁女性，诊断为RAS突变的横结肠癌伴19处肝转移。由于转移局限于肝脏，我们采用全身化疗以期进行转化手术。在接受6个周期的贝伐单抗联合FOLFOXIRI（5-氟尿嘧啶、亚叶酸钙、奥沙利铂、伊立替康）治疗后，我们对所有肝转移灶进行了部分肝切除术，并在又接受4个周期的贝伐单抗联合FOLFIRI治疗后对原发性肿瘤进行了左半结肠切除术。术后3个月，患者出现大量卵巢转移并伴有癌性腹水。我们进行了双侧卵巢切除术，并考虑到对贝伐单抗耐药的可能性，开始使用阿柏西普联合FOLFIRI治疗。在阿柏西普联合FOLFIRI治疗期间，患者2年无复发。停药后，出现两处远处转移。两处转移灶均可行切除，患者在最后一次手术后实现了2年3个月的无复发生存（自开始治疗起6年），未进行额外化疗。