%0 Journal Article
%T Management of a Patient with Metastatic Colorectal Cancer and Liver Metastases
%A Muhammad Wasif Saif
%J Case Reports in Oncological Medicine
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/790192
%X Liver metastases are commonly encountered in patients presenting with metastatic colorectal cancer (mCRC); resection is the treatment of choice. A number of systemic treatment options are currently available for such patients, including the use of 5-fluorouracil-based chemotherapies and oxaliplatin (e.g., FOLFOX) in combination with biologic agents that target angiogenesis (e.g., bevacizumab). For patients with progression following first-line treatment, current second-line options include a change in chemotherapy with bevacizumab (for patients who did or did not receive prior bevacizumab) or FOLFIRI in combination with aflibercept, a more recently approved antiangiogenesis therapy. Neurotoxicity is a well-established adverse event of oxaliplatin-based therapy. The current case details an mCRC patient with liver metastases who was treated with a capecitabine and oxaliplatin regimen (XELOX), and experienced two episodes of transient cortical blindness possibly related to oxaliplatin. After disease progression, the patient was switched to a regimen of FOLFIRI and aflibercept and did well on this second-line regimen. 1. Introduction In patients presenting with liver metastases in the context of metastatic colorectal cancer (mCRC), surgical resection is the treatment of choice where possible; for patients undergoing hepatic resection, five-year actuarial survival in some series ranges from 30% to over 50% [1, 2]. However, these patients remain at a high risk for relapse, with hepatic recurrence rates of up to 75% [2]. The current first-line options for systemic antitumor treatment include the use of 5-fluorouracil- (5-FU-) based therapies with oxaliplatin (e.g., FOLFOX) with or without the use of an antiangiogenesis agent (bevacizumab) [1]. The use of perioperative FOLFOX improves three-year survival rates by up to 8%, and postoperative FOLFOX can also be considered in patients with no perioperative treatment [2]. Although most patients typically present with unresectable disease, the use of regressive chemotherapies is indicated to convert patients to resectable status [1]. Indeed, the evolution of 5-FU-based chemotherapies in recent years has helped to improve resectability rates with the addition of agents such as oxaliplatin or irinotecan to these regimens [3]. Choice of pre- and/or postoperative chemotherapy depends on factors such as treatment history, patient response, and safety/toxicity issues [1]. The optimal sequence of chemotherapy relative to resection is unclear; for patients with resectable disease, perioperative treatment (neoadjuvant and
%U http://www.hindawi.com/journals/crionm/2014/790192/