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
References
[1]
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Colon Cancer. Version 3, NCCN, 2013, http://www.nccn.org.
[2]
E. Van Cutsem, B. Nordlinger, and A. Cervantes, “Advanced colorectal cancer: ESMO clinical practice guidelines for treatment,” Annals of Oncology, vol. 21, supplement 5, pp. v93–v97, 2010.
[3]
L. M. Ellis, S. A. Curley, and A. Grothey, “Surgical resection after downsizing of colorectal liver metastasis in the era of bevacizumab,” Journal of Clinical Oncology, vol. 23, no. 22, pp. 4853–4855, 2005.
[4]
W. R. Jarnagin, M. Gonen, Y. Fong et al., “Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade,” Annals of Surgery, vol. 236, no. 4, pp. 397–407, 2002.
[5]
R. Adam, “Chemotherapy and surgery: new perspectives on the treatment of unresectable liver metastases,” Annals of Oncology, vol. 14, supplement 2, pp. ii13–ii16, 2003.
[6]
J. Cassidy, S. Clarke, E. Díaz-Rubio et al., “Randomized phase III study of capecitabine plus oxaliplatin compared with fluorouracil/folinic acid plus oxaliplatin as first-line therapy for metastatic colorectal cancer,” Journal of Clinical Oncology, vol. 26, no. 12, pp. 2006–2012, 2008.
[7]
J. Cassidy, S. Clarke, E. Díaz-Rubio et al., “XELOX vs FOLFOX-4 as first-line therapy for metastatic colorectal cancer: NO16966 updated results,” British Journal of Cancer, vol. 105, no. 1, pp. 58–64, 2011.
[8]
C. Zhang, J. Wang, H. Gu et al., “Capecitabine plus oxaliplatin compared with 5-fluorouracil plus oxaliplatin in metastatic colorectal cancer: meta-analysis of randomized controlled trials,” Oncology Letters, vol. 3, no. 4, pp. 831–838, 2012.
[9]
L. B. Saltz, S. Clarke, E. Díaz-Rubio, et al., “Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study,” Journal of Clinical Oncology, vol. 26, no. 12, pp. 2013–2019, 2008.
[10]
Zaltrap [Package Insert], Sanofi-Aventis U.S., Bridgewater, NJ, USA, 2012.
[11]
E. Van Cutsem, J. Tabernero, R. Lakomy, et al., “Addition of aflibercept to fluorouracil, leucovorin, and irinotecan improves survival in a phase III randomized trial in patients with metastatic colorectal cancer previously treated with an oxaliplatin-based regimen,” Journal of Clinical Oncology, vol. 30, no. 28, pp. 3499–3506, 2012.
[12]
J. F. Sun, R. R. Wu, C. Norris et al., “Safety of chronic low-dose capecitabine as maintenance therapy in gastrointestinal cancers,” Gastrointestinal Cancer Research, vol. 3, no. 4, pp. 134–140, 2009.
[13]
Eloxatin [Package Insert], Sanofi-Aventis U.S., Bridgewater, NJ, USA, 2013.
[14]
H. Mentzel, J. Blume, A. Malich, C. Fitzek, J. R. Reichenbach, and W. A. Kaiser, “Cortical blindness after contrast-enhanced CT: complication in a patient with diabetes insipidus,” American Journal of Neuroradiology, vol. 24, no. 6, pp. 1114–1116, 2003.
