Trifluridine/Tipiracil in the 3rd Line Treatment of mCRC − Case Study
The following case study describes the treatment of a patient with metastatic colorectal cancer (mCRC) and the benefits of trifluridine/tipiracil within the therapeutic algorithm.
Introduction
A drug containing the active ingredients trifluridine and tipiracil belongs to the group of cytostatic antimetabolites within antitumor chemotherapy. It is indicated for the treatment of adults with mCRC who have previously used fluoropyrimidine cytostatics, oxaliplatin, and irinotecan, as well as targeted anti-VEGF or anti-EGFR therapy, or are not suitable candidates for these therapeutic modalities.
Case Description
The patient was a man born in 1947. Initially, in October 2012, a left-sided hemicolectomy was performed. The diagnosis was confirmed as C186: carcinoma colonis descendentis ad retroperitoneum crescens, pT3pN1M0 within the TNM classification. Histologically, it was a tubulopapillary, tubular to solidly cribriform adenocarcinoma of grade 1−2. Additionally, 7 lymph nodes were examined, 2 of which were positive for tumor cells.
By March 2013, the patient had received 6 series of chemotherapy in the XELOX regimen, which included capecitabine and oxaliplatin. He was then under surveillance. However, in October 2014, a CT scan of the abdomen revealed a metastatic lesion on the parietal peritoneum in the left subphrenium, and a PET/CT scan performed in December 2014 confirmed 2 tumor lesions − in a peritoneal nodule under the left abdominal wall and in a pelvic nodule pararectally on the left. Molecular biological examination confirmed an NRAS mutation.
1st Line of Treatment
The patient was indicated for combined chemotherapy in the FOLFIRI regimen (leucovorin, 5-fluorouracil, irinotecan) along with anti-VEGF treatment bevacizumab. Complete remission was achieved; however, due to toxic side effects, only maintenance therapy with bevacizumab continued until March 2017, when renal insufficiency progressed. Laboratory and clinical signs of nephrotic syndrome were evident, partly due to inadequate antihypertensive therapy. Consequently, bevacizumab was no longer administered based on nephrologist recommendations. The first line of treatment lasted 25 months.
2nd Line of Treatment
After 10 months of ending the first line of treatment, the patient experienced progression, with PET/CT revealing a new lesion in the liver. The patient was thus indicated for therapy with the oral multikinase inhibitor regorafenib, which began in February 2018. The patient poorly tolerated this treatment, experiencing numerous side effects (fatigue, hand-foot syndrome, worsening renal function, and hypertension). A control examination in May revealed another 2 lesions in the mesenteric fat in the left epigastrium and hypogastrium, leading to the discontinuation of the second line of treatment.
3rd Line of Treatment
In June 2018, the patient started taking trifluridine/tipiracil. This therapy was tolerated without complications, except for intermittent hematotoxicity (neutropenia). In October 2018, a PET/CT scan showed partial dimensional and metabolic regression. The liver lesion completely disappeared, and all 4 lesions in the abdominal cavity partially reduced. Repeated examinations confirmed the regression of the lesions and did not reveal any new ones. After 14 months of treatment with trifluridine/tipiracil, mild dimensional and metabolic progression of the generalized viable neoplasia in the abdominal cavity and peritoneum was observed, and the third line of treatment was concluded.
4th Line of Treatment
Due to the patient’s good overall condition, treatment with capecitabine was resumed in September 2019. In June 2020, a PET/CT scan revealed progression − multiple metastatic lesions in the liver and an increasing number and size of nodules in the abdominal cavity. The treatment was discontinued after 9 months.
The patient remains under the care of the palliative clinic in Litoměřice.
Summary and Conclusion
This case study presents the case of a patient diagnosed with colorectal cancer in 2012, which generalized 2 years later. Over more than 5 years, the patient underwent 4 lines of treatment as part of palliative systemic therapy. The patient subjectively and objectively tolerated treatment with trifluridine/tipiracil the best, experiencing virtually only asymptomatic neutropenia. Eight years have passed since the diagnosis, and the patient remains in palliative care.
(saz)
Source: Pukyová J. Case Study of a Patient Treated with Lonsurf Tablets Oncology Department of Masaryk Hospital, o. z. − Krajská zdravotní, a. s., Ústí nad Labem, 2020.
Did you like this article? Would you like to comment on it? Write to us. We are interested in your opinion. We will not publish it, but we will gladly answer you.
