Evolving Approaches for Controlling Liver Metastases in CRC - Episode 8
In this segment, David Liu, MD, shares a case study based on a 33-year-old woman with stage IV colorectal cancer that had metastasized to the liver. The patient presented to Liu's practice with the primary tumor intact and bowel obstruction. Following resection of the primary tumor, systemic therapy was initiated with cetuximab plus FOLFOX for two months before toxicity was encountered. At this time, it was discovered that the patient had a KRAS mutation, which limited her subsequent therapeutic options.
Upon review by a tumor board, the decision was made to treat her with liver-directed Yttrium-90-resin microsphere off protocol. Liu and his colleagues made this decision after a careful consideration of the patient’s presentation of disease, nonresponse and intolerance to previous systemic therapy, KRAS-mutant status, and her estimated survival of approximately 1 year.
After her selective internal radiation therapy (SIRT) procedure, the liver was not a consideration anymore, since subsequent scans continued to show a lack of liver lesions, says Liu. By treating the liver, the patients had an improved chance of living longer. The patient later developed ovarian drop metastases (Krukenberg tumor), which was surgically resected. She also developed pulmonary lesions, which were effectively treated with a combination of ablation and surgical resection. In the end, she developed brain metastases.
The patient survived 54 months, which is significantly longer than the 12-month anticipation, comments Liu. Through this experience and based on findings from the phase III SIRFLOX trial, Liu recommends SIRT as a viable therapy that can control liver metastases, which, in his experience, translates to improved quality of life and overall survival.