From palliative to curative treatment - stage IV mucinous adenocarcinoma, successfully treated with metronomic capecitabine in combination with Bevacizumab and surgery- a case report.

Karolina Vernmark, Maria Albertsson, Bergthor Björnsson, Thomas Gasslander, Per Sandström, Xiao-Feng Sun, Annika Holmqvist

Journal: BMC cancer 2016;15():884

PMID: 26555668

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Abstract

BACKGROUND

Mucinous adenocarcinoma (MAC) represents 6-19 % of all colorectal carcinoma. It is associated with poorer response to chemotherapy and chemoradiotherapy.

CASE PRESENTATION

A 27-year-old Swedish woman presented with stomach pain and weight loss, and was diagnosed with locally advanced MAC in the transverse colon as well as 3 liver metastases. Neoadjuvant treatment with fluorouracil, folinic acid and oxaliplatin (FLOX) failed due to several infections, pulmonary embolism and deteriorated performance status. The patient was therefore considered palliative. Palliative treatment with metronomic capecitabine 500 mg × 2 daily and bevacizumab every other week were initiated. After 4 months of treatment the tumors had regressed and the patient was able to undergo radical surgery, thereby changing the treatment intention from palliative to curative. No adjuvant chemotherapy was given. There were no signs of recurrence 9 months later.

CONCLUSIONS

The role of the combination of metronomic capecitabine and bevacizumab in patients with MAC merits further investigation.

Address: Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. [email protected].; Department of Oncology, Linköping University, S-58185, Linköping, Sweden. [email protected].; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. [email protected].; Department of Oncology, Linköping University, S-58185, Linköping, Sweden. [email protected].; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. [email protected].; Departement of Surgery, Linköping University, Linköping, Sweden. [email protected].; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. [email protected].; Departement of Surgery, Linköping University, Linköping, Sweden. [email protected].; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. [email protected].; Departement of Surgery, Linköping University, Linköping, Sweden. [email protected].; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. [email protected].; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. [email protected].; Department of Oncology, Linköping University, S-58185, Linköping, Sweden. [email protected].

DOI: 10.1186/s12885-015-1908-3

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MeSH Terms: Adenocarcinoma, Mucinous, Adult, Antineoplastic Combined Chemotherapy Protocols, Bevacizumab, Capecitabine, Female, Fluorouracil, Humans, Leucovorin, Neoplasm Recurrence, Local, Palliative Care