Curative resection for locally advanced sigmoid colon cancer using neoadjuvant chemotherapy with FOLFOX plus panitumumab: A case report

Kenji Tomizawa, Yuji Miura, Yudai Fukui, Yutaka Hanaoka, Shigeo Toda, Jin Moriyama, Naoko Inoshita, Yukinori Ozaki, Toshimi Takano, Shuichiro Matoba, Hiroya Kuroyanagi, Kenji Tomizawa, Yuji Miura, Yudai Fukui, Yutaka Hanaoka, Shigeo Toda, Jin Moriyama, Naoko Inoshita, Yukinori Ozaki, Toshimi Takano, Shuichiro Matoba, Hiroya Kuroyanagi

Abstract

Introduction: FOLFOX and panitumumab combined chemotherapy plays an important role for metastatic colorectal cancer. However the usefulness of this regimen for neoadjuvant therapy is unclear.

Case report: A 67-year-old man with abdominal pain and pneumaturia was diagnosed with RAS wild-type sigmoid colon cancer with urinary bladder invasion and colovesical fistulas. Because the cancer was considered to be unresectable, a transverse-loop colostomy was performed. Colonoscopy and computed tomography revealed a marked reduction in the size of the primary tumor after six courses of FOLFOX4 (oxaliplatin, leucovorin, and 5-fluorouracil) plus panitumumab. Laparoscopic sigmoidectomy and partial cystectomy were then performed. The pathological findings based on the resected specimen showed almost complete replacement of the tumor by fibrous tissue, with only a few degenerated tumor glands persisting in the submucosa. The patient's postoperative course was uneventful and he was doing well, without disease recurrence, after 36 months of follow up.

Conclusion: To our knowledge, this is the first report of a successful curative resection in a patient with initially unresectable, locally advanced colorectal cancer who was treated with FOLFOX4 combined with panitumumab.

Keywords: Case report; Neoadjuvant chemotherapy; Panitumumab; Sigmoid colon cancer.

Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Figures

Fig. 1
Fig. 1
(a) Colonoscopy before chemotherapy showed a circumferential tumor in the sigmoid colon, and biopsy specimens revealed moderately differentiated tubular adenocarcinoma. (b)　Colonoscopy after chemotherapy showed an excellent response and the biopsies were negative for cancer cells.
Fig. 2
Fig. 2
(a–c)Initial computed tomography showed a circumferential thickening of the sigmoid colon wall and involving urinary bladder with a pelvic abscess and urinary air (colovesical fistula). (d) After six courses of chemotherapy showed improvement of pelvic abscess and marked reduction of the tumor.
Fig. 3
Fig. 3
PET-CT showed the primary tumor in the sigmoid colon.
Fig 4
Fig 4
Microscopic findings with H&E showed the tumor had been almost replaced fibrous tissue, with only two glands cancer cells left in the submucosa.

References

    1. Parkin D.M., Bray F., Ferlay J., Pisani P. Global cancer statistics, 2002. CA Cancer J. Clin. 2005;55:74–108.
    1. Folprecht G., Gruenberger T., Bechstein W.O., Raab H.R., Lordick F., Hartmann J.T. Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial. Lancet Oncol. 2010;11:38–47.
    1. Wong R., Cunningham D., Barbachano Y., Saffery C., Valle J., Hickish T. A multicentre study of capecitabine, oxaliplatin plus bevacizumab as perioperative treatment of patients with poor-risk colorectal liver-only metastases not selected for upfront resection. Ann. Oncol. 2011;22:2042–2048.
    1. Foxtrot Collaborative Group Feasibility of preoperative chemotherapy for locally advanced, operable colon cancer: the pilot phase of a randomised controlled trial. Lancet Oncol. 2012;13:1152–1160.
    1. Arredondo J., Pastor C., Baixauli J., Rodríguez J., González I., Vigil C. Preliminary outcome of a treatment strategy based on perioperative chemotherapy and surgery in patients with locally advanced colon cancer. Colorectal Dis. 2013;15:552–557.
    1. Jakobsen A., Andersen F., Fischer A., Jensen L.H., Jørgensen J.C., Larsen O. Neoadjuvant chemotherapy in locally advanced colon cancer. A phase II trial. Acta Oncol. 2015;29:1–7.
    1. Douillard J.Y., Siena S., Cassidy J., Tabernero J., Burkes R., Barugel M. Randomized, phase III trial of panitumumab with infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX4) versus FOLFOX4 alone as first-line treatment in patients with previously untreated metastatic colorectal cancer: the PRIME study. J. Clin. Oncol. 2010;28:4697–4705.
    1. Peeters M., Price T.J., Cervantes A., Sobrero A.F., Ducreux M., Hotko Y. Randomized phase III study of panitumumab with fluorouracil, leucovorin, and irinotecan (FOLFIRI) compared with FOLFIRI alone as second-line treatment in patients with metastatic colorectal cancer. J. Clin. Oncol. 2010;28:4706–4713.
    1. Nelson H., Petrelli N., Carlin A., Couture J., Fleshman J., Guillem J. Guidelines 2000 for colon and rectal cancer surgery. J. Natl. Cancer Inst. 2001;93:583–596.
    1. Nelson H., Petrelli N., Carlin A., Couture J., Fleshman J., Guillem J. Guidelines 2000 for colon and rectal cancer surgery. J. Natl. Cancer Inst. 2001;93:583–596.
    1. Lehnert T., Methner M., Pollok A., Schaible A., Hinz U., Herfarth C. Multivisceral resection for locally advanced primary colon and rectal cancer: an analysis of prognostic factors in 201 patients. Ann. Surg. 2002;235:217–225.
    1. Taylor W.E., Donohue J.H., Gunderson L.L., Nelson H., Nagorney D.M., Devine R.M. The Mayo clinic experience with multimodality treatment of locally advanced or recurrent colon cancer. Ann. Surg. Oncol. 2002;9:177–185.
    1. Croner R.S., Merkel S., Papadopoulos T., Schellerer V., Hohenberger W., Goehl J. Multivisceral resection for colon carcinoma. Dis. Colon Rectum. 2009;52:1381–1386.
    1. Sauer R., Becker H., Hohenberger W., Rödel C., Wittekind C., Fietkau R. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N. Engl. J. Med. 2004;351:1731–1740.
    1. Cukier M., Smith A.J., Milot L., Chu W., Chung H., Fenech D. Neoadjuvant chemoradiotherapy and multivisceral resection for primary locally advanced adherent colon cancer: a single institution experience. Eur. J. Surg. Oncol. 2012;38:677–682.
    1. Schwartzberg L.S., Rivera F., Karthaus M., Fasola G., Canon J.L., Hecht J.R. PEAK: a randomized, multicenter phase II study of panitumumab plus modified fluorouracil, leucovorin, and oxaliplatin (mFOLFOX6) or bevacizumab plus mFOLFOX6 in patients with previously untreated, unresectable, wild-type KRAS exon 2 metastatic colorectal cancer. J. Clin. Oncol. 2014;32:2240–2247.
    1. Leone F., Artale S., Marino D., Cagnazzo C., Cascinu S., Pinto C. Panitumumab in combination with infusional oxaliplatin and oral capecitabine for conversion therapy in patients with colon cancer and advanced liver metastases. The MetaPan study. Cancer. 2013;119:3429–3435.
    1. Pinto C., Di Fabio F., Maiello E., Pini S., Latiano T., Aschele C. Phase II study of panitumumab, oxaliplatin, 5-fluorouracil, and concurrent radiotherapy as preoperative treatment in high-risk locally advanced rectal cancer patients (StarPan/STAR-02 Study) Ann. Oncol. 2011;22:2424–2430.
    1. Medical Research Council Oesophageal Cancer Working Group Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet. 2002;359:1727–1733.
    1. Cunningham D., Allum W.H., Stenning S.P., Thompson J.N., Van de Velde C.J., Nicolson M. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N. Engl. J. Med. 2006;355:11–20.
    1. Sebag-Montefiore D., Stephens R.J., Steele R., Monson J., Grieve R., Khanna S. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicenter, randomised trial. Lancet. 2009;373:811–820.
    1. Alberts S.R., Sargent D.J., Nair S., Mahoney M.R., Mooney M., Thibodeau S.N. Effect of oxaliplatin, fluorouracil, and leucovorin with or without cetuximab on survival among patients with resected stage III colon cancer: a randomized trial. JAMA. 2012;307:1383–1393.
    1. Allegra C.J., Yothers G., O’ConnellM.J. Sharif S., Petrelli N.J., Colangelo L.H. Phase III trial assessing bevacizumab in stages II and III carcinoma of the colon: results of NSABP protocol C-08. J. Clin. Oncol. 2011;29:11–16.
    1. Agha R.A., Fowler A.J., Saetta A., Barai I., Rajmohan S., Orgill D.P., The SCARE Group The SCARE statement: consensus-based surgical case report guidelines. Int. J. Surg. 2016;34:180–186.

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