Complete response of lung metastases from rectal cancer to combination first-line therapy of S-1 and irinotecan plus bevacizumab: A case report and review of the literature

Abstract

This report presents the case of a 72-year-old male who had undergone abdominoperineal resection following a diagnosis of lower rectal cancer with multiple lung metastases. Pathologically, the resected specimen exhibited advanced rectal cancer with regional lymphoid metastases and was classified as stage IV disease. S-1 and irinotecan (IRIS) plus bevacizumab combination therapy was used to treat the lung metastases following the surgery. S-1 (100 mg/body) was administered orally on days 1–14 of a 28-day cycle, and irinotecan (125 mg/m2) and bevacizumab (7.5 mg/kg) were administered by intravenous infusion on days 1 and 15. Computed tomography revealed a marked decrease in the size of the metastases following three therapeutic courses, and no lung metastases or new lesions were detected following nine therapeutic courses. The response was declared clinically complete. The patient refused additional treatment following nine therapeutic courses, and there was no recurrence 36 months after the final course of therapy. This case demonstrates the efficacy of IRIS plus bevacizumab as a first-line combination therapy against lung metastases of rectal cancer.

The Colorectal Cancer Tumor Microenvironment and Its Impact on Liver and Lung Metastasis

“…A case series of 11 patients who received neoadjuvant bevacizumab + FOLFOX/capecitabine followed by pulmonary metastasectomy had a 5-year disease-free survival of 10.9% [ 219 ]. A case report of rectal pulmonary metastasis treated with pulmonary metastasectomy as well as adjuvant S-1, irinotecan, and bevacizumab yielded a complete response [ 220 ]. It is possible that the presence of tumor cavitation predicts response to bevacizumab; in a study of 60 CRPM patients treated with bevacizumab + chemotherapy, the presence of tissue cavitation yielded a longer median overall survival (42.1 vs. 30.8 months) [ 221 ].…”