Long-term survival of an elderly female with metastatic colon cancer after treated with capecitabine monotherapy

Abstract

Rationale: Colorectal cancer (CRC) is one of the most common cancers all over the world, and approximately 70% of the newly diagnosed patients are over 65 years old. Due to the aging of society, there will be more and more elderly patients of CRC in the future. Treatment of CRC in elderly patients is much more challenging thanks to multiple factors including disabling comorbidities as well as declines in organs function, especially in advanced or metastatic settings. Patient concerns: An 82-year-old female without history of disease was admitted to the emergency room because of abdominal pain in December 2009. A computed tomography (CT) scan of the abdomen was performed immediately, which revealed bowel obstruction. Diagnoses: The histopathological examination of the resected specimen confirmed well-to-moderately differentiated colonic adenocarcinoma with a stage of IIIB (T3N1M0) based on the NCCN tumor-node-metastasis (TNM) classification system. Interventions: The patient underwent emergency surgery and rejected adjuvant chemotherapy, but was diagnosed with multiple liver metastases 3 months later. Then she received capecitabine monotherapy as first-line treatment. Outcomes: The efficacy achieved complete response (CR) when 8 cycles were completed and the agent was continued as maintenance treatment until totally 16 cycles were completed. Up to the latest follow-up, the disease remained CR and the progression-free survival (PFS) has achieved approximately 87 months. She is still alive and has good quality of life. Lessons: Capecitabine monotherapy may be an effective treatment in advanced or metastatic colorectal cancer (mCRC) for elderly patients.

Ongoing 5-year+ survival after multiple metastasectomies, followed by CAPOX plus bevacizumab, for metastatic colorectal cancer

“…In addition, the patient selected the regimen. However, several reports have described patients with mCRC who achieved long-term survival after the resection of distant metastases [2][3][4]. Ottone et al reported long-term survival in a patient after oxaliplatin-based chemotherapy and repeated thermoablation of liver metastases from CRC [5].…”

Metronomic Chemotherapy in Elderly Patients

“…In 2009, a case report described that the use of metronomic capecitabine as a first line and maintenance treatment for an elderly patient with advanced or metastatic colorectal cancer [ 72 ]. The 82-year-old patient was treated with capecitabine (1250 mg/m 2 ) twice a day for days 1 through 14, every three weeks, for a total of 12 cycles.…”

“…After two cycles, hepatic metastases decreased by 20% and vanished entirely after eight cycles. Interestingly, the patient experienced hand-foot syndrome and mild, manageable grade 1 leukopenia during the treatment, but there was no sign of metastasis or recurrence [ 72 ].…”