Safety and Efficacy of 5-FU, Leucovorin, and Oxaliplatin (FOLFOX) Followed by Cetuximab for Metastatic Colon Cancer With Severe Liver Dysfunction: A Case Report

Both 5-FU and oxaliplatin have been used as single agents in patients with colon cancer and severe liver dysfunction, but the combination of these drugs has not been yet investigated. A 67-year-old man diagnosed with colon cancer in 2008  presented in April 2011 to Stanford University Medical Center   with obstructive jaundice and weight loss. Imaging studies were compatible with a liver mass and dilatation of the intrahepatic bile ducts. A liver biopsy confirmed metastatic colon cancer. Because his total bilirubin level was 23.1 mg/dL, a percutaneous catheter was placed in May 2011. His total bilirubin level decreased to 5.9 mg/dL, but then increased to 9.4 mg/dL in June 2011. He was started on a FOLFOX regimen, with a 50% dose reduction of 5-FU bolus (200 mg/m2) and continuous infusion (1200 mg/m2) over 46 hours, and a 15% dose reduction of oxaliplatin (75 mg/m2) every 2 weeks. He tolerated this regimen very well, with normalization of his bilirubin level, a significant decrease in his tumor markers, and a partial response seen on PET/CT scan. His only significant toxicity was a grade 2 stomatitis. He received 21 cycles of FOLFOX, and was later switched to cetuximab treatment after disease progression. These findings suggest that FOLFOX might be effective in metastatic colon cancer with severe liver dysfunction, with minimal toxicity, and deserves further investigation.

Target Audience

This activity has been designated to meet the educational needs of physicians and nurses involved in the management of patients with cancer.

Learning Objectives

Upon completion of this activity, participants will be able to:

  • Summarize the diagnosis and treatment of patients with metastatic colon cancer with severe liver dysfunction
  • Discuss what is known regarding the safety and efficacy of 5-FU, leucovorin, and oxaliplatin (FOLFOX) in the treatment of patients with metastatic colorectal cancer (mCRC) and severe liver dysfunction
  • Evaluate available data regarding the safety of cetuximab monotherapy for treatment of mCRC in patients with severe liver dysfunction
Additional information
Supporters: 

No commercial support was received for this article.

Course summary
Available credit: 
  • 1.00 Participation
  • 1.00 Nurse
  • 1.00 Physician
Course opens: 
02/24/2014
Course expires: 
02/24/2015
Cost:
$0.00

Raymond Elsoueidi, MD
Department of Hematology Oncology
Appalachian Regional Healthcare
Hazard, Kentucky

Jessica Craig, PharmD
Department of Pharmacy
LewisGale Medical Center
Salem, Virginia

Hesham Mourad, PharmD
Department of Hematology Oncology
Appalachian Regional Healthcare
Hazard, Kentucky

Elie M. Richa, MD, MBA
Department of Medicine, Division of Oncology
Stanford University Medical Center
Stanford, California

Available Credit

  • 1.00 Participation
  • 1.00 Nurse
  • 1.00 Physician

Accreditation Period

Course opens: 
02/24/2014
Course expires: 
02/24/2015

Price

Cost:
$0.00
Please login or register to take this course.

Required Hardware/software

To access this activity, users will need:

  • A device with an Internet connection
  • Adobe Reader or other PDF reader software for article and certificate viewing/printing