PMC5328292_01
Computed tomography (CT) image before and after the chemotherapy. (A) CT performed before the first-line chemotherapy administration (September 2014). (B) CT performed following two cycles of first-line chemotherapy and before commencing second-line therapy. (C) CT performed 4 weeks after the initiation of anti-EGFR antibody combined second-line chemotherapy. The black arrows show the primary lesion, while the white arrows denote the liver metastases.
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Imaging examinations (computed tomography [CT], MRI, and positron-emission tomography-CT) at the time of the onset of back pain had not shown any suspicious lesions, but reexamination in September and October showed a rectal tumor with multiple metastatic lesions (bone, liver, left pararenal gland, peritoneum, and pleura; Figure 1); the cancer was diagnosed as clinical stage T4N0M1 (Union for International Cancer Control, 7th edition). CT after two cycles of chemotherapy showed progressive disease with worsening liver metastasis (Figure 1). CT after two cycles showed a partial response; his primary lesion and liver metastasis shrank, and pleural effusion and ascites decreased (Figure 1).
Changes in serum carcinoembryonic antigen levels. The time highlighted in gray corresponds to the period during which mFOLFOX6 + EGFR antibodies (three cycles of panitumumab and 17 cycles of cetuximab) were administered. The horizontal dotted line shows the cutoff level of serum CEA.. Abbreviations: mFOLFOX6, modified FOLFOX 6; EGFR, epidermal growth factor receptor; CEA, carcinoembryonic antigen.
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Moreover, his tumor markers normalized, as shown in Figure 2.