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PET/CT scan of the abdomen. The scan was performed at admission, before treatment, showing ascending colon cancer with incomplete intestinal obstruction and multiple liver metastatic tumors.
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Positron emission tomography/computed tomography (PET/CT) results showed upper colon cancer with multiple lymph nodes, pelvic peritoneum, liver and bone multiple metastases, and incomplete intestinal obstruction (Figure 1).
PMC8826103_02
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Changes in tumor biomarkers and liver function following treatment with different regimens. (a) Serum biomarkers. Data from the time of admission were used as a baseline (0). All three markers (CEA: carcino-embryonic antigen, CA-199: cancer antigen 199, CA-724: cancer antigen 724) continued to rise despite surgery and FOLFIRI chemotherapy. As a result, the treatment regimen was changed to a combination of "Nivolumab + regomafenil + oxali" on July 24. The serum level of all three markers continued to increased further. However, all five markers' level declined significantly after switching to a new combination therapy of "Nivolumab + ipilimumab + irinotecan + regorafenib" on 7 August 2019. The levels of CEA and CA-724 reduced to baseline within 3-4 weeks. (b) Levels of bilirubin and ALT and AST. FOLFIRI chemotherapy did not show any effect in controlling the rise in bilirubin. The treatment regimen changed on July 24 was ineffective. However, the bilirubin level declined sharply after switching to the "Nivolumab + ipilimumab + irinotecan + regorafenib" regimen on 7 August 2019.
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IB 0.09 mg/dL) (Figure 2).
Comparison of abdominal MRI images before (a) and after (b) effective treatment. Images in panel (a) were taken on 23 July 2019 while panel (b) images were from scanning on 4 September 2019, 4 weeks after the reported combinational therapy. A significant reduction in all multiple liver metastatic tumor masses was observed.
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The level of tumor biomarkers also significantly reduced (CEA 39.43 ng/mL, CA-199 8246 U/mL, and CA724 16.78 U/mL, as shown in Figure 3). Imaging results confirmed that the size of intrahepatic multiple metastases and abdominal pelvic and retroperitoneal lymph node metastases became smaller compared with the previous MRI scanning results. The overall improvement indicated that a partially response (PR) was achieved in this patient (Figure 3), the patient showing well-tolerance to the combinational treatment.