PMC6329477_01
(A) Therapeutic course timeline followed in the patient. (a) Oxaliplatin, 200 mg, d1 + capecitabine, 1.5 g, d1-d14; (b) irinotecan, 380 mg, d1 + 5-FU, 750 mg, d1 + 5-FU, 4.75 g, d1 and maintain for 46 hours; (c) irinotecan, 380 mg, d1 + 5-FU, 750 mg, d1 + 5-FU, 4.75 g, d1 and maintain for 46 hours + vemurafenib, 960 mg, qd + cetuximab, 900 mg, d1; (d) irinotecan, 380 mg, d1 + 5-FU, 750 mg, d1 + 5-FU, 4.75 g, d1 and maintain for 46 hours + vemurafenib, 960 mg, qd + cetuximab, 900 mg, d1. (B) Diffused peritoneal and pelvic metastases were demonstrated by PET/CT scan on January 3, 2018. (C) PET/CT scan on February 24, 2018 (after second treatment cycle) demonstrated recession of metastases with less sero-peritoneal involvement after therapy. (D) PET/CT scan on May 31, 2018 (after 10th treatment cycle) showed complete recession of metastases with no sero-peritoneal involvement after therapy. (E) Fluctuation of CEA (normal value: 0-5 microg/L) and CA 19-9-9 (normal value: 0-39 U/L) levels in the blood.. Abbreviations: CT, computed tomography; PET, positron emission tomography.
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A positron emission tomography (PET) scan on January 3, 2018 indicated peritoneal and pelvic metastases (Figure 1B), with concomitant rise in CEA (3.15 microg/L) and CA 19-9 (886 U/L) levels. This treatment regimen was scheduled for 12 cycles (first cycle: irinotecan + 5-FU; second cycle: irinotecan + 5-fluorouracil + vemurafenib + cetuximab) and a PET/CT scan on February 24, 2018 (after second treatment cycle) (Figure 1C) showed recession of metastases with less sero-peritoneal invasion. A subsequent PET/CT scan on May 31, 2018 (after 10th treatment cycle) (Figure 1D) showed complete recession of metastases with no sero-peritoneal invasion. Concomitant decrease in serum CEA (2.79 microg/L) and CA 19-9 (36.92 U/L) (Figure 1E) levels was also observed. The overall clinical progression along with the treatment course is given in Figure 1A.