IMPACT OF GENETICS ON NEOADJUVANT THERAPY
WITH COMPLETE PATHOLOGICAL RESPONSE
IN METASTATIC COLORECTAL CANCER:
CASE REPORT AND REVIEW OF THE LITERATURE
Bulajic P1, Bidzic N1,*, Djordjevic V1, Ceranic M1,2, Basaric D1,2, Pesic V3, Djordjevic-Pesic J4
*Corresponding Author: Nemanja Bidzic, M.D., Clinic for Digestive Surgery, Clinical Center of
Serbia, Koste Todorovica 6, Belgrade 11000, Serbia. Tel. +381-11-306-5957. Fax: +381-11-306-5967.
E-mail: nemanja bidzic@yahoo.com
page: 75
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Abstract
Treatment of colorectal metastatic cancer is still challenging,
despite recent improvements in chemotherapy.
A genetic cancer profile, such as the KRAS (Kirsten rat
sarcoma) gene status, plays a key role in individualized
tailored therapy. Molecular targeted therapy added to neoadjuvant
chemotherapy can achieve a better pathological
response and prolong survival. Pathological complete response
of colorectal cancer stage IV is rare. A 47-year-old
female patient presented with rectal adenocarcinoma and
three liver metastases (cT3d/4, N2, M1). After seven cycles
of Bevacizumab and CAPOX in neoadjuvant setting,
we noted more than 70.0% regression of metastases and
complete regression of the primary tumor. We performed
low anterior resection of rectum and synchronous subsegmental
resection of S3, because the other two lesions were
not detectable. Pathology revealed complete response of
the primary and also secondary tumors. After 8 months,
diagnostic tests did not show any sign of recurrence and
the remaining liver lesions disappeared. Colorectal cancer
is a heterogeneous disease and it is necessary to identify
patients who are at-risk of recurrence and suitable for neoadjuvant
therapy. Genetic biomarkers play an important
role in metastatic colorectal cancer treatment. Because of
the mutated KRAS gene, Bevacizumab was added to cytotoxic
therapy achieving a complete pathological response
of primary tumor and metastasis. This case is unique because
all reported cases with similar results, described
staged surgery and one of reverse staged surgery, but with
similar results. This neoadjuvant therapy has extraordinary
results for colorectal cancer stage IV and can help diseasefree
and long-term survival.
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