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Published in: BMC Cancer 1/2015

Open Access 01-12-2015 | Case report

From palliative to curative treatment - stage IV mucinous adenocarcinoma, successfully treated with metronomic capecitabine in combination with Bevacizumab and surgery- a case report

Authors: Karolina Vernmark, Maria Albertsson, Bergthor Björnsson, Thomas Gasslander, Per Sandström, Xiao-Feng Sun, Annika Holmqvist

Published in: BMC Cancer | Issue 1/2015

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Abstract

Background

Mucinous adenocarcinoma (MAC) represents 6-19 % of all colorectal carcinoma. It is associated with poorer response to chemotherapy and chemoradiotherapy.

Case presentation

A 27-year-old Swedish woman presented with stomach pain and weight loss, and was diagnosed with locally advanced MAC in the transverse colon as well as 3 liver metastases. Neoadjuvant treatment with fluorouracil, folinic acid and oxaliplatin (FLOX) failed due to several infections, pulmonary embolism and deteriorated performance status. The patient was therefore considered palliative. Palliative treatment with metronomic capecitabine 500 mg × 2 daily and bevacizumab every other week were initiated. After 4 months of treatment the tumors had regressed and the patient was able to undergo radical surgery, thereby changing the treatment intention from palliative to curative. No adjuvant chemotherapy was given. There were no signs of recurrence 9 months later.

Conclusions

The role of the combination of metronomic capecitabine and bevacizumab in patients with MAC merits further investigation.
Literature
1.
go back to reference Zhang H, Evertsson S, Sun X. Clinicopathological and genetic characteristics of mucinous carcinomas in the colorectum. Int J Oncol. 1999;14(6):1057–61.PubMed Zhang H, Evertsson S, Sun X. Clinicopathological and genetic characteristics of mucinous carcinomas in the colorectum. Int J Oncol. 1999;14(6):1057–61.PubMed
2.
go back to reference Verhulst J, Ferdinande L, Demetter P, Ceelen W. Mucinous subtype as prognostic factor in colorectal cancer: a systematic review and meta-analysis. J Clin Pathol. 2012;65(5):381–8.CrossRefPubMed Verhulst J, Ferdinande L, Demetter P, Ceelen W. Mucinous subtype as prognostic factor in colorectal cancer: a systematic review and meta-analysis. J Clin Pathol. 2012;65(5):381–8.CrossRefPubMed
3.
go back to reference Hyngstrom JR , Hu CY, Xing Y, You YN, Feig BW, Skibber JM et al. Clinicopathology and outcomes for mucinous and signet ring colorectal adenocarcinoma: analysis from the National Cancer Data Base. Ann Surg Oncol. 2012;19(9):2814–21.CrossRefPubMedPubMedCentral Hyngstrom JR , Hu CY, Xing Y, You YN, Feig BW, Skibber JM et al. Clinicopathology and outcomes for mucinous and signet ring colorectal adenocarcinoma: analysis from the National Cancer Data Base. Ann Surg Oncol. 2012;19(9):2814–21.CrossRefPubMedPubMedCentral
4.
go back to reference Umpleby HC, Ranson DL, Williamson RC. Peculiarities of mucinous colorectal carcinoma. Br J Surg. 1985;72(9):715–8.CrossRefPubMed Umpleby HC, Ranson DL, Williamson RC. Peculiarities of mucinous colorectal carcinoma. Br J Surg. 1985;72(9):715–8.CrossRefPubMed
5.
go back to reference Nozoe T , Anai H, Nasu S, Sugimachi K. Clinicopathological characteristics of mucinous carcinoma of the colon and rectum. J Surg Oncol. 2000;75(2):103–7.CrossRefPubMed Nozoe T , Anai H, Nasu S, Sugimachi K. Clinicopathological characteristics of mucinous carcinoma of the colon and rectum. J Surg Oncol. 2000;75(2):103–7.CrossRefPubMed
6.
go back to reference Akino F , Mitomi H, Nakamura T, Ohtani Y, Ichinoe M, Okayasu I. High apoptotic activity and low epithelial cell proliferation with underexpression of p21(WAF1/CIP1) and p27Kip1 of mucinous carcinomas of the colorectum: comparison with well-differentiated type. Am J Clin Pathol. 2002;117(6):908–15.CrossRefPubMed Akino F , Mitomi H, Nakamura T, Ohtani Y, Ichinoe M, Okayasu I. High apoptotic activity and low epithelial cell proliferation with underexpression of p21(WAF1/CIP1) and p27Kip1 of mucinous carcinomas of the colorectum: comparison with well-differentiated type. Am J Clin Pathol. 2002;117(6):908–15.CrossRefPubMed
7.
go back to reference Connelly JH, Robey-Cafferty SS, Cleary KR. Mucinous carcinomas of the colon and rectum. An analysis of 62 stage B and C lesions. Arch Pathol Lab Med. 1991;115(10):1022–5.PubMed Connelly JH, Robey-Cafferty SS, Cleary KR. Mucinous carcinomas of the colon and rectum. An analysis of 62 stage B and C lesions. Arch Pathol Lab Med. 1991;115(10):1022–5.PubMed
8.
go back to reference Halvorsen TB, Seim E. Influence of mucinous components on survival in colorectal adenocarcinomas: a multivariate analysis. J Clin Pathol. 1988;41(10):1068–72.CrossRefPubMedPubMedCentral Halvorsen TB, Seim E. Influence of mucinous components on survival in colorectal adenocarcinomas: a multivariate analysis. J Clin Pathol. 1988;41(10):1068–72.CrossRefPubMedPubMedCentral
9.
go back to reference Messerini L , Vitelli F, De Vitis LR, Mori S, Calzolari A, Palmirotta R et al. Microsatellite instability in sporadic mucinous colorectal carcinomas: relationship to clinico-pathological variables. J Pathol. 1997;182(4):380–4.CrossRefPubMed Messerini L , Vitelli F, De Vitis LR, Mori S, Calzolari A, Palmirotta R et al. Microsatellite instability in sporadic mucinous colorectal carcinomas: relationship to clinico-pathological variables. J Pathol. 1997;182(4):380–4.CrossRefPubMed
10.
go back to reference Lupinacci RM, Mello ES, Coelho FF, Kruger JA, Perini MV, Pinheiro RS et al. Prognostic implication of mucinous histology in resected colorectal cancer liver metastases. Surgery. 2014;155(6):1062–8.CrossRefPubMed Lupinacci RM, Mello ES, Coelho FF, Kruger JA, Perini MV, Pinheiro RS et al. Prognostic implication of mucinous histology in resected colorectal cancer liver metastases. Surgery. 2014;155(6):1062–8.CrossRefPubMed
11.
go back to reference Shin US, Yu CS, Kim JH, Kim TW, Lim SB, Yoon SN et al. Mucinous rectal cancer: effectiveness of preoperative chemoradiotherapy and prognosis. Ann Surg Oncol. 2011;18(8):2232–9.CrossRefPubMed Shin US, Yu CS, Kim JH, Kim TW, Lim SB, Yoon SN et al. Mucinous rectal cancer: effectiveness of preoperative chemoradiotherapy and prognosis. Ann Surg Oncol. 2011;18(8):2232–9.CrossRefPubMed
12.
go back to reference Younes M, Katikaneni PR, Lechago J. The value of the preoperative mucosal biopsy in the diagnosis of colorectal mucinous adenocarcinoma. Cancer. 1993;72(12):3588–92.CrossRefPubMed Younes M, Katikaneni PR, Lechago J. The value of the preoperative mucosal biopsy in the diagnosis of colorectal mucinous adenocarcinoma. Cancer. 1993;72(12):3588–92.CrossRefPubMed
13.
go back to reference Niv Y. Mucin and colorectal cancer metastasis. Am J Gastroenterol. 1994;89(5):665–9.PubMed Niv Y. Mucin and colorectal cancer metastasis. Am J Gastroenterol. 1994;89(5):665–9.PubMed
15.
go back to reference Lien K, Georgsdottir S, Sivanathan L, Chan K, Emmenegger U. Low-dose metronomic chemotherapy: a systematic literature analysis. Eur J Cancer. 2013;49(16):3387–95.CrossRefPubMed Lien K, Georgsdottir S, Sivanathan L, Chan K, Emmenegger U. Low-dose metronomic chemotherapy: a systematic literature analysis. Eur J Cancer. 2013;49(16):3387–95.CrossRefPubMed
16.
go back to reference Fedele P, Marino A, Orlando L, Schiavone P, Nacci A, Sponziello F et al. Efficacy and safety of low-dose metronomic chemotherapy with capecitabine in heavily pretreated patients with metastatic breast cancer. Eur J Cancer. 2012;48(1):24–9.CrossRefPubMed Fedele P, Marino A, Orlando L, Schiavone P, Nacci A, Sponziello F et al. Efficacy and safety of low-dose metronomic chemotherapy with capecitabine in heavily pretreated patients with metastatic breast cancer. Eur J Cancer. 2012;48(1):24–9.CrossRefPubMed
17.
18.
go back to reference Romiti A, Onesti CE, Roberto M, Barucca V, Tomao S, D'Antonio C et al. Continuous, low-dose capecitabine for patients with recurrent colorectal cancer. Med Oncol. 2015;32(3):54.CrossRefPubMed Romiti A, Onesti CE, Roberto M, Barucca V, Tomao S, D'Antonio C et al. Continuous, low-dose capecitabine for patients with recurrent colorectal cancer. Med Oncol. 2015;32(3):54.CrossRefPubMed
19.
go back to reference Digklia A, Voutsadakis IA. Combinations of vascular endothelial growth factor pathway inhibitors with metronomic chemotherapy: Rational and current status. World J Exp Med. 2014;4(4):58–67.CrossRefPubMedPubMedCentral Digklia A, Voutsadakis IA. Combinations of vascular endothelial growth factor pathway inhibitors with metronomic chemotherapy: Rational and current status. World J Exp Med. 2014;4(4):58–67.CrossRefPubMedPubMedCentral
20.
go back to reference Kelley RK, Hwang J, Magbanua MJ, Watt L, Beumer JH, Christner SM et al. A phase 1 trial of imatinib, bevacizumab, and metronomic cyclophosphamide in advanced colorectal cancer. Br J Cancer. 2013;109(7):1725–34.CrossRefPubMedPubMedCentral Kelley RK, Hwang J, Magbanua MJ, Watt L, Beumer JH, Christner SM et al. A phase 1 trial of imatinib, bevacizumab, and metronomic cyclophosphamide in advanced colorectal cancer. Br J Cancer. 2013;109(7):1725–34.CrossRefPubMedPubMedCentral
21.
go back to reference Baranyai Z, Jósa V, Krzystanek M, Eklund AC, Szász AM, Szállási Z. Evaluation of thrombocytosis as predictive factor in colorectal cancer. Magy Seb. 2013;66(6):331–7.CrossRefPubMed Baranyai Z, Jósa V, Krzystanek M, Eklund AC, Szász AM, Szállási Z. Evaluation of thrombocytosis as predictive factor in colorectal cancer. Magy Seb. 2013;66(6):331–7.CrossRefPubMed
22.
go back to reference Phipps AI, Buchanan DD, Makar KW, Win AK, Baron JA, Lindor NM et al. KRAS-mutation status in relation to colorectal cancer survival: the joint impact of correlated tumour markers. Br J Cancer. 2013;108(8):1757–64.CrossRefPubMedPubMedCentral Phipps AI, Buchanan DD, Makar KW, Win AK, Baron JA, Lindor NM et al. KRAS-mutation status in relation to colorectal cancer survival: the joint impact of correlated tumour markers. Br J Cancer. 2013;108(8):1757–64.CrossRefPubMedPubMedCentral
23.
go back to reference Carstens H, Albertsson M. Successful treatment with low-dose capecitabine for disseminated esophageal adenocarcinoma. Acta Oncol. 2007;46(6):866–8.CrossRefPubMed Carstens H, Albertsson M. Successful treatment with low-dose capecitabine for disseminated esophageal adenocarcinoma. Acta Oncol. 2007;46(6):866–8.CrossRefPubMed
Metadata
Title
From palliative to curative treatment - stage IV mucinous adenocarcinoma, successfully treated with metronomic capecitabine in combination with Bevacizumab and surgery- a case report
Authors
Karolina Vernmark
Maria Albertsson
Bergthor Björnsson
Thomas Gasslander
Per Sandström
Xiao-Feng Sun
Annika Holmqvist
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2015
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-015-1908-3

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