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Published on: October 27, 2014
Complete pathological response to bevacizumab and chemoradiation in advanced rectal cancer
Christopher G Willett1, Dan G Duda, Emmanuelle di Tomaso
1Duke University Medical Center, Durham, NC 27710, USA. christopher.willett@duke.edu
Background:
Localized rectal cancer responds well to 5-fluorouracil and radiation-based regimens. A phase I-II trial is currently testing the efficacy of adding bevacizumab, a VEGF-specific antibody, to standard chemoradiotherapy. The case presented here is a complete pathological response seen in a patient with extensive and locally invasive carcinoma after receiving this combined treatment.
Investigations:
Physical examination, rectal ultrasound, PET-CT scan, laboratory tests, proctoscopic examination, chest radiograph, rectal forcep biopsies with immunohistochemistry, and protein and flow cytometric analyses.
Diagnosis:
Large, invasive, ultrasound stage T4 carcinoma of the rectum, which was positive for survivin.
Management:
One 2-week cycle of bevacizumab alone, followed by 3 cycles of bevacizumab with continuous 5-fluorouracil infusion, and external-beam radiation therapy given 5 days per week to the pelvis, abdominoperineal resection with posterior vaginectomy, hysterectomy and bilateral salpingo-oophorectomy.
