Recurrent disease four years after surgery and adjuvant chemotherapy

A 71-year-old man with previous primary resection was found to have extensive liver metastases. Chemotherapy was initiated with FOLFIRI plus bevacizumab, in hopes of reducing the hepatic tumor burden; this resulted in manageable toxicity and was sufficiently effective to allow resection. After 6 weeks, 6 cycles of chemotherapy with FOLFIRI plus bevacizumab were administered; the patient was free of new lesions for the next 19 months. Readministration of FOLFIRI plus bevacizumab resulted in minor response and symptom control for another 9 months before further progression was observed. The subsequent administration of FOLFOX for 8 cycles and FOLFIRI plus cetuximab were unable to prevent further decline. Detailed explanation of the selection of appropriate surgical and chemotherapeutic options are provided throughout the case discussion.