Articles Vol. 67 No. 10 04/11/2026

DEEP RADIOLOGIC AND BIOCHEMICAL RESPONSE TO CETUXIMAB-BASED THERAPY IN EXTENSIVE COLORECTAL LIVER METASTASES: A CASE REPORT

Ha Van Tri, Ho Viet Hoanh, Vu Anh Hai, Phanh Khanh Hung, Nguyen Trong Hoe, Thai Khac Thao
DOI: 10.52163/yhc.v67i10.6979
13 Views
0 Downloads
Abstract

Background: Extensive colorectal liver metastases carry a poor prognosis. Anti-epidermal growth factor receptor (EGFR) therapy markedly improves outcomes in left-sided, RAS wild-type disease, yet near-complete radiologic response in patients with a very high initial tumour burden remains uncommon.

Case summary: A 53-year-old woman was diagnosed with sigmoid colon adenocarcinoma and extensive synchronous bilobar liver metastases comprising more than 30 lesions, the largest measuring 50-60 mm. Molecular testing showed RAS and BRAF wild-type status, while immunohistochemistry demonstrated proficient mismatch repair (pMMR). Baseline serum carcinoembryonic antigen (CEA) was 6 600 ng/mL and peaked at 8 776 ng/mL.

Intervention and outcome: Because of the risk of bowel obstruction, the patient underwent resection of the primary tumour with regional lymph node dissection, followed by 12 cycles of mFOLFOX6 combined with cetuximab, and was then switched to maintenance UFT (tegafur-uracil) plus cetuximab. After 12 cycles, liver metastases showed marked radiologic regression, with the largest lesion decreasing from 50-60 mm to 15-20 mm, low T2 signal intensity, thin peripheral rim enhancement and no diffusion restriction; positron emission tomography showed no detectable fluorodeoxyglucose uptake in the residual lesions. CEA fell by more than 99.9% to 7 ng/mL and remained stable at 7-9 ng/mL. The main toxicities (graded by CTCAE version 5.0) were grade 2 leukopenia and thrombocytopenia (managed with filgrastim and eltrombopag), grade 2 oxaliplatin-induced peripheral neuropathy, and grade 1 cetuximab-related skin toxicity. At 15 months after diagnosis, the patient remained clinically stable without radiologic progression.

Conclusion: This case demonstrated a profound biochemical and radiological response to cetuximab-based combination therapy in a patient with RAS/BRAF wild-type, pMMR, left-sided metastatic colorectal cancer with diffuse liver metastases. The sustained clinical course suggests the potential for durable disease control; tumor dormancy remains only a biological hypothesis and cannot be established from this single case. Longer follow-up is required.

Keywords
colorectal cancer; liver metastases; cetuximab; anti-EGFR therapy; radiologic response; pMMR.
References
[1]
1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249. doi:10.3322/caac.21660 Google Scholar
[2]
2. Martin J, Petrillo A, Smyth EC, Shaida N, Khwaja S, Cheow HK, et al. Colorectal liver metastases: current management and future perspectives. World J Clin Oncol. 2020;11(10):761-808. doi:10.5306/wjco.v11.i10.761 Google Scholar
[3]
3. Misiakos EP, Karidis NP, Kouraklis G. Current treatment for colorectal liver metastases. World J Gastroenterol. 2011;17(36):4067-4075. doi:10.3748/wjg.v17.i36.4067 Google Scholar
[4]
4. Heinemann V, von Weikersthal LF, Decker T, Kiani A, Kaiser F, Al-Batran SE, et al. FOLFIRI plus cetuximab or bevacizumab for advanced colorectal cancer: final survival and per-protocol analysis of FIRE-3, a randomised clinical trial. Br J Cancer. 2021;124(3):587-594. doi:10.1038/s41416-020-01140-9 Google Scholar
[5]
5. Tejpar S, Stintzing S, Ciardiello F, Tabernero J, Van Cutsem E, Beier F, et al. Prognostic and predictive relevance of primary tumor location in patients with RAS wild-type metastatic colorectal cancer: retrospective analyses of the CRYSTAL and FIRE-3 trials. JAMA Oncol. 2017;3(2):194-201. doi:10.1001/jamaoncol.2016.3797 Google Scholar
[6]
6. Chen D, Gu K, Wang H. Optimizing sequential treatment with anti-EGFR and VEGF mAb in metastatic colorectal cancer: current results and controversies. Cancer Manag Res. 2019;11:1705-1716. doi:10.2147/CMAR.S196170 Google Scholar
[7]
7. Ciardiello F, Tortora G. EGFR antagonists in cancer treatment. N Engl J Med. 2008;358(11):1160-1174. doi:10.1056/NEJMra0707704 Google Scholar
[8]
8. Yoshida M, Shimura T, Sato M, Ebi M, Nakazawa T, Takeyama H, et al. A novel predictive strategy by immunohistochemical analysis of four EGFR ligands in metastatic colorectal cancer treated with anti-EGFR antibodies. J Cancer Res Clin Oncol. 2013;139(3):367-378. doi:10.1007/s00432-012-1340-x Google Scholar
[9]
9. Colloca GA, Venturino A, Guarneri D. Carcinoembryonic antigen-related tumor kinetics after eight weeks of chemotherapy is independently associated with overall survival in patients with metastatic colorectal cancer. Clin Colorectal Cancer. 2020;19(4):e200-e207. doi:10.1016/j.clcc.2020.05.007 Google Scholar
[10]
10. van der Reijd DJ, Soykan EA, Heeres BC, Lambregts DMJ, Vollebergh MA, Kuhlmann KFD, et al. Colorectal liver metastases on gadoxetic acid-enhanced MRI: typical characteristics decrease after chemotherapy. Clin Imaging. 2025;119:110417. doi:10.1016/j.clinimag.2025.110417 Google Scholar
[11]
11. Fernández-Hernández S, Hidalgo-León MÁ, Lacalle-González C, Olivera-Salazar R, Ochieng’ Otieno M, García-Foncillas J, et al. Dormancy in colorectal carcinoma: detection and therapeutic potential. Biomolecules. 2025;15(8):1119. doi:10.3390/biom15081119 Google Scholar
[12]
12. Dueland S, Syversveen T, Solheim JM, Solberg S, Grut H, Bjørnbeth BA, et al. Survival following liver transplantation for patients with nonresectable liver-only colorectal metastases. Ann Surg. 2020;271(2):212-218. doi:10.1097/SLA.0000000000003404 Google Scholar
[13]
13. Wei L, Lin Z, Xie S, Ruan D, Jiang W, Cui Y, et al. Complete response with cetuximab-based treatment of metastatic colorectal cancers: two case reports and literature review. Front Oncol. 2022;12:798515. doi:10.3389/fonc.2022.798515 Google Scholar