J Gastrointest Canc DOI 10.1007/s12029-014-9611-1

CASE REPORT

A Case Report—Treatment of Metastatic Colorectal Cancer in a Patient on Hemodialysis Ryan M. Bolonesi & Jane E. Rogers & Imad Shureiqi

# Springer Science+Business Media New York 2014

Introduction

Case Report

End-stage renal disease (ESRD) represents a prevalent issue throughout the USA. In 2011, there were 615,899 ESRD patients with 430,273 patients on dialysis [1]. ESRD patients are often accompanied by multiple comorbidities such as diabetes, cardiovascular disease, hypertension, risk for hospitalization, and risk of infection. In addition, ESRD may be associated with an increased cancer risk dependent on the type of cancer and age [2, 3]. Data regarding cancer management in ESRD patients is limited. This lack of experience and associated comorbidities presents a complex challenge in administering antineoplastic therapy. Multiple considerations need to be evaluated prior to chemotherapy and targeted therapy administration in ESRD dialysis patients. These include the type of dialysis, pharmacodynamics and pharmacokinetic aspects of the agent selected, drug clearance by dialysis, dosing adjustments needed, literature available, when to administer these agents in regard to dialysis treatment, and goal of providing cancer treatment [3, 4]. We report experience in a 55-year-old male with ESRD on hemodialysis that tolerated multiple lines of dose-reduced metastatic colorectal (mCRC) treatment. These regimens included FOLFIRI (fluorouracil, leucovorin, irinotecan) with intermittent bevacizumab, panitumumab plus irinotecan, FOLFOX (fluorouracil, leucovorin, oxaliplatin), and regorafenib.

A 55-year-old mCRC male with a history of non-insulindependent diabetes mellitus since age 35, hypertension, anemia of chronic disease, and ESRD on hemodialysis three times weekly presented to our institution for a second opinion. Prior to presenting to our institution, a diagnostic colonoscopy at an outside facility revealed colonic tumor at the hepatic flexure occupying 75–99 % of the lumen. Right hemicolectomy was then performed. Surgical pathology revealed a moderately differentiated adenocarcinoma with perforation to the visceral peritoneum, metastasis in 6/41 resected lymph nodes, and extramural tumor deposits. Intra-operatively, there was evidence of metastatic nodules in the liver which was then visualized on a post-operative PET/CT scan. The patient was then treated with weekly regimen of 5-fluorouracil, leucovorin, and irinotecan for approximately 5 months before a break in chemotherapy, at which point, he came to our institution for a second opinion. Upon presentation at our institution, the patient had baseline CT scans performed. Chest CT scan was negative for metastatic disease, and CT of the abdomen revealed numerous unresectable hepatic metastasis including a lesion in the right lobe measuring 2.6×2.3 cm as well as a lesion in the left lobe measuring 3.7×3.7 cm. Baseline laboratory findings were as follows: carcinoembryonic antigen (CEA) 54.5 ng/ml, hemoglobin 12.1 g/dL, platelet count 146,000, absolute neutrophil count (ANC) 3.41×103, aspartate aminotransferase (AST) 22 IU/L, alanine aminotransferase (ALT)

A case report--treatment of metastatic colorectal cancer in a patient on hemodialysis.

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