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Lack of efficacy: case report A 53-year-old man exhibited lack of efficacy during treatment with bevacizumab, capecitabine, fluorouracil, folinic acid, irinotecan and oxaliplatin for metastatic rectal adenocarcinoma [not all routes stated]. The man presented with rectal bleeding. He did not smoke and drank alcohol occasionally. Examinations showed hepatomegaly and iron deficiency anaemia. Following examinations, a diagnosis of pT3pN1b G2 rectal adenocarcinoma was made. BRAF and RAS mutations were identified on PCR. After 2 months, he was admitted and received first-line chemotherapy with the FOLFOX-4 regimen comprising of IV oxaliplatin 85 mg/m2 on day 1, IV fluorouracil [5-FU] bolus 400 mg/m2 followed by 600 mg/m2 22 hour continuous infusion on day 1 and 2 and IV folinic acid [leucovorin] 200 mg/m2 on days 1 and 2 along with bevacizumab 5 mg/kg on a 2 week schedule. He developed peripheral neuropathy after 12 cycles [aetiology unknown]. Subsequently, oxaliplatin was stopped and he continued receiving bevacizumab at 7.5 mg/kg every 3 weeks and capecitabine 1000 mg/m2 days 1 to 14. Six months after the initiation of chemotherapy, his disease was stable. Over the next six months, he continued receiving bevacizumab and capecitabine. Subsequent CT examination showed disease progression. Hence, the chemotherapy was switched to FOLFIRI comprising of IV irinotecan 180 mg/m2 on day 1, IV fluorouracil bolus 400 mg/m2 on day 1 followed by 2400 mg/m2 continuous infusion for 46 hours, and IV folinic acid 400 mg/m2 on day 1 every 2 weeks. Then, bevacizumab was discontinued due to proteinuria [aetiology unknown]. A palliative radiotherapy was suggested but he refused to receive. After 4 cycles of FOLFIRI, imaging revealed disease progression. Twenty three months after diagnosis, he died due to liver failure. Afrasanie V-A, et al. The coexistence of ras and braf mutations in metastatic colorectal cancer: A case report and systematic literature review. Journal of Gastrointestinal and Liver Diseases 29: 253-258, No. 2, Jun 2020. Available from: URL: http://doi.org/10.15403/jgld-1003 803500142

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