Durable Disease Control with Regorafenib in a Patient with Metastatic KIT-Mutated Colorectal Cancer
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CASE REPORT
Durable Disease Control with Regorafenib in a Patient with Metastatic KIT-Mutated Colorectal Cancer Jefferson Rios Pimenta 1 & Douglas Jorge Racy 2 & Luciana Mejia Zapata 2 & Renata D’Alpino Peixoto 3,4 Accepted: 14 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Introduction Colorectal cancer (CRC) is a common, but potentially lethal neoplasia, in which 20% of patients are already metastatic at diagnosis and one-third will die from the disease in 5 years. According to the World Health Organization (WHO), in 2018, 1,800,000 new cases of CRC were diagnosed, and there were 861,000 deaths related to the disease worldwide [1]. In relation to Brazil, according to the National Cancer Institute (INCA), 36,360 new cases of CRC were reported in 2018. Excluding nonmelanoma skin cancer cases, CRC was the second most diagnosed neoplasm in women and the third in men, a position that is similar to global data [2]. Despite the fact that mortality rates due to CRC have progressively declined over the years due to the detection and removal of colonic polyps, the earlier diagnosis of the disease, and the emergence of more effective treatments, survival rates are still unsatisfactory. Currently, median overall survival (OS) for metastatic CRC is around 30 months [3]. The standard treatment for metastatic disease consists of chemotherapy based on fluoropyrimidine, oxaliplatin, and irinotecan, in combination or in sequence; monoclonal antibodies against vascular endothelial growth factor (anti-VEGF) bevacizumab, aflibercept, or ramucirumab; and, in the case of wild RAS tumors, monoclonal antibodies against the epidermal growth factor receptor (anti-EGFR) cetuximab or panitumumab [3, 4]. Despite the progression of the disease after available therapies for
* Renata D’Alpino Peixoto [email protected] 1
Oncology Department, Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815 – Bela Vista, São Paulo, SP 01327-001, Brazil
2
Radiology Department, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
3
Universidade Nove de Julho, São Paulo, Brazil
4
Centro Paulista de Oncologia-Grupo Oncoclínicas, São Paulo, Brazil
metastatic CRC, many patients remain with good clinical performance and may be candidates for other lines of treatment, obtaining gains in OS. More recently, regorafenib, a multiple kinase inhibitor that targets signaling pathways involved in tumor angiogenesis (VEGFR1, VEGFR2, VEGFR3, TIE2), on oncogenesis (KIT, RET, RAF1, BRAF, BRAF V600E), in the tumor microenvironment (PDGFR and FGFR), and in immune modulation, has been approved by several regulatory agencies, conferring significant clinical benefits compared with placebo in patients with metastatic CRC, ECOG 0 or 1, who progress after standard treatment. To date, there is no predictive biomarker of response or benefit with regorafenib, and it has been used regardless of the mutational status of RAS or BRAF, laterality, or the presence of microsatellite instability. Here, we present a case of later lin
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