ESMO Preceptorship Programme

Locally advanced BRAF mutant positive

colon cancer

Dr.S.R.Muthuramalingam

Consultant Medical Oncologist

Portsmouth Oncology Centre

Queen Alexandra Hospital

United Kingdom

Locally advanced– Right side – 25/11/16

ESMO PRECEPTORSHIP PROGRAM

Case Presentation

� 38-yr old lady with with two young children aged 11 and 8

� Past medical history: Low BP, Transient collapse due to atrial flutter, low platelet counts during pregnancies

� Admitted in the hospital with fever and diarrhoeafollowing holiday in the Dominican Republic

� Readmission after a few months with fever, diarrhoea, backache and lump in the right abdomen

� Two stones of weight loss

� Clinically palpable lump in the right abdomen

ESMO PRECEPTORSHIP PROGRAM

Investigations

� CT scan: 6x5 cm mass in the hepatic flexure invading retroperitoneal space and extending to third part of duodenum with a 15 mm defect in the anterior wall of duodenum; enlarged local regional nodes.

� PET scan: SUV 15.4 hepatic flexure tumourextending to the duodenum with no distant metastases

� Colonoscopy and biopsy: Adenocarcinoma RAS wild type; BRAF (V600) and TP53 mutation positive

ESMO PRECEPTORSHIP PROGRAM

Treatment

� Discussed in the colorectal and hepatobiliary MDTs

� FOLFOX plus panitumumab – 6 cycles

� Post treatment CT: Significant reduction in the size of the hepatic flexure tumour from 53 to 28 mm but still remained adherent to the duodenum

� MRI of abdomen: No pancreatic involvement but distal part of the duodenum involved with the tumour

� Right hemicolectomy with enbloc wedge resection of duodenum

� Histology: T4 N1 Adenocarcinoma with 1 out 3 nodes positive

� 6 cycles of adjuvant FOLFOX chemotherapy

ESMO PRECEPTORSHIP PROGRAM

Post treatment

� Post treatment CT: No evidence of recurrence

� She has been referred to the regional genetic department

� She will be followed up in the colorectal follow-up programme