Safety and efficacy of radiofrequency ablation with aflibercept and FOLFIRI in a patient with metastatic colorectal cancer.

Background: A vast majority of patients with metastatic colorectal cancer (mCRC) are not candidates for surgical resection. Radiofrequency ablation (RFA) is a safe and effective technique for treatment of isolated liver metastasis. After radiofrequency ablation, residual tumor can have aggressive growth, part of which is driven by the up-regulation of vascular endothelial growth factor (VEGF). Angiogenesis inhibitor bevacuzimab has been used in the management of mCRC with RFA. We present a patient with recurrent colorectal cancer and four hepatic metastases who was treated with RFA combined with aflibercept, another VEGF inhibitor and systemic chemotherapy. We believe that this is the first report of using aflibercept with RFA.

Case Report: A 35-year-old female with stage IV rectal cancer with metastasis to a lymph node and multiple hepatic metastases was treated with chemo-radiation, surgical resection of the tumor and surgical resection of two segments of the liver. She underwent RFA of the hepatic lesions that could not be resected. She received adjuvant chemotherapy consisting of 5-fluorouracil (5-FU) and oxaliplatin for a total of 6 months. However, a positron emission tomography (PET) scan showed progression of disease with new and growing lymph nodes. She was treated with 6 cycles of capecitabine monotherapy. A follow-up PET scan showed four new liver lesions. She has RFA of her four liver lesions and was started on a combination of aflibercept and FOLFIRI. She received 10 cycles and a repeat magnetic resonance imaging (MRI) and PET scan showed stable disease.

Discussion: This is the first reported case of a patient managed with RFA with aflibercept, an anti-VEGF agent, and FOLFIRI. This case showed both efficacy, as well as safety for the combined modalities in the management of mCRC.