FOLFOX AND FOLFIRI CHEMOTHERAPY IN A METASTATIC COLORECTAL CANCER PATIENT: A CASE REPORT OF DUAL REGIMEN INTOLERANCE
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Keywords
Colorectal cancer, Chemotherapy, FOLFOX rechallenge, FOLFIRI toxicity, Capecitabine, Irinotecan, Palliative Care
Abstract
Background: FOLFOX and FOLFIRI are standard chemotherapy regimens for metastatic colorectal cancer (mCRC). While both regimens are associated with distinct toxicity profiles, intolerance to both is uncommon and poses a major therapeutic challenge.
Case Presentation: The case of a 54-year-old male diagnosed with metastatic adenocarcinoma of the rectosigmoid region (stage IV B), confirmed to be microsatellite stable (MSS) on immunohistochemistry. The patient initially received 12 cycles of FOLFOX plus bevacizumab, achieving a partial metabolic response. Maintenance capecitabine was initiated but discontinued due to gastrointestinal intolerance. A subsequent whole-body PET-CT showed progressive disease. The patient was started on FOLFIRI with bevacizumab but developed severe grade 4 lower gastrointestinal toxicity and acute cholinergic syndrome, necessitating hospitalization and FOLFIRI regimen discontinuation. A rechallenge with the FOLFOX regimen was attempted; however, the patient again experienced significant intolerance. In view of prior fluoropyrimidine response, low-dose capecitabine was re-initiated with supportive care and close monitoring.
Conclusion: This case highlights the complexity of managing mCRC in patients who exhibit intolerance to both FOLFOX and FOLFIRI regimens. Early recognition of severe toxicity, careful dose modification, and personalized therapeutic planning are essential.
Keywords:
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Dr. Shivani Sodhi
Senior Resident, Department of Pharmacology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
Dr. Himanshu Singh
Senior Resident, Department of Pharmacology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
Dr. Jyoti Singh
Assistant Professor Department of Radiation Oncology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
Dr Lalit Kumar Gupta
Professor and Head, Department of Pharmacology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
Dr. Hiramani Rabha
Senior Resident, Department of Pharmacology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India