Abstract
A 62-year-old man had unresectable sigmoid colon cancer with hepatic and pulmonary metastases and jaundice. The cancer was a wild-type KRAS tumor. He received 5-fluorouracil (5-FU), leucovorin and oxaliplatin (FOLFOX) and panitumumab as first-line chemotherapy ; 5-FU, leucovorin, and irinotecan (FOLFIRI) and bevacizumab as second-line chemotherapy ; TAS-102 as third-line chemotherapy ; and regorafenib as fourth-line chemotherapy. Because he was eager to initiate the next course of chemotherapy and his performance status (PS) was PS0, cetuximab monotherapy was initiated as fifth-line chemotherapy in spite of his hyperbilirubinemia (total bilirubin, 16.3mg/dl). After 4 courses of cetuximab monotherapy, S-1 and cetuximab combination therapy was initiated because hyperbilirubinemia disappeared. He exhibited no serious adverse reactions, so S-1, oxaliplatin, and cetuximab combination therapy was initiated. Thereafter, the appearance of new hepatic metastases and elevation in total bilirubin levels resulted in a change in the combination therapy to ramucirumab and FOLFIRI. However, the patient subsequently died due to disease progression 36 months after his first visit and 6 months after his first cetuximab chemotherapy.
