Long-term survival in an octogenarian patient with carcinomatous pleurisy from recurrent colon cancer, responding to Bevacizmab and CPT-11

Takahisa Fujikawa1

1 Department of Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan.

Conflict-of-interest statement: The author(s) declare(s) that there is no conflict of interest regarding the publication of this paper.

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Correspondence to: Takahisa Fujikawa, MD, PhD, FACS, Department of Surgery, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, Fukuoka 802-8555, Japan.
Email: fujikawa-t@kokurakinen.or.jp
Telephone: +81-93-511-2000
Fax: +81-93-511-3240

Received: July 3, 2019
Revised: July 17, 2019
Accepted: July 18, 2019
Published online: October 21, 2019


Cancerous pleurisy of recurrent colorectal cancer is relatively rare, and standardized chemotherapy has not been established. We herein presented a case of octogenarian with recurrent colon cancer with carcinomatous pleurisy, which successfully treated by modulated bevacizmab and CPT-11 combination chemotherapy and a total of 5-year long-term survival was achieved. Significantly responsive cases of Bevacizmab-combined chemotherapy have been reported for cancer pleurisy from different carcinomas, and its usefulness for cancerous pleural effusion cases is expected. We discuss the efficacy of Bevacizmab for elderly patients with recurrent or advanced colorectal cancer and cancerous pleurisy.

Key words: Carcinomatous pleurisy; Recurrent colon cancer; Bevacizmab; CPT-11

© 2019 The Author(s). Published by ACT Publishing Group Ltd. All rights reserved.

Fujikawa T. Long-term survival in an octogenarian patient with carcinomatous pleurisy from recurrent colon cancer, responding to Bevacizmab and CPT-11. Journal of Gastroenterology and Hepatology Research 2019; 8(5): 2994-2996 Available from: URL: http://www.ghrnet.org/index.php/joghr/article/view/2623


An 84-year-old woman was presented with massive right pleural effusion. She was initially underwent ileocecal resection for Stage II ascending colon cancer at the age of 77 years, and also received partial liver resection for liver metastasis at the age of 80 years (Figure 1A, 1B). At the age of 81 years, multiple liver metastases were recognized (Figure 1C). After 7 courses of Bevacizmab + FOLFOX6 therapy were performed with the result of PR response, she underwent partial liver resection (Figure 1D). Postoperatively, adjuvant chemotherapy was not performed and no recurrence occurred for two years, but the right lung metastasis was recognized at the age of 83 years (Figure 2A). Oral UFT / USEL therapy was introduced and continued in consideration of her high age, but massive right pleural effusion was observed, and chest drainage was performed (Figure 2B, 2C). She was diagnosed as carcinomatous pleurisy by pleural examination. After small intrathoracic administration of CDDP, Bevacizmab + CPT-11 therapy (80% dose) was continued on an outpatient basis. Pleural effusion was not observed and disease control in the state of SD was achieved over a long period of 5 years (Figure 2D-2F). However, she finally passed away due to respiratory failure resulting from relapsed pleural effusion, 12 years after the initial colon resection (Figure 3). Cancerous pleurisy from recurrent colorectal cancer is relatively rare, and standardized chemotherapy has not been established. It leads to massive pleural effusion, which impairs the normal function of the heart and lung, and thus is related to poor prognosis. The initial therapy for patients with cancerous pleurisy includes tube drainage, chemical pleurodesis, and intrapleural administration of antineoplastic agents such as cisplatin. Although the current mode of therapy can occasionally alleviate the symptoms, the relapse rate is as high as 50%[1]. Vascular endothelial growth factor (VEGF) is an endothelial cell-specific growth factor that stimulates vasculogenesis and angiogenesis, and has been shown to be an essential intermediate in the formation of pleural effusions[2,3]. Synthesis of VEGF by both autocrine and paracrine pathways has shown it to be present in multiple solid cancers[4]. It is well documented that bevacizumab, a humanized monoclonal antibody against VEGF, is able to directly inhibit proliferation, migration and differentiation of vascular endothelial cells. It can also promote apoptosis of endothelial cells and suppress VEGF-induced neoangiogenesis and vascular permeability[5], leading to synergize with chemotherapeutic agents to block the accumulation of pleural fluid[6-8]. In the current report, we achieved the 5-year long-term survival octogenarian case of cancerous pleurisy from colorectal cancer. Thus, bevacizumab is one of the promising options for the clinical management of cancerous pleurisy from different carcinomas, even in an elderly with relatively poor performance status.

Figure 1 (A) Gross specimen of the initially resected ascending colon showed irregular wall thickness. Small image (lower right) showed microscopic findings of moderately differentiatede adenocarcinoma. (B) CT scan showed liver metastasis located at S7 (small image: resected tumor). (C, D) CT scan showed secondary liver lesion in S8 (Figure 1C), and it was also resected after Bevacizmab+FOLFOX6 chemotherapy (Figure 1D).

Figure 2 (A) Follow-up CT scan 24 months after surgery revealed new lung metastasis in his right lung. (B,C) Massive right pleural effusion was observed 7 months later, and the chest drainage and intrathoracic administration of CDDP were performed (2B: before drainage, 2C: after drainage). (D-F) Pleural effusion was not observed and disease control in the state of SD was achieved over a long period of 5 years (2D: at the age of 85 years, 2E: 86 years, 2F: 88 years).

Figure 3 The whole clinical course of the current patient with serial changes in serum CEA values. Abbreviations: CEA; carcinoembryonic antigen, CDDP; cisplatin, Beva; Bevacizmab, CPT-11; irinotecan.


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