My Colon Cancer
A 98-year-old white male was seen in and evaluated in the Sarasota/Manatee area for colon cancer.
The patient previously had a hemicolectomy and was found to have a poorly differentiated adenocarcinoma. Because of his age at presentation, adjuvant chemotherapy was not a serious consideration. Subsequently he developed liver metastasis documented by CT scan and CT PET Fusion scan with an elevated CEA. The patient Karnofsky performance status upon presentation to us was 100% (asymptomatic). Remarkably the patient had no significant medical problems which he attributed to a good wife, clean living, and the assistance of his holistic primary physician. The patient and his wife were curious whether we could help him.
“I AM ALMOST 100 YEARS OLD. I FEEL WELL. IS IT REASONABLE TO GIVE ME TREATMENT FOR MY CANCER?”
The patient was evaluated and found to have no evidence of cardiac disease and reasonable cardiac function. He lived independently with no restrictions of any kind with regard to physical activity. We decided that we could help him and we started treatment.
[tabs tab1=”Diagnosis” tab2=”Significant Findings” tab3=”Pharmacology” tab4=”Management” tab5=”Comments”]
[tab num=1]The patient at the time of his initial visit with us was thought to have Stage IV colon cancer with metastatic disease to the liver.[/tab]
[tab num=2]The patient has a good performance status and desires aggressive therapy.[/tab]
[tab num=3]The practice of geriatric oncology is challenging.
A decision was made with the patient to treat him with very modest doses of 5FU with Leucovorin (75% dose reduction) and IV Avastin (75% dose reduction). There is very little data from clinical trials regarding the pharmacology of chemotherapeutic and biologic agents in patients over the age of 90. The dose reductions here were arbitrary and made with the patient’s consent due to his age.[/tab]
[tab num=4]This patient was started on treatment with 5FU Leucovorin, and Avastin. He received approximately four months of treatment. He then developed refractory hypertension felt to be due to Avastin therapy. After 4 weeks his blood pressure was under adequate control and the patient requested a resumption of his cancer therapy. I suggested restaging prior to reinitiating of therapy. A repeat CT PET scan demonstrated a complete response to therapy. The patient has been restarted on 5FU Leucovorin only.[/tab]
[tab num=5]This is the oldest patient that I have treated for any malignancy with chemotherapy. We currently have 4 patients over the age of 90 undergoing treatment with Avastin based regimens in our office. In all cases at the initiation of therapy Avastin was started at 25% of normal doses. Refractory hypertension can occur as a consequence of Avastin therapy. In the several cases of Avastin associated hypertension that I have seen kidney function has been normal and the hypertension has been difficult to control. Once this complication has developed I have stopped Avastin in all cases.[/tab]