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ESMO Preceptorship Programme
Management of MSI CRC patient treated with anti-PD-1
Davide CiardielloMedical Oncology Unit-University of Campania “Luigi Vanvitelli”
Naples-Italy
Colorectal Cancer– Valencia – 18-19 May 2018
ESMO PRECEPTORSHIP PROGRAMME
DISCLOSURE OF INTEREST
I have received a grant to participating to a scientific
congress by Sanofi
ESMO PRECEPTORSHIP PROGRAMME
Diagnosis
Male, 53 years old
No comorbidity
July 2015: Anemia, Fatigue
polipoid lesion in right colon (G3 adenocarcinoma)
Right hemicolectomy pT3N2a (6/24) G3
Chest and abdominal CT scan : negative
Adjuvant treatment : CAPOX q21 (Sep 2015- Mar 2016) 8 cycles
ESMO PRECEPTORSHIP PROGRAMME
September 2016:
CT scan: pelvic, lung and peritoneal progression
Molecular assessment: c. 436G>A (p. Ala146Thr) codon 146 exon 4
KRAS, MSI-H (immunohistochemistry)
First Line treatment:
FOLFIRI + bevacizumab
September 2016 - February 2017 : 12 cycles
PFS: 6 months, (best response: SD)
ESMO PRECEPTORSHIP PROGRAMME
February 2017:
CT scan: liver and nodal progression
Second Line treatment:
Regorafenib
March 2017- July 2017 : 4 cycles
PFS: 4 months, (best response: SD)
ESMO PRECEPTORSHIP PROGRAMME
September 2017:
Admitted to our unit :ECOG PS 2, TPN, Cancer Cachexia
Third line treatment:
in consideration of MSI-H status we requested pembrolizumab as off label
use
October 2017 : 1st cycle pembrolizumab200 mg q21
ESMO PRECEPTORSHIP PROGRAMME
ESMO PRECEPTORSHIP PROGRAMME
ESMO PRECEPTORSHIP PROGRAMME
Treatment EvaluationB
asal
V c
ycle
CEA : 97,3 ng/mLCa19-9: 167,6 U/mL
CEA : 22 ng/mLCA19.9 : 50,6 UI/mL
Clinical improvement, ECOG 1, stop TPN
ESMO PRECEPTORSHIP PROGRAMME
Discussion
I lineFolfiri+bevacizumab
II line Regorafenib
III line Pembrolizumb
PFS 6 mo 4 mo 5 mo
Best response SD SD ?
ECOG PS 2 patient improvement of clinical response
Excellent treatment tolerability, AEs manageable
Doubt in evaluation of response? Pseudo-PD?
ESMO PRECEPTORSHIP PROGRAMME
ESMO PRECEPTORSHIP PROGRAMME
In consideration of clinical improvement, the patient
continued the treatment
After 8 weeks a new evaluation demonstrated a PR
ESMO Preceptorship Programme
Thank you for your attention!