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

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DISCLOSURE OF INTEREST

I have received a grant to participating to a scientific

congress by Sanofi

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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

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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)

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February 2017:

CT scan: liver and nodal progression

Second Line treatment:

Regorafenib

March 2017- July 2017 : 4 cycles

PFS: 4 months, (best response: SD)

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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

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ESMO PRECEPTORSHIP PROGRAMME

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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

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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?

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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!