North Texas GME Research Forum 2024



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North Texas


Medical City Weatherford


Internal Medicine

Document Type


Publication Date



colorectal cancer, liver failure


Internal Medicine | Medicine and Health Sciences | Neoplasms


Introduction: Colorectal cancer, commonly known as colon cancer, is a globally widespread and formidable malignancy originating from the epithelial cells lining the colon and rectum. This disease, demonstrating geographical and demographic variations, particularly prevails in Western countries. The progression of colon cancer typically spans years, initiated by the development of adenomatous polyps, presenting an opportune timeframe for early detection and intervention. The substantial morbidity and mortality rates associated with colon cancer underscore its significance as a public health concern. Various risk factors, such as age, family history, genetic predisposition, inflammatory bowel diseases, and lifestyle factors like diet and physical activity, contribute to its development. A comprehensive understanding of the pathogenesis, risk factors, and molecular mechanisms driving colon cancer is crucial for effective prevention, early diagnosis, and the formulation of optimal therapeutic strategies. Case Presentation: A 56-year-old male diagnosed with metastatic moderately to poorly differentiated adenocarcinoma featuring focal signet ring cells in the right colon (pathologic stage IV, colon T3 N2b M1a) presented with a 3.2 cm cecal tumor invading the pericolonic fat, metastatic carcinoma involving 7 out of 12 lymph nodes, and biopsy-confirmed multiple liver metastases. Next-generation sequencing (NGS) testing revealed a BRAF V600E mutation and KRAS wild type with stable microsatellite instability (MSI). Initial treatment with Irinotecan plus bevacizumab resulted in hospitalization due to florid liver failure. Upon discharge, the patient commenced targeted therapy with Encorafenib and Cetuximab, demonstrating an early clinical response marked by significant improvement in liver function tests and overall performance status. Learning Points: This case report delves into the intricate facets of colon cancer through the lens of a specific clinical scenario involving a 56-year-old male diagnosed with metastatic moderately to poorly differentiated adenocarcinoma. The distinctive features of this case, encompassing presentation, staging, and molecular profile, provide valuable insights into the complexities and triumphs encountered in the management of advanced colon cancer. Our examination of this case seeks to contribute to the continually expanding body of knowledge that guides clinical practice, especially with targeted therapy, and elevates outcomes for individuals confronting this formidable malignancy.

Original Publisher

HCA Healthcare Graduate Medical Education

A Case Report of Florid Liver Failure Responding Favorably to Targeted Therapy with Cetuximab and Encorafenib Following Treatment with Irinotecan and Bevacizumab in Metastatic Colorectal Cancer



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