Effective second-line treatment with cetuximab and bevacizumab in a patient with hepatic metastases of colorectal cancer and hyperbilirubinemia

Background: Irinotecan-based second-line chemotherapy of metastatic
colorectal cancer (CRC) is effective, it might, however, be
contraindicated in cases of severe liver dysfunction due to
advanced liver metastases. Case Report: A 57-year-old woman with
diffuse CRC liver metastases showed progressive disease on
first-line treatment with capecitabine and oxaliplatin (XELOX).
Chronic cholestasis and hyperbilirubinemia caused by advanced liver
involvement prohibited second-line treatment with irinotecan-based
chemotherapy. We initiated combined antibody treatment with
cetuximab and bevacizumab. Results: Clinical performance status as
well as laboratory parameters improved rapidly. Staging
investigations after 8 weeks revealed a partial remission. Since
bilirubin levels had returned to the upper limit of normal, therapy
could be changed to standard irinotecan, 5-fluorouracil, folinic
acid, and bevacizumab. Conclusion: Combined treatment with
cetuximab and bevacizumab may be considered as an effective
treatment option in patients who cannot be treated with standard
chemotherapy regimens due to impaired liver metabolism of cytotoxic
substances.