levoleucovorin and Jaundice

A 64-year-old male with fatigue and icterus was referred to our hospital. Computed tomography(CT)demonstrated multiple liver metastases and colonoscopic examination revealed advanced rectal cancer, which was diagnosed as moderately- differentiated adenocarcinoma without KRAS mutation. His serum total bilirubin level was 15.6 mg/dL. We started combination chemotherapy with 5-fluorouracil, Leucovorin and oxaliplatin(modified FOLFOX6)at a 20% lower than standard dosage for safety. When his bilirubin fell to 2.3 mg/dL after 4 courses of mFOLFOX6, the doses of 5-fluorouracil and oxaliplatin were increased to standard doses, and treatment with bevacizumab of 5 mg/kg every 2 weeks was begun. After another 3 courses of chemotherapy, his bilirubin was normalized to 0.8 mg/dL. No significant toxicity was observed. Combination chemotherapy with mFOLFOX6 plus bevacizumab was effective and feasible in this case of metastatic rectal cancer with icterus due to diffuse liver metastases.

Topics: Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Bevacizumab; Fatal Outcome; Fluorouracil; Humans; Jaundice; Leucovorin; Liver Neoplasms; Male; Middle Aged; Organoplatinum Compounds; Rectal Neoplasms

A 35-year-old man was diagnosed with initially unresectable synchronous liver metastases from sigmoid colon cancer. We started FOLFOX plus panitumumab therapy. After 3courses of chemotherapy, the liver metastases became resectable. Sigmoidectomy, extended left lobectomy, and partial hepatectomy were performed. On the final histopathological analysis, all hepatic lesions were fibrotic without viable cancer cells. Nineteen months after the surgery, CT revealed isolated residual liver recurrence in segment 5. After partial hepatectomy, the patient is alive without recurrence. We report a case of pathological complete response with FOLFOX plus panitumumab therapy for initially unresectable colorectal liver metastases with icterus.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Colorectal Neoplasms; Fluorouracil; Hepatectomy; Humans; Jaundice; Leucovorin; Liver Neoplasms; Male; Organoplatinum Compounds; Panitumumab

The prognosis of patients with advanced colorectal cancer with icterus is dismally poor, and adequate chemotherapy for these patients has not been established yet. A 59-year-old male with fatigue, anorexia and icterus with serum total bilirubin 9.7 mg/dL was referred to our institution. He was diagnosed with advanced sigmoid colon cancer with multiple liver metastases. A biopsy specimen of the primary tumor showed well-differentiated adenocarcinoma without KRAS mutation. Since biliary drainage was impossible due to diffuse liver metastases, we initiated combination chemotherapy with 5-fluorouracil, Leucovorin, oxaliplatin (modified FOLFOX6) and cetuximab. The doses of 5-fluorouracil and oxaliplatin were reduced, but cetuximab was administered at the standard dosage. After 3 courses of chemotherapy, total bilirubin dropped to 0.8 mg/dL. No significant toxicity other than grade-2 skin toxicity and neuropathy was observed, and the patient has continued chemotherapy on an outpatient basis. Combination chemotherapy with mFOLFOX6 plus cetuximab was effective and feasible in this case of metastatic colon cancer with icterus due to diffuse liver metastasis.

Topics: Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Cetuximab; Colorectal Neoplasms; Fluorouracil; Humans; Jaundice; Leucovorin; Liver Neoplasms; Male; Middle Aged; Organoplatinum Compounds; Tomography, X-Ray Computed

A 49-year-old man was hospitalized because of a 2-month history of purpura in his extremities and for back pain. Laboratory findings showed alkaline phosphatase to be greatly elevated, and platelet counts and coagulation factor showed that the patient had disseminated intravascular coagulation (DIC). Compression fractures of the thoracic vertebrae were found on radiological examination. The histological findings from bone marrow showed metastasis of adenocarcinoma with signet-ring cells, although the primary site was unknown. To reduce tumor cells in number and improve DIC, 11 cycles of 5-Fluorouracil and leucovorin therapy were done, and the patient survived for 12 months. Autopsy showed a 0.8 cm diameter, poorly differentiated adenocarcinoma with the signet-ring cell type in the lamina propria of the Vater's ampulla. Many metastatic foci and micro tumor emboli were found in the lung and in bone marrow. The sections of the stomach, the gallbladder, urinary bladder, prostate, and thyroid gland showed no malignant cells. These findings suggest that the origin of the cancer may have been located in the Vater's ampulla. This is a rare case of an ampullary tumor of poorly differentiated adenocarcinoma with the signet-ring cell type, without jaundice but with multiple metastasis. 5-Fluorouracil and leucovorin were effective for increasing survival time and improving quality of life.

Topics: Ampulla of Vater; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Neoplasms; Carcinoma, Signet Ring Cell; Common Bile Duct Neoplasms; Disseminated Intravascular Coagulation; Fatal Outcome; Fluorouracil; Humans; Jaundice; Leucovorin; Lung Neoplasms; Male; Middle Aged; Neoplastic Cells, Circulating; Quality of Life

Most nonendocrine pancreatic neoplasms are adenocarcinomas of ductal cell or acinar origin. Primary carcinomas of the pancreas with squamous differentiation are rare enough to warrant a search for other primary tumors. In the past few decades, well-documented individual reports and large series reviews support the view that these squamous neoplasms are indeed of pancreatic origin and not uncommonly exhibit cystic degeneration. Late manifestation and unfavorable prognosis seem to be uniform features. We report a case with many of these features.

Topics: Abdominal Pain; Anorexia; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Carcinoma, Squamous Cell; Cholangiopancreatography, Endoscopic Retrograde; Deoxycytidine; Fluorouracil; Gemcitabine; Humans; Jaundice; Leucovorin; Liver Neoplasms; Male; Middle Aged; Pancreatic Cyst; Pancreatic Neoplasms; Tomography, X-Ray Computed

The aim of this study was to evaluate the effect of 5-fluorouracil (5-FU) and folinic acid on liver function and bile production in patients with recurrent gastric cancer and jaundice. Thirteen patients were studied for liver function and hyperbilirubinaemia, and six patients were studied for bile production retrospectively, who were treated with 5-FU [700 mg m(-2)] and folinic acid [20 mg m(-2)] for 4 days. Serum total bilirubin, aspartate aminotransferase (AST), gamma-glutamyl transferase (gamma-GT) and alkaline phosphatase (ALP) concentrations all improved with treatment (P<0.0001), and bile production increased significantly (P<0.0001) following treatment. 5-FU and folinic acid can significantly improve jaundice and liver function, and promote bile production. It is possible that 5-FU and folinic acid may become a new method for the relief of jaundice in patients with gastrointestinal tract malignancies.

Topics: Adult; Aged; Antidotes; Antineoplastic Agents; Bile; Drug Administration Schedule; Drug Synergism; Drug Therapy, Combination; Female; Fluorouracil; Humans; Jaundice; Leucovorin; Liver; Male; Middle Aged; Retrospective Studies; Stomach Neoplasms