WIN-MTB-2024002 - WIN International Molecular Tumor Board: A 52-year-old female with unmeasurable Stage IIIc colon cancer.
Wafik S El-Deiry, Alberto Hernando-Calvo, Shai Magidi et al.
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Case in brief
A 52-year-old woman with stage IIIc colon cancer had KRAS, TP53, IDH1, and APC mutations, high tumor PD-L1 expression, and elevated VEGFR1 and VEGFR3. After resection and adjuvant FOLFOX, FOLFIRI with bevacizumab, and local radiation, disease status remained difficult to assess: small aortocaval lymph nodes were not FDG-avid, while circulating tumor DNA persisted. An international Molecular Tumor Board reviewed her molecular profile and discussed maintenance and relapse treatment options, including targeted combinations and immunotherapy approaches. The report describes treatment planning rather than a documented resolution or outcome.
What made this case unusual
Persistent circulating tumor DNA alongside small, non-FDG-avid aortocaval nodes made disease assessment challenging despite the absence of measurable disease, prompting molecularly guided discussion of multiple maintenance and relapse strategies.
Diagnostic / clinical pearl
When imaging does not provide measurable disease, persistent circulating tumor DNA and tumor molecular profiling may inform multidisciplinary treatment planning; this report presents options discussed, not evidence of their efficacy.