Liver-directed conversion therapy in metastatic colon cancer

Dr. Kemeny: A 37-year-old female had a fever for 1 week post-partum. Work-up identified an elevated alkaline phosphatase of 306 units/L (normal range, 30-88 units/L), associated with an estimated 24 liver lesions on ultrasound. A computed tomography (CT) scan showed a mass in the ascending colon, multiple regional nodes, and multiple liver metastases up to 6.5 cm × 6.4 cm in size, occupying at least 40% of the liver volume. Colonoscopy with biopsy showed a moderately differentiated adenocarcinoma with a KRAS G12D mutation. She had no significant family history. Genomic testing showed no microsatellite instability. She started treatment with FOLFOX6, and achieved a partial response over 4 months.