title: Effective second-line treatment with cetuximab and bevacizumab in a patient with hepatic metastases of colorectal cancer and hyperbilirubinemia.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors: Medizinische Klinik III, Campus Grosshadern, Klinikum der Ludwig-Maximilians-Universität München, Germany. Nicolas.Moosmann@med.uni-muenchen.de
authors: Nicolas
authors: N
authors: Moosmann
authors: Dorit
authors: D
authors: Laessig
authors: Henrik Jakob
authors: HJ
authors: Michaely
authors: Christoph
authors: C
authors: Schulz
authors: Volker
authors: V
authors: Heinemann
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D000068258:Bevacizumab; D000068818:Cetuximab; D056486:Chemical and Drug Induced Liver Injury; D015179:Colorectal Neoplasms / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006932:Hyperbilirubinemia / Q000139:chemically induced / Q000150:complications*; D008107:Liver Diseases / Q000517:prevention & control*; D008113:Liver Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000556:secondary*; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D000068818:Cetuximab