Patient details

Mrs Wanita Gomez 47 years old (Ht -152 cm; Wt 44Kg; BMI 19)

Patient History

Patient has Stage IV CRC.

15 months ago, she began to feel excessively tired. Even walking to work became more difficult.
Whilst she was able to do light activities at home, she found it difficult to keep up with the prep
students that she taught. She didn’t think she was unhealthy as she had a balanced diet, walked
regularly and had recently lost weight. However, she had experienced some abdominal pain and on
occasion some anal blood loss but as she had experienced haemorrhoids in the past, it hadn’t
concerned her. After 2 months of tiredness and repeated bouts of abdominal pain, she decided to
see her doctor. Given her symptoms and her mother’s previous diagnosis of colorectal carcinoma
(CRC), the doctor organised a colonoscopy. The results identified a suspicious polyp which was
removed for further analysis. Histology confirmed a poorly differentiated (grade III)
adenocarcinoma (right colon). Wanita underwent surgical resection to remove the affected bowel
and to evaluate nearby lymph nodes. Subsequent surgical staging identified that Wanita had Stage
IIIA cancer of the bowel. An initial PET scan confirmed no visible evidence of metastasis.

Wanita underwent a CAPOX (XELOX) which is a combination of capecitabine and oxaliplatin (8

cycles; Day 1 oxaliplatin 130mg/m2 by IV infusion and capecitabine 2bd 1000mg/m2 orally for 14
days were performed). Wanita tolerated the chemotherapy well with her adverse effects being
diarrhoea (grade 2; lasting 24hrs) nausea and vomiting during and post treatment (managed with
medication), mild neutropenia, partial alopecia, and Grade 1 hand-foot syndrome. Whilst she
tolerated the oxaliplatin therapy, she developed a hypersensitivity reaction in her last cycle (CTCAE
grade 3). Wanita completed treatment 5 months ago and has since recovered from the adverse
effects she experienced during treatment.

1 month ago, Wanita began to re-experience pain in her abdomen and bloating. A Pet Scan
performed which revealed peritoneal metastasis. Further resection is not possible. She has been
given a prognosis of 3-6 months. Her oncologist, Dr Smith, has suggested she recommence
chemotherapy in combination with a targeted therapy. However, Wanita, after recalling her mum’s
experience, has decided she would rather participate in a clinical trial. The oncologist would like
your advice regarding a suitable trial Wanita.

Medical conditions
Lynch Syndrome
mCRC
Constipation (before diagnosis)

Medication history
Palonosetron 0.25mg IV and dexamethasone 8mg PO
Metoclopramide 10 mg three times a day when necessary
Loperamide (manage grade 2 diarrhoea) stat 4mg then 2mg 4 hourly

Allergies and medication use

No known adverse drug reactions.
No problems taking mediation. Good adherence.