晚期大腸癌精準(zhǔn)治療完成(E)

PrecisionTreatmentformCRCCaseHistoryMale,57yrsChiefComplains:Abdominalpainfor2monthswithdiarrhea2015.09.29Colonscopy:massincolon,pathologicallyconfirmedasadenocarcinomaPET-CT(2015.10.10)：thickeningbowelwallindescendingcolon,pulmonary,lymphnodeandlivermetastases.PE：ECOG

1,enlargedleftsupraclavicularlymphnode.HypertensionwithgoodcontrolDiagnosis:Descendingcoloncancer,liver,lungandlymphnodemetastases.cTxNxM1,stage

IV,

K-RAS,N-RASandB-RAFwild-typeCaseHistoryGenetest(NGS)RAS

WTBRAF

WTHER-2amplification（-）MSSTP53

524G>AmtAPC

2008

A>TmtTreatmentProcess-11-stline：

2015.10.13-2016.03.02FOLFOX+Cetuximab*11cyclesAdverseevents:I°decreasedplatelet;I

°transaminaseincrease,

I

°rash,I

°fatigueandI°anorexia；Bestefficacy：PR2015.102016.022015.102015.122016.02MaintenanceTreatment2016.03.31-2016.07Cetuximab,q2w。2016-7newlesioninliverctDNAdynamicmonitoring-1C-225+FOLFOXC-225NewLivermetsPDOligometastaticProgressionTreatment：

Localtreatment:2016.07.14

LiverlesionRFA

Systemictreatment：

2016.07.21-2016.10.25LV5FU2+C225*7cycles2016.062016.112016.062016.11Reintroductionofoxaliplatin2016.11.18-2016.12.22“mFOLFOX6+C225”*3cycles2016.12.08

LiverRFAPDctDNAdynamicmonitoring-2C-225+FOLFOXC-225NewLivermetsPDRFAC-225+LV5FU2RFAC-225+FOLFOX二線治療2017.01.12-2017.03.01

FOLFIRI+貝伐珠單抗*4周期

2017.03.22-08.01

伊立替康單藥+貝伐珠單抗*8周期AE:II度中性粒細(xì)胞降低；2度乏力及食欲下降最佳療效:PR2017.012017.03ctDNAdynamicmonitoring-3C-225+FOLFOXC-225NewLiverMetsPDRFAC-225+LV5FU2RFAC-225+FOLFOXC-225+FOLFIRIQ

and

AChoicefor1st-linetreatment,primarytumorsitefirstorbiomarkerfirst(RAS\BRAFetc)？WhatistheclinicalsignificanceofliquidbiopsyinthetreatmentofC225？AfterC225+CTfailedin1st-line,wheth