Neoadjuvant FOLFOXIRI in a Locally Advanced Right Colon Cancer Patient: A Case Report From a Limited-Resource Setting.
- 1Department of Medical Oncology Latakia University Hospital Latakia Syria.
- 2Cancer Research Center Latakia University Latakia Syria.
- 3Faculty of Medicine Latakia University Latakia Syria.
Abstract
Although upfront surgery followed by adjuvant chemotherapy is the standard of care for locally advanced colon cancer (LACC), high rates of recurrence and surgical morbidity remain significant challenges in bulky T4 tumors. Neoadjuvant chemotherapy (NAC) is gaining traction to improve downstaging and resectability. Although doublet regimens (FOLFOX/CAPOX) are established, the use of the intensive triplet regimen FOLFOXIRI in the neoadjuvant setting for nonmetastatic LACC is less common because of toxicity concerns and limited clinical data. A 55-year-old male presented with a bulky, obstructive, right-sided colonic mass (cT4bN+M0). Given the high-risk features and the need for significant cytoreduction in a resource-limited setting where molecular profiling was unavailable, neoadjuvant FOLFOXIRI was initiated. After six cycles, the patient achieved an 85% reduction in tumor volume and normalization of tumor markers (CEA/CA19-9). Despite experiencing manageable Grade 3 neutropenia and anorexia, he underwent successful R0 resection. Histopathology confirmed significant downstaging to ypT2pN0 (0/12), reflecting a near-complete pathological response. Following four cycles of adjuvant CAPOX, the patient remains disease-free at 1.5 years. Neoadjuvant FOLFOXIRI can achieve significant downstaging in bulky tumors and facilitates R0 resection in selected high-risk LACC patients, even in resource-limited settings. Despite requiring careful management of treatment toxicities, triplet NAC offers exploratory, hypothesis-generating option for first colon cancer patients with T4 primary tumors, and can be further supported with future large clinical data.
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BibTeX
@article{alazka2026neoadjuvant,
title = {{Neoadjuvant FOLFOXIRI in a Locally Advanced Right Colon Cancer Patient: A Case Report From a Limited-Resource Setting.}},
author = {Osama Alazka and Rita Mohammad and Haya Alreem Saied and Hamza Abedallaa and Nader Abedallaa},
journal = {Case reports in oncological medicine},
year = {2026},
month = nov,
doi = {10.1155/crom/5532415},
url = {https://europepmc.org/article/MED/42999708},
note = {CC BY},
}
RIS
TY - JOUR
TI - Neoadjuvant FOLFOXIRI in a Locally Advanced Right Colon Cancer Patient: A Case Report From a Limited-Resource Setting.
AU - Osama Alazka
AU - Rita Mohammad
AU - Haya Alreem Saied
AU - Hamza Abedallaa
AU - Nader Abedallaa
PY - 2026
DA - 2026/11/06
JO - Case reports in oncological medicine
DO - 10.1155/crom/5532415
UR - https://europepmc.org/article/MED/42999708
AB - Although upfront surgery followed by adjuvant chemotherapy is the standard of care for locally advanced colon cancer (LACC), high rates of recurrence and surgical morbidity remain significant challenges in bulky T4 tumors. Neoadjuvant chemotherapy (NAC) is gaining traction to improve downstaging and resectability. Although doublet regimens (FOLFOX/CAPOX) are established, the use of the intensive triplet regimen FOLFOXIRI in the neoadjuvant setting for nonmetastatic LACC is less common because of toxicity concerns and limited clinical data. A 55-year-old male presented with a bulky, obstructive, right-sided colonic mass (cT4bN+M0). Given the high-risk features and the need for significant cytoreduction in a resource-limited setting where molecular profiling was unavailable, neoadjuvant FOLFOXIRI was initiated. After six cycles, the patient achieved an 85% reduction in tumor volume and normalization of tumor markers (CEA/CA19-9). Despite experiencing manageable Grade 3 neutropenia and anorexia, he underwent successful R0 resection. Histopathology confirmed significant downstaging to ypT2pN0 (0/12), reflecting a near-complete pathological response. Following four cycles of adjuvant CAPOX, the patient remains disease-free at 1.5 years. Neoadjuvant FOLFOXIRI can achieve significant downstaging in bulky tumors and facilitates R0 resection in selected high-risk LACC patients, even in resource-limited settings. Despite requiring careful management of treatment toxicities, triplet NAC offers exploratory, hypothesis-generating option for first colon cancer patients with T4 primary tumors, and can be further supported with future large clinical data.
SN - 2090-6706
SN - 2090-6714
ER -