WIN-MTB-2024002 – WIN International Molecular Tumor Board: A 52-year-old female with unmeasurable Stage IIIc colon cancer
9 affiliations
- 1Worldwide Innovative Network (WIN) Association - WIN Consortium, Chevilly-Larue 94550, France
- 2Legorreta Cancer Center at Brown University, Providence, Rhode Island 02912, USA
- 3These authors contributed equally to this work
- 4Vall d'Hebron Hospital Campus and Institute of Oncology (VHIO), Barcelona 08035, Spain
- 5Institute of Science Tokyo Hospital Tokyo 113-8510, Japan
- 6King Hussein Cancer Center, Amman 11941, Jordan
- 7Fudan University Shanghai Cancer Center, Shanghai 200032, China
- 8Avera Cancer Institute, Sioux Falls, South Dakota 57105, USA
- 9Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA
Abstract
Colorectal cancer (CRC) is a leading cause of cancer-related mortality, with a complex molecular profile that impacts tumor behavior and treatment response. This case report discusses a 52-year-old female diagnosed with Stage IIIc colon cancer, exhibiting KRAS, TP53, IDH1, and APC mutations, as well as a tumor microenvironment with high PD-L1 expression and elevated VEGFR1 and VEGFR3. Despite surgical resection and adjuvant treatment which included FOLFOX, FOLFIRI with bevacizumab and local radiation, the patient’s disease was difficult to track due to small, non-FDG-avid lymph nodes in the aortocaval region and persistent circulating tumor DNA (ctDNA). Following a review by an international Molecular Tumor Board (MTB), maintenance therapy options were discussed, including the personalized combinations of regorafenib, sulindac, and metformin, or fruquintinib, sulindac, and metformin, based on the patient’s molecular alterations. Alternatively, 5-FU with or without bevacizumab was suggested. In the event of relapse, the MTB recommended the combination of regorafenib, sulindac, and metformin, with the addition of trametinib and ivosidenib. The combination of regorafenib, ipilimumab, and nivolumab (RIN) was also considered due to the patient’s high PD-L1 expression. Further clinical trial options, such as pan-RAF inhibitors, NK cell agonists, and TAS-102 with bevacizumab, were also discussed. Additionally, the potential combination of PD-1 and TGFβ inhibitors was explored. This case underscores the critical role of molecular profiling in tailoring personalized treatment strategies for advanced CRC, providing novel avenues for managing recurrent disease, even in the absence of measurable disease.
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BibTeX
@article{eldeiry2026winmtb2024002,
title = {{WIN-MTB-2024002 – WIN International Molecular Tumor Board: A 52-year-old female with unmeasurable Stage IIIc colon cancer}},
author = {Wafik S. El-Deiry and Alberto Hernando-Calvo and Shai Magidi and Catherine Bresson and Sadakatsu Ikeda and Hikmat Abdel-Razeq and Arjun Oberoi and Susana Aguilar Izquierdo and Zhihuang Hu and Tobias Meissner and Rachel Elsey and Amal Al-Omari and Fanny Wunder and Razelle Kurzrock},
journal = {Oncotarget},
year = {2026},
month = oct,
doi = {10.18632/oncotarget.28921},
url = {https://doi.org/10.18632/oncotarget.28921},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - WIN-MTB-2024002 – WIN International Molecular Tumor Board: A 52-year-old female with unmeasurable Stage IIIc colon cancer
AU - Wafik S. El-Deiry
AU - Alberto Hernando-Calvo
AU - Shai Magidi
AU - Catherine Bresson
AU - Sadakatsu Ikeda
AU - Hikmat Abdel-Razeq
AU - Arjun Oberoi
AU - Susana Aguilar Izquierdo
AU - Zhihuang Hu
AU - Tobias Meissner
AU - Rachel Elsey
AU - Amal Al-Omari
AU - Fanny Wunder
AU - Razelle Kurzrock
PY - 2026
DA - 2026/10/16
JO - Oncotarget
DO - 10.18632/oncotarget.28921
UR - https://doi.org/10.18632/oncotarget.28921
AB - Colorectal cancer (CRC) is a leading cause of cancer-related mortality, with a complex molecular profile that impacts tumor behavior and treatment response. This case report discusses a 52-year-old female diagnosed with Stage IIIc colon cancer, exhibiting KRAS, TP53, IDH1, and APC mutations, as well as a tumor microenvironment with high PD-L1 expression and elevated VEGFR1 and VEGFR3. Despite surgical resection and adjuvant treatment which included FOLFOX, FOLFIRI with bevacizumab and local radiation, the patient’s disease was difficult to track due to small, non-FDG-avid lymph nodes in the aortocaval region and persistent circulating tumor DNA (ctDNA). Following a review by an international Molecular Tumor Board (MTB), maintenance therapy options were discussed, including the personalized combinations of regorafenib, sulindac, and metformin, or fruquintinib, sulindac, and metformin, based on the patient’s molecular alterations. Alternatively, 5-FU with or without bevacizumab was suggested. In the event of relapse, the MTB recommended the combination of regorafenib, sulindac, and metformin, with the addition of trametinib and ivosidenib. The combination of regorafenib, ipilimumab, and nivolumab (RIN) was also considered due to the patient’s high PD-L1 expression. Further clinical trial options, such as pan-RAF inhibitors, NK cell agonists, and TAS-102 with bevacizumab, were also discussed. Additionally, the potential combination of PD-1 and TGFβ inhibitors was explored. This case underscores the critical role of molecular profiling in tailoring personalized treatment strategies for advanced CRC, providing novel avenues for managing recurrent disease, even in the absence of measurable disease.
SN - 1949-2553
ER -