Surgical History

1. Appendectomy

My first abdominal surgery was an appendectomy. No malignancy was detected at that time. This preceded the colorectal cancer diagnosis.

2. Right Hemicolectomy

Cancer was subsequently identified in the right side of my colon. A right hemicolectomy was performed, removing the right half of the colon and the primary tumor. Pathology confirmed colorectal adenocarcinoma.

Following surgery, I completed 12 cycles of FOLFOX chemotherapy. Treatment intent at that stage was curative.

3. Recurrence — Stage IV

Approximately nine months after completing FOLFOX, follow-up imaging revealed metastatic disease. Liver lesions were detected and the disease was reclassified as Stage IV colorectal cancer. Systemic therapy was restarted with FOLFIRI.

Current Disease Status

• Primary cancer type: Colorectal adenocarcinoma
• Stage: IV (metastatic)
• Active disease sites: Liver metastases; pelvic involvement visible on MRI

Imaging Interpretation

Multiple modalities are used to monitor disease. Each measures something different and results should not be conflated.

• PET scan: Measures metabolic activity. A PET-negative result does not mean cancer is absent — it means lesions are not hypermetabolically active at that moment.
• MRI / CT: Measures structural anatomy. Used to track size and location of lesions over time.

Recent findings: No hypermetabolic bone disease on PET. Structural lesions remain visible on MRI.

Tumor Biology — Genomic Profile (FoundationOne CDx)

Tumor tissue was analyzed using FoundationOne CDx, a comprehensive genomic profiling test that evaluates hundreds of cancer-related genes to identify driver mutations, biomarkers, targeted therapy eligibility, and clinical trial matches.

Key Findings

• KRAS mutation: G12V
• MMR / MSI status: MSS / pMMR (microsatellite stable; mismatch repair proficient)
• Tumor Mutational Burden (TMB): 4 muts/Mb — Low
• HRD status: Negative
• BRAF mutation: None detected
• ERBB2 (HER2) amplification: None detected

Clinical Implications

• KRAS G12V: Predicts resistance to EGFR inhibitors. Cetuximab and panitumumab are not viable options.
• MSS / pMMR + Low TMB: Immunotherapy (checkpoint inhibitors) is unlikely to be effective and is not currently indicated.
• No other actionable mutation: No approved targeted therapy has been identified. Standard chemotherapy remains the primary treatment backbone.

Why Genomic Testing Still Matters

Even without an actionable mutation, comprehensive genomic profiling provides value: it eliminates ineffective therapies, pre-screens for clinical trial eligibility, and establishes a documented molecular baseline. That data is archived and available if the treatment strategy needs to change.

Chemotherapy

Prior Regimen — FOLFOX

• Cycles completed: 12
• Intent: Curative at time of treatment
• Outcome: Disease recurred in liver approximately nine months after completion

Current Regimen — FOLFIRI

• Schedule: Every 14 days
• Current status: Active — measurable disease response ongoing
• Cycle pattern:
  • Day 0: ~5+ hour infusion clinic visit, followed by 48-hour portable pump
  • Days 1–2: Peak fatigue, nausea, cognitive fog
  • Day 3+: Gradual recovery window until next cycle

Dose Adjustments

Chemotherapy strength has been reduced due to ongoing inflammation and elevated liver enzymes. Treatment 3 was reduced approximately 30%. The objective is to apply enough therapeutic pressure to shrink disease without causing unnecessary liver toxicity.

Current Treatment Strategy

FOLFIRI is actively shrinking disease. As long as measurable response continues, the current plan is to stay on standard-of-care chemotherapy and re-image after every 3–4 cycles.

Clinical trials are generally reserved for cases where approved therapies have stopped working. Enrollment is not indicated at this time.

Monitoring Plan

• Continue FOLFIRI
• Repeat imaging after several cycles
• Track liver function and inflammatory markers each cycle
• Reassess treatment strategy based on measurable response

Summary

• Diagnosis: Stage IV colorectal adenocarcinoma
• Key mutation: KRAS G12V
• Targeted therapy options: None currently available
• Immunotherapy: Not indicated (MSS / Low TMB)
• Active treatment: FOLFIRI — responding
• Genomic data: Archived via FoundationOne CDx for future decisions

Treat. Scan. Adjust. Repeat.