Ocular Toxicity Related to Cetuximab Monotherapy in an Advanced Colorectal Cancer Patient

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Abstract
A 58-year-old Italian woman was diagnosed in December 1997 with colon adenocarcinoma. After resection and preoperative clinical evaluation for distant metastases, the disease was classified as pT4, pN1, cM0. She received six courses of adjuvant chemotherapy with 5-fluorouracil and folinic acid, according to the Mayo Clinic schedule ( 1 ) . By October 2000, the disease had progressed to the liver, and the patient was therefore treated with 12 courses of irinotecan plus bimonthly, high-dose leucovorin and bolus and continuous infusion of 5-fluorouracil (FOLFIRI regimen), after which she attained a clinical partial response. However, 5 months after chemotherapy ended, disease progressed to the liver and to the lungs. The patient was then started on second-line chemotherapy with oxaliplatin plus bimonthly, high-dose leucovorin and bolus and continuous-infusion 5-fluorouracil (FOLFOX 4 regimen). Restaging after 12 courses of the second-line chemotherapy showed stable disease, so we decided to stop treatment and perform follow-up examination every 3 months. Six months after the FOLFOX 4 regimen was stopped, disease progression was identified, and the patient started chemotherapy with Raltitrexed plus irinotecan. However, the patient experienced grade 3 gastrointestinal toxicity, so treatment was stopped after the second cycle. Subsequently, we decided to test the primary tumor for epidermal growth factor receptor (EGFR) expression using immunohistochemical staining. The tumor stained positive for EGFR, so we began treating the patient with immunotherapy using cetuximab, a monoclonal antibody that specifically blocks EGFR activity ( 2 ) . Cetuximab at standard dosages was started, and a mild, self-limiting cutaneous acneiform eruption was evident after just 1 week.