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Date | Treatment (medical, surgical) | CEA (ng/ml) and CA 19-9 (U/ml) range during treatment period | Outcome | Complications |
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1996 | Ileocolic resection for obstructive disease, maintained on 6-MP | | Tolerated procedure well | (i) Was well until June 2008, when noted to have two areas of small bowel dilation along with two hypodense liver lesions |
September 2008 | Underwent resection of strictures was found to have SBA | CEA: 0.1-0.9 | Tolerated procedure well | (i) PET scan showed nine metastatic liver lesions |
October 2008 | Chemotherapy with FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin) for 12 cycles | CEA: 0.1-0.9 | PET scan in December 2008 showed interval resolution of majority of the liver mets except 2 enhancing lesions on the left liver lobe with the stable appearance of small bowel thickening | (i) Weight loss, fistulae, failure to thrive, and bone marrow suppression |
January 2009 | Left hepatic lobe resection for isolated liver metastasis Received 4 additional cycles of chemotherapy with FOLFOX | | Tolerated procedure well | (i) Patient had treatment response until December 2011 when noted to have widespread disease progression to the peritoneal LNs, liver, and lung (ii) In April 2012, he was hospitalized with obstructive symptoms. He underwent resection of the large mesenteric mass of matted LNs resulting stricture |
April 2012-May 2015 | Gemcitabine, 5-flourouracil, irinotecan, leucovorin, and oxaliplatin (GFLIO) | CEA: 0.1 to 2.7 CA 19-9: 13 to 32 | Stable disease without evidence of recurrence on PET scan in May 2015 and September 2015 | (i) Continued fistulizing CD requiring mesenchymal stromal cell (MSC) infusion in December 2013 (ii) PET scan in November 2015 showed progression of the tumor |
November 2015-May 2016 | Cetuximab + (GFLIO) | CEA: 0.3 to 2.9 CA 19-9: 28 to 71 After May 2016: CEA: 0.3 to 21 CA 19-9: 91 to 567 | Clinically stable without progression | (i) May 2016: disease metastasized to the lungs and thoracic spine requiring laminectomy and resection of the extradural tumor and radiotherapy to spinal metastasis in March 2017 |
July 2017–February 2018 | Trastuzumab was added for HER2+ with Cetuximab + (GFLIO) | CEA: 9.5 to 41 CA 19-9: 398 to 1338 | Clinically stable | (i) Patient remained clinically stable |
March 2018 | | | | (i) Recurrence of tumor at fistula site with bleeding |
June 2018 | | | | (i) Died due to complication from metastatic SBA |
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