How a 42-Year-Old Patient Battled Stage IV Disease and Found Hope

In June 2018, a 42-year-old woman presented with rectal bleeding and fatigue, revealing colorectal cancer with lung metastases. Following a palliative colectomy, pathology showed moderately differentiated adenocarcinoma (pT4aN0Mx) with mucinous features, KRAS wild-type, NRAS mutation, MSS, and PD-L1 negativity.

First-line chemotherapy (oxaliplatin/capecitabine) was stopped after one cycle due to severe thrombocytopenia. Second-line treatment (irinotecan, capecitabine, bevacizumab) stabilized platelets, but capecitabine and bevacizumab alone, and even single-agent bevacizumab, caused critical platelet drops.

As lung lesions progressed, she received local radiotherapy. Third-line therapy with regorafenib stabilized disease and improved platelet counts. This case highlights the challenges of treating advanced colorectal cancer with significant toxicity. Each treatment decision required balancing efficacy with severe thrombocytopenia.

Currently, her lung tumors are stable, and her platelet levels, though low, allow daily activities. This case demonstrates that personalized care, careful monitoring, and proactive therapy adjustments can offer extended survival and reasonable quality of life despite complex challenges.