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Interactive Case Discussions: Colorectal Cancer
Dr. Katherine Teh presents a real-world case on the precision management of metastatic KRAS G12C-mutated colorectal cancer, demonstrating how comprehensive genomic profiling and ctDNA testing guided personalized treatment selection, response monitoring, and longitudinal disease management.
In this case-based presentation, Dr. Katherine Teh discusses the management of a 68-year-old patient with initially resected Stage I sigmoid colon adenocarcinoma who subsequently developed an isolated liver metastasis during surveillance despite favourable pathological features at diagnosis. Following detection of rising carcinoembryonic antigen (CEA) levels and confirmation of hepatic recurrence, comprehensive genomic profiling (K-TRACK) identified a KRAS G12C mutation, creating an opportunity for biomarker-guided targeted therapy after surgical resection of the metastatic lesion.
As the patient declined conventional chemotherapy, treatment was individualized using a combination of panitumumab and sotorasib. Serial monitoring demonstrated a rapid decline in CEA levels, radiological complete response on PET imaging, and conversion to ctDNA negativity using K-TRACK, indicating clearance of detectable molecular residual disease. Throughout treatment, therapy-related adverse events were proactively managed through dose modification and supportive care, allowing treatment to continue with good tolerability while maintaining the patient's quality of life.
This case highlights the evolving role of precision oncology beyond initial diagnosis, demonstrating how comprehensive genomic profiling, targeted therapy, and ctDNA monitoring can complement conventional imaging and tumour markers throughout disease surveillance and treatment. It illustrates how molecular testing can support personalized therapeutic decision-making, monitor treatment effectiveness, and provide additional confidence during long-term follow-up for patients with metastatic colorectal cancer.
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