The combination of fruquintinib, raltitrexed and S-1 as a third-line treatment for metastatic colorectal cancer: A case report

Abstract Effective late-line therapies for metastatic colorectal cancer (mCRC) are urgently needed. This case report presents a patient with mCRC who received third-line treatment with fruquintinib, raltitrexed and S-1. A 54-year-old male presenting with hematochezia was admitted to our hospital in June 2017 and underwent surgery for a tumor between the rectum and sigmoid colon. Postoperative pathology identified adenocarcinoma (wild-type RAS/RAF, no PIK3CA mutation), and the patient was diagnosed with mCRC (pathological stage, pT3pN1apM0). The mFOLFOX6 regimen was administered. The patient was subsequently diagnosed with Hodgkin lymphoma in May 2018 and treated with the ABVD regimen after multidisciplinary discussions. Liver metastases (intestinal-type adenocarcinoma) were detected in November 2018, and second-line therapy with the FOLFIRI regimen was initiated in January 2019. Lung metastases were identified in September 2019, so the patient was treated with the combination of raltitrexed, S-1 and fruquintinib. A partial response was detected in November 2019, and the patient underwent resection of the hepatic lesion on November 5, 2020. CT images in November 2021 revealed stable disease, thus raltitrexed was discontinued and S-1 and fruquintinib was maintained. The patient remains alive at the time of writing. The case was characterized by the simultaneous existence of mCRC and Hodgkin lymphoma, which required management by a multidisciplinary team. Third-line therapy with fruquintinib, raltitrexed and S-1 achieved a partial response that permitted surgical resection as well as a relatively long progression-free survival. This regimen may have potential as a late-line therapy for mCRC.