Resolution of Severe Jaundice Following Hepatic Artery Infusion of Bevacizumab and 5-Fluorouracil With Oral Regorafenib in Metastatic Colorectal Cancer：A Case Report.
Xiuli Zhang, Yan Zhou, Wenxi Yu et al.
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Case in brief
A patient with sigmoid colon cancer and recurrent liver metastases, previously treated with surgery, systemic chemotherapy, transcatheter arterial chemoembolization, and radiotherapy, presented with severe jaundice. Total bilirubin was 204 μmol/L (≈12 mg/dL), and MRI showed multiple hepatic lesions without biliary obstruction. The patient received hepatic artery infusion (HAI) of fluorouracil and bevacizumab with oral regorafenib. Bilirubin fell by the morning after the first infusion; subsequent imaging showed improving arterial staining and substantial reduction in lesion size. The report attributes a likely greater contribution to HAI, while acknowledging that regorafenib’s role cannot be excluded.
What made this case unusual
Despite severe jaundice and extensive prior treatment, the patient’s bilirubin decreased by the morning after the first HAI infusion, with subsequent radiographic improvement.
Diagnostic / clinical pearl
In a heavily pretreated patient with metastatic colorectal cancer and severe jaundice, MRI may show hepatic disease without biliary obstruction; this case reports improvement during HAI-based treatment.