Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2021; 9(21): 6170-6177
Published online Jul 26, 2021. doi: 10.12998/wjcc.v9.i21.6170
Fruquintinib beneficial in elderly patient with neoplastic pericardial effusion from rectal cancer: A case report
Ying Zhang, Jia-Yun Zou, Yan-Yan Xu, Jing-Ni He
Ying Zhang, Jia-Yun Zou, Yan-Yan Xu, Department of Clinical Oncology, Shengjing Hospital of China Medical University, Shenyang 110022, Liaoning Province, China
Jing-Ni He, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110022, Liaoning Province, China
Author contributions: Zhang Y wrote and edited the original draft; Zou JY contributed to data collection and analysis; Xu YY reviewed the literature, He JN reviewed and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing-Ni He, MD, PhD, Associate Professor, Attending Doctor, Surgeon, Department of General Surgery, Shengjing Hospital of China Medical University, No. 39 Huaxiang Street, Shenyang 110022, Liaoning Province, China. hejn@sj-hospital.org
Received: March 29, 2021
Peer-review started: March 29, 2021
First decision: April 28, 2021
Revised: May 7, 2021
Accepted: May 24, 2021
Article in press: May 24, 2021
Published online: July 26, 2021
Processing time: 114 Days and 5.6 Hours
Abstract
BACKGROUND

Neoplastic pericardial effusion (NPE) is a rare consequence of rectal cancer and carries a poor prognosis. Optimal management has yet to be determined. Fruquintinib is an oral anti-vascular endothelial growth factor receptor tyrosine kinase inhibitor approved by the China Food and Drug Administration in September 2018 as third-line treatment of metastatic colorectal cancer.

CASE SUMMARY

Herein, we report an elderly patient with NPE from rectal cancer who responded to the use of fruquintinib. In March 2015, a 65-year-old Chinese woman diagnosed with KRAS-mutated adenocarcinoma of the rectum was subjected to proctectomy, adjuvant concurrent chemoradiotherapy, and adjuvant chemotherapy. By October 2018, a mediastinal mass was detected via computed tomography. The growth had invaded parietal pericardium and left hilum, displaying features of rectal adenocarcinoma in a bronchial biopsy. FOLFIRI and FOLFOX chemotherapeutic regimens were administered as first- and second-line treatments. After two cycles of second-line agents, a sizeable pericardial effusion resulting in tamponade was drained by pericardial puncture. Fluid cytology showed cells consistent with rectal adenocarcinoma. Single-agent fruquintinib was initiated on January 3, 2019, as a third-line therapeutic. Ten cycles were delivered before the NPE recurred and other lesions progressed. The recurrence-free interval for NPE was 9.2 mo, attesting to the efficacy of fruquintinib. Ultimately, the patient entered a palliative care unit for best supportive care.

CONCLUSION

Fruquintinib may confer good survival benefit in elderly patients with NPEs due to rectal cancer.

Keywords: Neoplastic pericardial effusion; Rectal cancer; Fruquintinib; Anti-vascular endothelial growth factor receptor tyrosine kinase inhibitor; Case report

Core Tip: Neoplastic pericardial effusion (NPE) is a rare consequence of rectal cancer and carries a poor prognosis. We report an elderly patient with NPE from rectal cancer who responded to the use of fruquintinib. In March 2015, a 65-year-old Chinese woman diagnosed with adenocarcinoma of the rectum. By October 2018, FOLFIRI and FOLFOX chemotherapeutic regimens were administered as first- and second-line treatments. After two cycles of second-line agents, she was diagnosed with NPE. Single-agent fruquintinib was initiated as a third-line therapeutic. The recurrence-free interval for NPE was 9.2 mo, attesting to the efficacy of fruquintinib.