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January 18, 1995

New Therapeutic Strategies for Patients With Gastrointestinal Malignancies Using Biochemical Modulation of Fluorouracil

Author Affiliations

From the National Cancer Institute—Navy Medical Oncology Branch, National Cancer Institute, Bethesda, Md.

JAMA. 1995;273(3):236-239. doi:10.1001/jama.1995.03520270070034

SELECTED CASE  A 53-year-old man was evaluated for a several-month history of generalized fatigue and vague lower abdominal cramping. A barium enema revealed an encircling lesion in the distal sigmoid colon, and computed tomographic scanning of the abdomen revealed multiple hepatic defects consistent with metastatic disease. The patient underwent an exploratory laparotomy with resection of the sigmoid colon and a needle biopsy of one of the hepatic masses. The pathology demonstrated a moderately to poorly differentiated adenocarcinoma arising in the sigmoid colon with metastatic spread to the liver. The patient was referred to the National Cancer Institute and enrolled in a clinical trial using a combination of fluorouracil, leucovorin, and interferon alfa. After 3 months of therapy, the patient's repeat computed tomographic examination of the liver demonstrated regression of his metastatic disease by greater than 50%. In addition, his serum carcinoembryonic antigen level had fallen to 7.3 μg/L from a

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