Resolution of Severe Jaundice Following Hepatic Artery Infusion of Bevacizumab and 5-Fluorouracil With Oral Regorafenib in Metastatic Colorectal Cancer：A Case Report

Objective:Unusual or unexpected effect of treatment Background:Hepatic artery infusion (HAI) chemotherapy has been established as an indispensable treatment for hepatic metastatic colorectal cancer (CRLM), particularly in patients with multiple lesions. Case Report:We report the case of a patient diagnosed with liver metastasis from sigmoid colon cancer.The patient underwent hepatic segmentectomy and resection of the colon lesion in April 2019, following 8 cycles of systemic chemotherapy.After 4 postoperative courses of chemotherapy, the patient was monitored with regular follow-up.However, by November 2021, the patient had experienced 2 episodes of hepatic lesion recurrence and received late-line chemotherapy, combined with transcatheter arterial chemoembolization (TACE) and radiotherapy.In April 2024, the patient presented with severe jaundice, with total bilirubin (TB) up to 204 μmol/L (≈ 12 mg/dL), and concurrent abdominal magnetic resonance imaging (MRI) demonstrated multiple hepatic lesions without evidence of biliary obstruction.After thorough discussion, shared decisionmaking led to the initiation a treatment regimen consisting of HAI with fluorouracil and bevacizumab, along with regorafenib.Because the bilirubin level decreased the next morning after the first infusion, additional cycles were performed, and subsequent arteriography showed a gradual transition from diffuse neoplastic abnormal staining to normal vascular patterns, and the liver lesions were significantly reduced in size. Conclusions:Given the patient's poor adherence to regorafenib and its low late-line efficacy reported in the literature, we believe that HAI likely contributed more significantly to this case.While regorafenib's contribution cannot be fully excluded, this case shows that patients with heavily pretreated CRLM accompanied by jaundice can tolerate HAI of bevacizumab and fluorouracil.