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Neoadjuvant FOLFOXIRI in a Locally Advanced Right Colon Cancer Patient: A Case Report From a Limited‐Resource Setting

Year: 2026

Type: article

Abstract: Background: Although upfront surgery followed by adjuvant chemotherapy is the standard of care for locally advanced colon cancer (LACC), high rates of recurrence and surgical morbidity remain significant challenges in bulky T4 tumors. Neoadjuvant chemotherapy (NAC) is gaining traction to improve downstaging and resectability. Although doublet regimens (FOLFOX/CAPOX) are established, the use of the intensive triplet regimen FOLFOXIRI in the neoadjuvant setting for nonmetastatic LACC is less common because of toxicity concerns and limited clinical data. Case Presentation: A 55-year-old male presented with a bulky, obstructive, right-sided colonic mass (cT4bN+M0). Given the high-risk features and the need for significant cytoreduction in a resource-limited setting where molecular profiling was unavailable, neoadjuvant FOLFOXIRI was initiated. After six cycles, the patient achieved an 85% reduction in tumor volume and normalization of tumor markers (CEA/CA19-9). Despite experiencing manageable Grade 3 neutropenia and anorexia, he underwent successful R0 resection. Histopathology confirmed significant downstaging to ypT2pN0 (0/12), reflecting a near-complete pathological response. Following four cycles of adjuvant CAPOX, the patient remains disease-free at 1.5 years. Conclusion: Neoadjuvant FOLFOXIRI can achieve significant downstaging in bulky tumors and facilitates R0 resection in selected high-risk LACC patients, even in resource-limited settings. Despite requiring careful management of treatment toxicities, triplet NAC offers exploratory, hypothesis-generating option for first colon cancer patients with T4 primary tumors, and can be further supported with future large clinical data.

Source: Case Reports in Oncological Medicine

DOI: 10.1155/crom/5532415

Authors: Osama Alazka, Rita Mohammad, Haya Alreem Saied, Hamza Abedallaa, Nader Abedallaa

Institution: Latakia University

Language: English

Topic: Colorectal Cancer Surgical Treatments

Subfield: Oncology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $790