Sequential colorectal cancer–based therapy including anti-angiogenics and 3rd-line trifluridine/tipiracil-bevacizumab for metastatic urachal adenocarcinoma: a case report

Urachal adenocarcinoma is a rare malignancy without prospective treatment trials. Management of metastatic disease is typically extrapolated from colorectal cancer (CRC) due to histologic and molecular similarities. An 80-year-old woman with metastatic urachal adenocarcinoma received sequential CRC-based therapy including first-line CAPOX plus bevacizumab, second-line FOLFIRI plus bevacizumab, third-line trifluridine/tipiracil plus bevacizumab, in addition to brief administration of regorafenib and fruquintinib in the fourth- and fifth-line setting. Oxaliplatin was discontinued after one cycle due to worsening of vision on a background of pre-existing retinopathy. The longest disease control (time to progression ~11 months) occurred with trifluridine/tipiracil plus bevacizumab. To our knowledge, this represents the first report describing use of this combination in the third-line setting for metastatic urachal carcinoma. Overall survival was 27 months. This case is hypothesis-generating for the use of modern CRC-based therapies, including anti-VEGF–containing combinations.