Clinician brief

Moderately differentiated adenocarcinoma, rectosigmoid colon. ypT4a ypN1b (3/24 nodes) M1a V+. Treatment began Dec 2021; primary resected Mar 2022.
Sites of disease Lungs · mediastinal lymph nodes · liver segment VII (new, Jul 2026).
Also Smouldering myeloma (diagnosed end of 2021, under haematology surveillance); Gilbert's syndrome (can raise bilirubin). Original pathology Clinician letter

KRAS/NRAS wild-type · BRAF wild-type · pMMR / MSS · HER2 IHC 0 · TMB-low · 3 Mut/Mb · PD-L1 <1% (22C3, 28-8)
Key detected tumour alterations APC p.S1415Rfs*4; TP53 p.R342*; PTEN reported, not specified Commercial sequencing
Platform Oncomine Comprehensive Plus, 517-gene targeted panel, hg19. Not whole genome or whole exome. Reported tumour-only.

Dec 21–Feb 22	Neoadjuvant XELOX ×4 · good partial response
Mar–Oct 22	Primary resected · liver met resected (R0) · adjuvant CAPOX
Oct 22–Apr 23	Lung mets appear, progress · SABR 55 Gy/5
Jun & Aug 24	Lung ablations (1 left, then 1 left + 4 right)
Feb 25	EBUS confirms mediastinal nodal disease
Apr–Jul 25	FOLFIRI + cetuximab ×6 · good partial response
Feb–May 26	Rechallenge ×6 · excellent partial response
Jul–Aug 26	Progression during the break · FOLFIRI + cetuximab restarted 19 Aug

Clinician letter

FOLFIRI + cetuximab (rechallenge, 3rd block), 14 days cycles. Plan: 8–12 weeks, then consider maintenance 5-FU + cetuximab if response is good. CT after Cycle 5.

Chemo day	Standard pre-meds (Akynzeo, dexamethasone, chlorphenamine, atropine) · pegfilgrastim 24h after
Supportive	Dexamethasone ×3 days · domperidone · loperamide · doxycycline + Plazon (skin) · Laxido · antihistamine · zopiclone PRN
Other	Citalopram 30 mg (breakfast) · melatonin 60 mg (evening) · loratadine 10 mg

Not currently taking Mistletoe and most supplements / off-label drugs, during chemo on my oncologist's advice Patient-reported

Metformin — introducing this week · Mebendazole — following, over the next few weeks · Atorvastatin — following, over the next few weeks
As at 2 October 2026 · Source Proposed by my integrative oncologist (private). Not yet discussed with my primary oncologist or the NHS team. Each step is subject to tolerance. Nothing here is agreed with my treating oncologist yet. Patient-reported

23 Jul 2026 · CT chest, abdomen & pelvis: Progression above and below the diaphragm, and a new liver metastasis. Imaging report

12 May 26 15.8 · 23 Jul 26 49.4 · 07 Aug 26 87.6 · 01 Sep 26 146 · 14 Sep 26 50.9 · 29 Sep 26 44.6 ug/L, ref 0–5.2 Laboratory bloods

29 September 2026: Haemoglobin 126 g/L (low, ref 130–170) · Red cells 4.09 ×10¹²/L (low, ref 4.40–5.80) · ALP 169 U/L (high, ref 30–130) · Bilirubin 21 µmol/L (high, ref 0–20) Laboratory bloods

• Which alteration is the driving event? The panel reports APC p.S1415Rfs*4 and TP53 p.R342* as detected, but it does not designate a driver and no clinician has characterised one on my file. If a driver were formally called, would it change anything actionable?
• NHS whole genome sequencing referral — the testing to date is a 517-gene panel, not WGS or WES.
• Matched tumour/normal sequencing — the tumour panel is reported tumour-only.
• Platelet count from 29 Sep 2026 — unreadable on my copy of the report, not yet confirmed.

Primary oncologist — Consultant clinical oncologist, Bath Clinic; Haematologist — Consultant haematologist, Bath Clinic (smouldering myeloma); Integrative — Integrative oncologist (private), separate from my NHS/Bath Clinic team
Named identifiers are not published here. A version carrying them is sent to clinicians directly on request.