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Objective: In this case report, we describe a huge response of pulmonary lung lesions that resulted in a pneumothorax in a metastatic colorectal cancer patient treated with Regorafenib.  Case Report: A 65-year-old woman, diagnosed with lung metastases from colon cancer began in the assumption of Regorafenib after failure of a prior line of chemotherapy. The disease was re-evaluated every two months by CT scan and a responding disease was reported, through the cavitation of all pulmonary nodules. Suddenly, after 9 months of a well-tolerated treatment, the patient showed cough, dyspnea and asthenia. She was admitted in our ward and a sub-massive pneumothorax was diagnosed and treated by thoracic surgeons by positioning a chest tube to get a normal expansion of the collapsed lung. Pneumothorax was solved, but patient discontinued Regorafenib as its positive activity on lung metastases, showing a deep response to treatment, was considered an adverse event that caused such a threatening side effect. Results: The pneumothorax was very probably caused by an excessive cavitation of lung sub-pleural nodules responding to chemotherapy extraordinarily.  Conclusions: This case highlights the need to monitor constantly patients with lung metastases receiving regorafenib especially with subpleural localization for the consistent risk of such sequelae.

From Cavitation of Lung Metastases to Pneumothorax: An Amazing Response to Regorafenib in Metastatic Colorectal Cancer? A Case Report