Given the rarity of adenocarcinoma of the appendix, the options of chemotherapy regimen are largely informed by empirical evidence in the management of colorectal cancers, which include 5-fluorouracil-based treatment schedules, carboplatin with paclitaxel, and capecitabine with oxaliplatin.14-16 The role of other treatment modalities such as Vascular Endothelial Growth Factor (VEGF) inhibitors, and other molecularly targeted therapies remains controversial.13 This patient was being optimized for chemotherapy and spine irradiation until he had deterioration in his performance status. Here, VEGFA is linked to appendix adenocarcinoma.