Despite oncological advances over the past years, survival outcomes for patients with pancreatic ductal adenocarcinoma (PDAC) remain poor. For most PDAC patients, the disease is often asymptomatic at ...early phases and is therefore typically diagnosed at the advanced or metastatic stage. As a result, up to 85% of the cases are unresectable, and systemic chemotherapy is the predominant treatment modality for this patient population. While the current therapeutic strategies for the local disease include surgical resection and adjuvant chemotherapy, FOLFIRINOX and gemcitabine plus nab-paclitaxel regimens are the frontline standard of care in the unresectable locally advanced and metastatic settings. In Switzerland, nanoliposomal irinotecan (nal-IRI) is currently the only regimen approved in the second line following progression on gemcitabine plus nab-paclitaxel, based on the results from the phase III NAPOLI-1 trial. Recently, olaparib, a poly (ADP-ribose) polymerase (PARP) inhibitor, and larotrectinib, a first-in-class tropomyosin receptor kinases (TRK) inhibitor, were added to the treatment armamentarium of patients with a molecularly-defined subset of metastatic adenocarcinoma of the pancreas. This article provides an overview of the current treatment landscape of pancreatic cancer in Switzerland. In addition, we report a case of a long-term survivor with advanced pancreatic adenocarcinoma who achieved a notably good response to nal-IRI plus 5-FU/LV after progression on gemcitabine plus nab-paclitaxel.
Despite oncological advances over the past years, survival outcomes for patients with pancreatic ductal adenocarcinoma (PDAC) remain poor. For most PDAC patients, the disease is often asymptomatic at ...early phases and is therefore typically diagnosed at the advanced or metastatic stage. As a result, up to 85% of the cases are unresectable, and systemic chemotherapy is the predominant treatment modality for this patient population. While the current therapeutic strategies for the local disease include surgical resection and adjuvant chemotherapy, FOLFIRINOX and gemcitabine plus nab-paclitaxel regimens are the frontline standard of care in the unresectable locally advanced and metastatic settings. In Switzerland, nanoliposomal irinotecan (nal-IRI) is currently the only regimen approved in the second line following progression on gemcitabine plus nab-paclitaxel, based on the results from the phase III NAPOLI-1 trial. Recently, olaparib, a poly (ADP-ribose) polymerase (PARP) inhibitor, and larotrectinib, a first-in-class tropomyosin receptor kinases (TRK) inhibitor, were added to the treatment armamentarium of patients with a molecularly-defined subset of metastatic adenocarcinoma of the pancreas. This article provides an overview of the current treatment landscape of pancreatic cancer in Switzerland. In addition, we report a case of a long-term survivor with advanced pancreatic adenocarcinoma who achieved a notably good response to nal-IRI plus 5-FU/LV after progression on gemcitabine plus nab-paclitaxel.
Background
In recurrent head and neck squamous cell carcinoma ineligible for resection or irradiation, treatment aims primarily at symptom control and quality of life enhancement with an expected ...outcome of 6–12 months.
Methods
In 2005, a male patient, born in 1944, with a second local recurrence of human papillomavirus negative tonsil cancer was enrolled in the EXTREME trial, and randomized to platinum/5-fluorouracil/cetuximab arm resulting in partial remission with progression-free survival of 12 months. The second-line systemic therapy comprised 5 cycles of 3-weekly docetaxel/cisplatin/5-fluorouracil regimen plus weekly cetuximab.
Results
As confirmed on imaging and repeated biopsies, complete response was achieved with disease-free survival of 8 years and follow-up period of 12 years. Severe acute toxicities during the taxane-based chemotherapy plus cetuximab included grade 4 anorexia and grade 3 febrile neutropenia.
Conclusions
Poor tumor differentiation, no weight loss, oropharyngeal location, white race, and particularly the induced complete response were most likely the key favorable prognostic factors in the reported patient. The possibility of a synergistic interaction between taxanes and cetuximab should be further explored.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
ABSTRACTTemporal arteries are typically below detectable levels of PET scanners, which repeatedly showed to be limiting in finding increased F-FDG accumulation even in histologically proven cases of ...giant cell arteritis. In 2010, Gaemperli and coworkers showed metabolic active inflammation in temporal arteries in an experimental study using PET with C-PK11195 combined with CT angiography. Herein, we present the case where an increased accumulation of routinely used tracer F-FDG can be identified directly in temporal and occipital arteries and even in smaller branches using a common hybrid PET/CT scanner if a brain acquisition protocol is applied.
Amyloidosis is a disease characterized by deposits of abnormal protein known as amyloid in various organs and tissues. It can be classified into systemic or localized forms, the latter of which is ...less frequent. Deposition of amyloidogenic monoclonal light chains leads to the most common type of this disease called light-chain (AL) amyloidosis. (18)F-FDG positron emission tomography/ computed tomography hybrid imaging (FDG-PET/ CT) demonstrates tracer uptake usually in all patients with localized amyloidosis as opposed to the systemic form.
Herein, we present a case of an otherwise healthy 56-year-old women diagnosed with a nasal polyp on the right side. The biopsy results were consistent with amyloidosis. FDG-PET/ CT imaging revealed a pathological, metabolically active lesion measuring 11 × 9 mm with a maximum standardized uptake value (SUV(max)) of 3.47. No other distant pathological changes were identified. After a radical resection, the patient has been regularly followed-up with clinical and imaging methods (MRI, FDG-PET/ CT), both of which repeatedly showed normal findings with disease-free survival of 27 months. Thus, FDG-PET/ CT imaging plays an important role not only for obtaining the right diagnosis but also in the follow-up of patients after surgical resection. In accordance with the literature, this case report confirms that FDG-PET/ CT imaging holds promise as an auxiliary method for distinguishing between localized and systemic forms of amyloidosis.
ABSTRACTIn some patients, granulomatous reactions around foreign-bodies with FDG-PET positivity may be misinterpreted as malignancy. We report a case of a 31-year-old man diagnosed with testicular ...germinal tumor with retroperitoneal and left supraclavicular metastases. The diagnosis was based on left supraclavicular lymph node biopsy. Restaging examinations after orchiectomy and chemotherapy showed normalization of tumor markers and significant regression of the retroperitoneal infiltrate, however, with a residual FDG-PET positive lesion in the left supraclavicular fossa. The etiology behind this infiltration was revealed by a repeated histological examination, which surprisingly showed a foreign-body granuloma formation around a cotton pad left after the first surgery.
In rare disorders, there are often no standard therapy recommendations. Patients with refractory disease may require novel experimental approaches. Applied as second- up to fourth-line treatment, ...lenalidomide (10–25 mg perorally on days 1–21 in a 28-day cycle) was used in our cohort of four adult patients with aggressive, multisystem and relapsing diseases. Complete and long-lasting remissions (more than 1 year, no maintenance therapy) were achieved in patients with Langerhans cell histiocytosis (11 cycles, combination with dexamethasone and etoposide, consolidated by allogeneic blood stem cell transplant) and plasma-cell Castleman disease (15 cycles, monotherapy). Mixed response with complete disappearance of brain infiltrates was reached in Erdheim-Chester disease (6 cycles, monotherapy) and gastrointestinal bleeding was well controlled in multiple angiomatosis (9 cycles, combination with thalidomide). For disease activity evaluation each patient underwent fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography scan imaging, which was complemented by clinical and laboratory investigations.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
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