Duodenal adenocarcinoma is a rare digestive cancer, often diagnosed at a late stage and harbours a poor prognosis. The arrival of immunotherapy has changed the prognosis of many neoplasia, including ...digestive adenocarcinomas with MSI-H status. Hereby, we describe three cases of MSI-H locally advanced duodenal adenocarcinoma who received neoadjuvant treatment with a PD1 inhibitor, pembrolizumab. A partial metabolic and endoscopic response was observed in all patients after 2 cycles. Duodenopancreatectomy was performed at the end of treatment (4–6 cycles), and anatomopathological analysis demonstrated pathological complete response in all patients. Our case series paves the way for prospectively exploring neoadjuvant immunotherapy in duodenal MSI-H adenocarcinoma and raises the question of organ sparing surgery in case of complete clinical response as observed in gastric and colo-rectal adenocarcinomas.
•Duodenal adenocarcinoma is rare cancer with poorly defined standard therapies.•Immune checkpoint inhibitors have changed management of MSI-H tumours.•Neoadjuvant immunotherapy may lead to pathological complete response.•Our observation paves the way to further explore organ sparing surgery.
Hepatocellular carcinoma accounts for 90% of primary liver cancers and represents a growing health problem worldwide. We report the complex case of a 71 year-old patient diagnosed with a large ...hepatocellular carcinoma and presenting an extensive vascular invasion of the middle hepatic vein and the inferior caval vein ascending to the right atrium with no extrahepatic spread. Due to several comorbidities, a systemic treatment by tyrosine kinase inhibitors was contraindicated. After discussion at the multidisciplinary hepatology tumor board, he was referred for selective internal radiation therapy. Unfortunately, the work-up showed an important lung shunt not allowing radioembolization. No clear recommendations are available in this situation. The decision was made to propose a combination treatment by transarterial chemoembolization, that was performed using a new generation of radio-opaque microspheres loaded with doxorubicin, followed by immunotherapy. This allowed a complete response with a very good quality of life.
Highlights • Comorbidities are frequent in patients with lung cancer. • Anticancer therapy has to be adapted to the patient's comorbidities. • Comorbidities impact on anticancer treatment is poorly ...assessed. • Level of evidence is often limited to experts’ opinion and to case reports. • There is a strong need for improving our knowledge in that field.
The objective of this paper is to review the literature published in 2013 and 2014 in the field of intensive care and emergency related to oncology. Are discussed because of new original ...publications: prognosis, life-supporting techniques, septic shock and infectious complications, anticancer treatment in intensive care, tumoral lysis syndrome, respiratory, thromboembolic and vascular, digestive and hepatic, and neurologic complications, oncologic emergencies, therapeutic limitations.
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