Small cell lung cancer (SCLC) is differentiated from non-small cell lung cancers with its histological and morphological features, rapid response to chemotherapy, and recurrence in a short time after ...treatment is discontinued. Platinum plus etoposide chemotherapy combination has been used as a standard treatment, and no new drug has been found for more than 30 years in this disease. In research, the targeted pathways that may affect survival have not been identified yet. During the second half of the second decade of the 2000s, with immunotherapies that inhibit immune checkpoints, improvements in survival were achieved for the first time in treating SCLC after many years. Then a rapid increase was observed in chemotherapy plus immunotherapy combination studies in this field. Updated analyses of these studies were represented at international oncology meetings in 2020. Here, we reviewed immunotherapy studies conducted in patients with SCLC and the reflections on the daily practice.
Introduction
Leukocytoclastic vasculitis is a histopathological term describing vasculitis in which the inflammatory infiltrate in small vessels consists of neutrophils. Although FLOT is given ...perioperatively in locally advanced, resectable gastric or gastroesophageal junction adenocarcinoma, it has recently become a popular treatment option for metastatic cancers. In this case report, we present a case of FLOT-induced LCV.
Case Report
We present a 52-year-old patient with metastatic gastric adenocarcinoma treated with FLOT. The patient developed necrotizing vasculitis in the lower extremity after 5 cycles of FLOT.
Management & Outcome
After discontinuation of the FLOT regimen, the necrotizing morbid LCV gradually regressed with steroid therapy.
Discussion
To the best of our knowledge, our case is the first case of LCV that developed after FLOT chemotherapy. The clinical appearance of the patient, occurrence after chemotherapy, erythematous rash developing on bilateral lower extremities, and palpable purpuric vasculitis made us suspect. We found a potential relationship between FLOT and vasculitis according to the Naranjo scale (score 4 + ).
Introduction
Regorafenib, a receptor tyrosine kinase inhibitor, is a routinely used targeted agent in the current treatment of patients with refractory metastatic colorectal carcinoma (mCRC). The ...aims of this study were to detect the presence of bowel wall edema during regorafenib treatment via computed tomography (CT) and to assess the relationship between survival and regorafenib-induced bowel wall edema in patients with mCRC receiving regorafenib.
Patients and methods
We retrospectively evaluated the presence of bowel wall edema on CT of 25 mCRC patients who received regorafenib and analyzed its relationship with progression free survival (PFS) and overall survival (OS).
Results
Among the 25 patients, 25 had small bowel wall edema (SBWE) and 14 had large bowel wall edema (LBWE) on at least one CT examination. The median SBWE value was 4.85 milimeters (mm). Of the 25 patients, 14 had SBWE ≤4.85 mm and 11 had SBWE >4.85 mm. Regorafenib intolerance was significantly higher at SBWE >4.85 mm patients (p = 0.03). The median PFS was 4.6 months (95% CI: 2.4–6.8) and median OS was 9.3 months (95% CI: 3.1–15.4). Median PFS and OS were shorter in patients with SBWE > 4.85 mm than in those with ≤4.85 mm, but not statistically significant (median PFS: 3.9 vs 4.6 months, p: 0.523; median OS: 5.6 vs 9.3 months, p: 0.977).
Conclusions
Regorafenib caused SBWE in patients with mCRC. Patients who developed more SBWE had a higher regorafenib intolerance and a shorter survival. Further studies are needed to confirm the predictor value of SBWE on the survival outcomes of patients with mCRC receiving regorafenib.
Introduction
Pazopanib is an agent that is being successfully used in soft tissue sarcomas. Some endocrine side effects may develop during pazopanib treatment. Here, we presented a case diagnosed ...with secondary adrenal insufficiency while being investigated for etiology of hypoglycemia which developed after pazopanib.
Case report
A 69-year-old male patient was operated in June 2019 due to a lung mass 26 × 18 × 10 cm in size. Pathological diagnosis revealed a solitary fibrous tumor with malignant behavior. The patient received three lines of chemotherapy. After pazopanib treatment, a hypoglycemic attack was reported.
Management and outcome: Blood cortisol and ACTH (Adrenocorticotropic hormone) levels were not increased at the time of the hypoglycemic attack, and levels of other pituitary hormones were found to be normal. Electrolyte levels were in normal range. Since the counteracting hormone did not reach a sufficient level, it was considered secondary adrenal insufficiency. Hypoglycemic attacks did not occur during follow-up while taking steroid therapy and pazopanib.
Discussion
A single case of primary adrenal insufficiency has been reported in the literature. We here present a case who developed hypoglycemia after pazopanib and was diagnosed with drug-associated secondary adrenal insufficiency. When hypoglycemia develops during pazopanib treatment, we must be aware of adrenal insufficiency.
ÖZET
Timomalar ve timik karsinomlar genellikle ön mediasten yerleşimli timus kökenli nadir görülen tümörlerdir.
İlk tanı anındaki evre ve timik tümörün cerrahi olarak tam çıkarılabilmesi en önemli ...prognostik faktörlerdir.
Hastaların evresine göre neoadjuvan/adjuvan kemoterapi ve radyoterapiyi içeren tedavi stratejileri multidisipliner
tümör konseylerinde planlanmalıdır. Ancak, lokal tedavilere rağmen hastaların az bir kısmında zaman içinde
nüks gelişebilmekte veya daha ilk tanı anında metastaz saptanabilmektedir. Lokal tedavilere uygun olmayan
hastalarda platin ve doksorubisin ile kombine kemoterapi rejimleri standart birinci basamak tedavidir. Ancak
ikinci basamakta kesin kabul görmüş bir tedavi önerisi yoktur. Birinci basamak tedavi sonrası progresyon gelişen
hastalarda vasküler endotelyal büyüme faktörünü hedefleyen tirozin kinaz inhibitörleri ve immünoterapiler
ile yapılan çalışmaların sonuçları yakın zamanda açıklanmıştır. Bu derlemede, timoma ve timik karsinomlu
hastaların genel olarak tedavi yönetimini, hedefli tedavilerin ve immünoterapi çalışmalarının sonuçlarını ve
güncel pratiğe potansiyel yansımalarını analiz ettik.
Anahtar Kelimeler: Hedefleyici tedaviler, immünoterapi, timik karsinom, timoma
ABSTRACT
Thymomas and thymic carcinomas are rare tumors of thymus origin, usually located in the anterior mediastinum.
The stage at the time of first diagnosis and complete surgical removal of the thymic tumor are the most important
prognostic factors. According to the stage of the patients, treatment strategies including neoadjuvant/adjuvant
chemotherapy and radiotherapy should be planned in multidisciplinary tumor boards. However, despite local
treatments, a small number of patients may develop recurrence over time or metastasis can be detected at the
first diagnosis. Combination chemotherapy regimens with platinum and doxorubicin are the standard firstline therapy in patients who are not suitable for local treatments. There is no definitively accepted treatment
recommendation in secondary care. The results of studies with tyrosine kinase inhibitors targeting vascular
endothelial growth factor and immunotherapies in patients with progression after first-line therapy have been
recently reported. In this review, I analyzed the overall treatment management of patients with thymoma and
thymic carcinoma, the results of targeted therapies and immunotherapy studies, and their potential implications
for current practice.
Key words: Targeted treatments, immunotherapy, thymic carcinoma, thymoma
The metastatic pattern of non-small cell lung cancer (NSCLC) has been described in several studies. Frequent metastatic sites are lung, liver, bone, surrenal, and brain. Hypotheses were speculated to ...explain the tendency of specific sites. Over-expression of EGFR alters the biology and tumoral behavior. The mutations of EGFR mainly occur in exon 19, and 21and could lead the way through the tumor growth and metastasis. We try to elucidate the relationship between EGFR mutation and metastatic pattern.
In this retrospective nested case-control study, one hundred and five patients diagnosed with lung adenocarcinoma included who had EGFR mutation status and imaging studies at the time of diagnosis.
The metastatic pattern was not different between EGFR mutant and wild type patients. There was no statistical difference in terms of survival between EGFR mutant and wild type patients (p = 0.25). The OS according to the organ metastasis between EGFR mutant and wild type group was not significant except liver. The EGFR mutant patients with liver metastasis had better survival compared with wild type patients (p = 0.04). Also, the multiplicity and solidarity of the metastatic tumors were compared in metastatic organs. There was no significant difference between groups. The subsequent EGFR mutation type was not related to the metastatic pattern.
The incidence of the metastatic sites was not different between EGFR mutant and wild type patients in our study. In contrast to the literature, liver metastasis found to be related to improved OS.
Introduction
Soft tissue sarcomas are a heterogeneous and rare group of cancers with a short median overall survival despite the chemotherapy. Pazopanib has approval for the treatment of advanced ...soft tissue sarcoma. We aimed to investigate the clinical outcomes of Turkish patients with advanced soft tissue sarcoma who received pazopanib.
Patients and methods
This was a retrospective study. The inclusion criteria were: ≥18 years of age, having histologically proven advanced soft tissue sarcoma and receiving pazopanib at least one day.
Results
A total of 79 patients were assessed in this study. The median age was 49.6 years. The average dose intensity of pazopanib was 767 mg (400–800). The median duration of pazopanib treatment was 6.11 months. Fourteen patients (17.7%) used pazopanib at first line for advanced soft tissue sarcomas. The most common cause of discontinuation of pazopanib was the progression of the disease (89.6%). Pazopanib was well tolerated. The most common grade ≥3 side effect was anemia. The most common grade ≤2 side effects were anemia and hyperbilirubinemia. The median progression-free survival, overall survival, and follow-up were 3.97 months, 11.40 months, and 32.72 months, respectively. Female gender, good performance status, and the presence of pazopanib-induced hypothyroidism were associated with longer progression-free survival. Also, good performance status and being a responder to first-line treatment were associated with longer overall survival.
Conclusions
We showed that pazopanib was well tolerated and had clinical benefit in patients with advanced soft tissue sarcoma in a Turkish cohort. This is the first study that suggests pazopanib-induced hypothyroidism may act as a predictive marker for better outcomes in patients with advanced soft tissue sarcoma.
Primary pure neuroendocrine carcinoma of the breast is an extremely rare tumor. We report a case of primary solid neuroendocrine carcinoma in a 77-year-old postmenopausal woman who was admitted to ...the hospital with masses on her right breast and axillary region. Radical mastectomy with axillary lymph node resection was performed. Immunohistochemical stainings of the tumor cells with synaptophysin, GCDFP-15, estrogen, progesterone, and c-erbB-2 were positive. Five of 16 lymph nodes were metastatic. She did not receive adjuvant chemotherapy. After 15 months of follow-up she is free of the disease. Literature review revealed that this is the second case of HER-2 positive primary neuroendocrine tumor of the breast.
Oxaliplatin is a third-generation platinum anti-neoplastic agent, which is used in the treatment of colorectal, gastric, and biliary tract cancers with combination other chemotherapy drugs. In rare ...cases, thrombocytopenia may occur suddenly in approximately 24 hours due to immune-mediated reactions. This reaction is usually seen after long term usage of oxaliplatin-based chemotherapy. Here, we present our case of immune-mediated thrombocytopenia associated with oxaliplatin.
A 56 years old man who had stage IV rectum cancer with liver metastasis, had palliative surgery due to bowel obstruction after initial diagnostic approach. After failure of first line treatment, mFOLFOX6 plus Cetuximab (Cetuximab: 500mg/m2 on day 1, Oxaliplatin: 85 mg/m2 day 1, Leucovorin (LV): 400 mg/m2 day 1, 5-FU 400 mg/m2 IV bolus on day 1 followed by 2400 mg/m2 on day 1 infused over 46 hours every two weeks) regimen was started. Before the 21st cycle of oxaliplatin plus cetuximab regimen, the patient had normal thrombocyte, haemoglobin and neutrophile count. Approximately 8 hours after the chemotherapy patient had been taken to the emergency service with petechia, vigorous gastrointestinal and nasal bleeding. The thrombocyte levels were 3000 at μl. The patient was given methylprednisolone for three days. The thrombocyte levels recover quickly in 24 hours. After this reaction, oxaliplatin stopped and the chemotherapy was changed to capesitabine plus cetuximab regimen.
In conclusion, oxaliplatin induced immune-mediated thrombocytopenia is a rare side effect but a life threatening complication. A physician who uses oxaliplatin as a treatment option should keep in mind the possibility immune-mediated thrombocytopenia which may cause life-threatening bleeding. Especially the long term use of oxaliplatin (median >10 cycles) may alert the physician for immune-mediated adverse effects.
The discovery of the epidermal growth factor receptor (EGFR) mutation, especially in adenocarcinoma, has led to a major change in the treatment of non-small-cell lung cancer (NSCLC). This study ...investigated the relationship between the EGFR mutation status and the carcinoembryonic antigen (CEA) levels at the time of diagnosis.
A total of 102 patients with EGFR mutation and tested CEA levels were recruited for this study. Of the patients, 24 were EGFR mutants (23.5%), while 78 patients (76.5%) did not harbor any EGFR mutations.
The CEA levels did not differ across groups. Additionally, the CEA levels were analyzed between female and male patients separately due to EGFR mutations; no difference was observed. When the CEA levels were categorized as positive or negative based on different cut-off values, such as 5 and 10 ng/ml, no statistical difference was found between groups.
In this study, no relationship between EGFR mutation and pre-treatment CEA levels was observed. Despite positive trials having shown a predictive value of CEA levels for EGFR mutation, more clinical trials are needed to elucidate the racial, clinical, and pathological differences of the study populations. Most studies have been located in the Far East, but new trials in Caucasian, African, and Hispanic populations are still lacking.
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