Cancer treatment communications最新文献

Background

The aim of this study was to determine the recommended dose of irinotecan (CPT-11) with fixed regimen of oxaliplatin (L-OHP)/fluorouracil (5-FU)/leucovorin (LV) (FOLFOXIRI) plus bevacizumab in Japanese patients with metastatic colorectal cancer.

Patients and methods

Patients received CPT-11 followed by L-OHP 85 mg/m², LV 200 mg/m², and 5-FU 3200 mg/m² infused as a 48-h continuous infusion and bevacizumab 5 mg/kg, repeated every 2 weeks. A decrease of the CPT-11 dose was planned (started at level 1: CPT-11 165 mg/m²). This trial was registered with the University Hospital Medical Information Network (number UMIN000012991).

Results

Six patients were enrolled, and MTD was not reached at level 1. CPT-11 165 mg/ in combination with L-OHP 85 mg/m², LV 200 mg/m², 5-FU 3200 mg/m² infused as a 48-h continuous infusion and bevacizumab 5 mg/kg could be administered with acceptable toxicity, and all patients were treated at these dose levels. The most common grade 3 or 4 toxicities were neutropenia (67%) and leukopenia (50%). No treatment death was observed. The overall response rate was 67% (95% confidence interval: 30.0–90.3 %).

Conclusion

This biweekly triplet plus bevacizumab regimen was well tolerated by Japanese patients with metastatic colorectal cancer. The recommended phase II dose was determined to be the same as the standard doses for this regimen used worldwide.

Micro abstract

The efficacy of the FOLFOXIRI plus bevacizumab regimen for patients with metastatic colorectal cancer has been proven in a recent phase III study. However, there is no report of the FOLFOXIRI plus bevacizumab regimen in Japanese patients, and recommended doses of this regimen for Japanese patients have not been determined. The present study demonstrates that the recommended doses of FOLFOXIRI plus bevacizumab for Japanese patients are the same as the standard doses used worldwide.

Introduction

Epithelioid hemangioenthothelioma (EH) is a rare vascular neoplasm of endothelial origin. It most commonly develops in the lung and liver, but may also arise from any organ, and typically displays an intermediate clinical behavior between haemangioma and angiosarcoma. Because of the rarity of this tumor no standard therapy has been proposed. Targeted antiangiogenic therapy using bevacizumab, a monoclonal antibody against vascular endothelial growth factor, has been previously reported in very few isolated cases with contradictive results.

Presentation of cases

We herein report a case series of four patients with EH, including two cases of localized lung and pleural EH and two cases of liver and bone EH with pulmonary metastases, which were all treated with bevacizumab.

Discussion

Among our studied cases, bevacizumab monotherapy was well tolerated and resulted in stable disease in three patients with advanced-stage lung, liver and bone EH, for a period of 11, 7 and 12 months, respectively. Moreover, in one of these cases (primary liver EH with pulmonary metastases), long-term disease stabilization for an additional period of 17 months was observed following administration of chemotherapy with cyclophosphamide, adriamycin and vincristine (CAV) and hepatic arterial chemoembolization combined with thalidomide.

Conclusion

Bevacizumab monotherapy at 15 mg/kg may benefit the outcome of patients with advanced EH. We also report a long-term disease stabilization following treatment with CAV and hepatic arterial chemoembolization combined with thalidomide, in a case of liver EH with pulmonary metastases.

Recent analysis indicated that afatinib could be effective in treating non-small cell lung cancer harboring uncommon EGFR mutations. A 59-year-old man undergoing hemodialysis for chronic renal failure was diagnosed with adenocarcinoma of the lung (cT4N3M1b). EGFR mutation analysis of his cancer revealed G719A point mutation in exon 18, and we started daily administration of 30 mg afatinib with hemodialysis (three times a week). As the feasibility of afatinib in patients with chronic renal failure undergoing hemodialysis has not been established, we analyzed the pharmacokinetics of afatinib in this patient. The trough level of afatinib in his plasma was almost similar to that of patients with normal renal function. Two months later there was marked tumor shrinkage, indicating a partial response. Our results suggest that afatinib could be safely administered and may exhibit good tumor response in a patient who has advanced lung adenocarcinoma with uncommon mutations undergoing hemodialysis.

In earlier work it was unclear whether there was any true prognostic value when high numbers of eosinophils were seen in the peripheral blood of lung cancer patients. As time passed, it became somewhat clearer that this occurrence may correlate with a poor prognosis in these patients. These ideas reflected what we came to know about the pathophysiology of hypereosinophilia in the blood in this setting. With paraneoplastic processes and distant metastases (to the bone marrow) thought to function at least in part as the mechanism of hypereosinophilia in these patients, it became more evident why these patients tended to have a poorer prognosis. However interestingly and paradoxically, there also has been work indicating that this occurrence may actually be protective against metastatic disease.

Here, we present the case of a sixty year old Caucasian female who presented with non-small cell lung cancer (NSCLC), diffusely metastatic at presentation, who also presented with hypereosinophilia which proved to be a poor prognostic indicator in this case.

Complete bone marrow infiltration with profound pancytopenia is very uncommon in breast cancer. Bone marrow metastasis can frequently occur following development of metastatic breast cancer. However, bone marrow failure as the herald of this disease is not typically seen. Very limited data exists as to the safest and most efficacious manner to treat patients with profound pancytopenia due to metastatic solid tumor involvement. In this case, the patient׳s thrombocytopenia was particularly worrisome, requiring daily platelet transfusions. There was also concern that cytotoxic chemotherapy would exacerbate the patient׳s thrombocytopenia and increase bleeding risk. The patient׳s dramatic response to chemotherapy with full platelet recovery is also highly unusual. For our patient, continuous doxorubicin successfully “unpacked” the bone marrow despite a low baseline platelet level, and without increasing the need for more frequent platelet transfusion or risk of catastrophic bleeding. Given the rarity of this presentation, it is currently unknown if the majority of similar patients experience near full recovery of hematopoietic function after initiation of appropriate systemic treatment for metastatic disease.

Introduction

Collision tumors of adenocarcinoma and lymphoma in the gastrointestinal tract are especially rare with few reported cases in literature. We report a unique case of a collision tumor and perform a literature review.

Presentation of case

An 86-year-old patient with a history of rheumatoid arthritis on chronic azathioprine and prednisone was found to have an invasive adenocarcinoma in the descending colon. A large atypical lymphocytic infiltrate was found at the base of this lesion, which demonstrated CD20, lambda and EBER positivity consistent with adenocarcinoma colliding with EBV-driven and lambda-restricted large B-cell lymphoma.

Discussion

With this report, there are now fifteen cases of this type of collision tumor although the true incidence may be higher. Our case is unique among previous reports as the collision developed within the setting of iatrogenic immunosuppression and tumor EBV positivity was demonstrated. The pathogenesis is unknown, and diagnosis requires a high-degree of suspicion.

Conclusion

It is important to consider immunosuppression in a patient with adenocarcinoma, as presence of atypical lymphoid cells may be indicative of lymphoma.

To the best of our knowledge, this is the first report of an undifferentiated pleomorphic sarcoma arising from a renal graft. Transplantectomy was performed in a 47-year old woman presenting to the emergency room because of general weakness. Preoperative workup revealed a 5.5 cm malignant mass of the graft which was not present on routine ultrasound performed 12 months earlier. Following transplantectomy, local recurrence developed despite complete tumor resection and interruption of immunosuppression. Despite radiation therapy, the outcome was ultimately fatal. Genetic analysis revealed that the tumor had arisen from donor tissue. Annual ultrasound surveillance might not be enough effective to screen for these rare high grade neoplasms.

Introduction

About four to six percent of non-small cell lung cancer (NSCLC) harbor Anaplastic lymphoma kinase rearrangement (ALK). ALK positive NSCLC has a distinct clinicopathological features. In the advanced setting ALK tyrosine kinase inhibitors are used in the first and second line of treatment. However, less is known about the outcome of stage one ALK positive NSCLC.

Presentation of case

Our case is a 58 year old man who presented initially with stage one ALK positive NSCLC. He relapsed 17 years later.

Discussion

It is very unusual for stage one NSCLC to relapse beyond 10 years. It is surprising that our patient relapsed many years after his initial diagnosis.

Conclusion

This may highlight a different biology and outcome. It may also mean a longer follow up is needed for this subset of patients.

Tumor lysis syndrome (TLS) is a potential complication in cancer therapy. It may occur in highly treatment sensitive tumors, especially in childhood cancers and hematologic malignancies, whereas it is rare in the treatment of adult solid tumors. We report a case of TLS during chemotherapy in a patient with metastatic non-small cell lung cancer (NSCLC, squamous cell carcinoma) and review the literature regarding the occurrence of TLS in patients with NSCLC. Reviewing the literature, a total of 120 patients with solid tumors who developed TLS have been reported. There are only 9 other reported cases of NSCLC complicated with TLS. TLS is a potentially fatal complication especially in solid tumors because of its poor clinical outcome.

We report on a patient with metastatic lung adenocarcinoma who underwent testing for EGFR mutations in a pleural effusion that failed to show any alterations and received standard first and second-line chemotherapy. She received erlotinib as third-line therapy with a prolonged partial response. At time of progression, re-biopsy showed squamous cell carcinoma, supported by histology and immunohistochemistry. Molecular profiling confirmed EGFR exon 21 L858R and exon 20 T790M mutations. Squamous cell transformation should not defer EGFR re-sequencing.