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Author(s):
Edvina Elena , Cristina Elena .
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Tuberculosis Reactivation in a Patient Treated With Nivolumab for Non-small Cell Lung Cancer: A Case Report
Abstract
The antibody against programmed cell-death nivolumab and other immune checkpoint inhibitors are used to promote reactivation of anti-tumor immunity in the fight against cancer. Data from case reports recently raised the question of a particular immune-related adverse event: secondary pulmonary tuberculosis as a consequence of excessive reactivation of the immune responsiveness to latent Mycobacterium tuberculosis infection. This case report describes a 67-year old Caucasian male who presented with reactivation of tuberculosis infection of the pleura and pericardium while on nivolumab therapy for non-small cell lung cancer. He received antituberculous treatment, with favorable evolution. With no available guidelines for the management of tuberculosis during PD-1/PD-L1 blockade, a high index of suspicion should be considered when the evolution of the patient is not respecting the expected pattern. This approach should be applied especially in countries with a high burden of tuberculosis.
| 2 |
Author(s):
Madalina-Cristina, Mihaela.
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Neuroendocrine carcinoma of the prostate – a case report
Abstract
Poorly differentiated neuroendocrine carcinomas are very rare. Most of them arise from the lung, only 9% are found in extrapulmonary sites. In the prostate, neuroendocrine cells are more commonly present compared to other organs of the genitourinary tract.
We present the case of a 67-year-old male patient who was investigated for constipation, loss of appetite and pelvic-perineal pain; a large prostatic mass was discovered upon further investigation. After a thorough work-up and multidisciplinary approach, the patient was diagnosed with de novo large cell neuroendocrine carcinoma of the prostate with multiple metastases. He underwent 5 cycles of chemotherapy with cisplatin and etoposide before we evaluated the therapeutic response by CT scan, which showed partial response according to RECIST v 1.1. Because of important nephrotoxicity, the treatment was discontinued after the 6th cycle and follow-up after three months was recommended.
The rarity of this case made the diagnosis process challenging, but was manageable with the involvement of the multidisciplinary team. The treatment was initiated according to the international guidelines concerning extrapulmonary poorly differentiated neuroendocrine carcinomas/ large or small cell carcinomas. Although the evaluation showed partial response, large cell neuroendocrine carcinoma of the prostate is an aggressive tumor with a poor prognosis.
| 3 |
Author(s):
Mircea, Aurelia , Cristina Ligia , Petra, Polixenia , Bogdan .
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Clinical outcomes, treatment and testing patterns in patients with advanced non-small lung cell cancer with epidermal growth factor receptor mutations: results of the Romanian cohort from a multi-national retrospective chart review (REFLECT)
Abstract
Background: To characterize clinical outcomes, treatments and proportion of T790M testing in patients with advanced non-small cell lung cancer (NSCLC) receiving first- or second-generation (1G/2G) tyrosine kinase inhibitors (TKIs) of the epidermal growth factor receptor (EGFR) in first-line (1L) in the Romanian cohort of an international study.
Methods: REFLECT was a retrospective, non-interventional study conducted in 8 countries, with 11 sites from Romania that retrieved data from the medical records of 90 patients. Eligible patients had confirmed EGFR-mutated advanced NSCLC with 1G/2G EGFR TKIs initiated between Jan 2015 and Jun 2018. All analyses are descriptive.
Results: In the Romanian cohort, the median age at diagnosis was 67.5 years, with 68% females. Distribution of 1L EGFR TKIs was 50% erlotinib, 31% afatinib, and 19% gefitinib. 1L was discontinued in 76 (84%) patients due to progression (79%), toxicities (3%), patient’s decision (1%) or surgery (1%). Median progression free survival on 1L was 12.0 (95% CI 10.3-15.6) months, and median overall survival from 1L start was 26.4 (95% CI 22.4-34.2) months. T790M testing was performed for 69% patients progressing on 1L, and 57% of patients tested yielded positive results. Second-line (2L) was started in 63% of patients discontinuing 1L. Third-line was started in 50% patients discontinuing 2L.
Conclusion: Survival outcomes mirrored the results of randomized trials. Suboptimal T790M testing rate (69%) underlines the importance of reflex testing procedures, while attrition rates on 1L (26%) emphasize the need of upfront selection of most effective treatments.
Clinicaltrials.gov registration number: NCT04031898
Date of registration on clinicaltrials.gov: 04-Jul-2019
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Author(s):
Monica-Emilia, Monica-Emilia.
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The Journey of Learning and the Healing Power of Art – A Discussion with Dr. Berardino De Bari
Abstract
Dr. Berardino De Bari is an Italian Radiation Oncologist based in Switzerland, recognized as one of the European experts on prostate cancer. Apart from his clinical activity, he is also involved in educational activities of ESTRO, IAEA, and ESO. He is also a musician - composer and singer.
| 5 |
Author(s):
Adrian-Marian, Ana.
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Treatment approach for intraorbital metastasis with origin in breast cancer: case report
Abstract
Breast cancer is the most common diagnosed cancer worldwide and although well-known its impressive characteristic to metastasize everywhere, orbital spreads are considered an exceptional event.
We present a case of a 53-year-old patient initially diagnosed with luminal B cT4cN1M1 breast cancer (M1PUL, M1OSS) and received palliative chemotherapy, zoledronic acid and hormonotherapy without any major benefits (progressive disease). Two years later, the patient experienced right eye proptosis, local pain and decreasing visual acuity; CT (computed tomography) followed by MRI (magnetic resonance imaging) showed a soft tissue mass in the right orbit, along the right optic nerve but without invading it. A multidisciplinary team decided that the next therapeutical step should be orbital palliative radiotherapy. Taking into consideration the location of the metastasis and the high risk of imminent vision loss, stereotactic body radiation therapy (SBRT) was conducted. Two months after palliative SBRT, the proptosis and the local pain were resolved and an imaging partial response was obtained.
| 6 |
Author(s):
Andrada, Cristina , Vlad, Cristina, Dana.
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SECOND, PECULIAR RECURRENCE OF A WILMS TUMOUR- PLEURAL AND LATE
Abstract
We present the case of a 2-year-old boy diagnosed in 2010 with intermediate risk, regressive type Nephroblastoma in the left kidney. He was treated with neoadjuvant chemotherapy followed by surgery and chemotherapy (SIOP protocol). After 11 months the cancer recurred in the left lung, so the patient was (re)classified as high risk and treated with 7C of chemotherapy. After 9 disease-free years, the periodic CT scan showed a 10/5cm tumour in the left lung, arising from the pleura. The tumour was completely resected, and pathology confirmed the nephroblastoma recurrence. The patient was further treated according to the UMBRELLA protocol (BB group) with chemotherapy and local irradiation. The tumour bed was irradiated with 25.2 Gy/14 fr, using Helical Tomotherapy. Following irradiation, the patient underwent high-dose chemotherapy and autologous stem-cell transplantation. The last clinical examination showed no signs of recurrence or severe toxicities and a good overall status of the patient.
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Author(s):
Alida.
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ASCO 2022 Breast Cancer Updates
Abstract
Practice changing clinical trials were presented in ASCO 2022 for breast cancer and will be reviewed here. Starting with the plenary session with DESTINY-Breast04 we are turning a new page in the treatment of metastatic human epidermal growth factor receptor 2 (HER2)-low breast cancer patients. The results of the DESTINY-Breast04 trial open a new therapeutic option for half of the patients with metastatic breast cancer, establishing HER2-low metastatic breast cancer as a targetable population with trastuzumab deruxtecan. The indications for antibody drug conjugates are expanding to patients with metastatic hormone receptor positive endocrine resistant disease based on TROPICS-02. From the multitude of clinical trials with antibody drug conjugates, we can envision that this will be likely the new way to deliver chemotherapy in the future. Differences in survival within the three cyclin-dependent kinase 4/6 (CDK4/6) inhibitors in upfront metastatic hormone positive breast cancer are emerging. We have data on continuation of ribociclib beyond disease progression on CDK4/6 in the MAINTAIN trial. The FAKTION trial does prove the benefit of the AKT inhibitor capivasertib and does highlight the importance of an extended molecular panel of the phosphatidylinositol3-kinase PI3K pathway. Furthermore, the exploratory analysis of KEYNOTE- 522, examining the correlation of event free survival and residual cancer burden after neoadjuvant treatment in patients with triple negative breast cancer does demonstrate a benefit of pembrolizumab extending to patient which did not achieve pathologic complete response, mainly by a decrease in residual cancer burden. Advances in biomarkers of response to immunotherapy are needed.
| 8 |
Author(s):
Monica-Emilia, Alessio Giuseppe.
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High Tech – High Touch – the Two Sides of Radiation Oncology
Abstract
Professor Alessio Giuseppe Morganti teaches at the University “Alma Mater Studiorum” from Bologna. He is an expert in radiotherapy of prostate cancer and of gastrointestinal malignancies (rectal, pancreatic and biliary tract cancers), and also in palliative care. He was the principal investigator in more than 50 clinical studies and published more than 400 papers in Scopus- indexed journals.
He kindly accepted to share his view about current aspects of Radiation Oncology.
| 9 |
Author(s):
Jose Ma. H. , Kenneth C. , Angela.
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[Revised] The ABCs of Aneurysmal Bone Cysts: Is there a Role for Radiation Therapy?
Abstract
Aneurysmal bone cyst (ABC) is a rare osteolytic lesion which, though benign, can have devastating effects on the patient’s function and cosmesis. Surgery is the mainstay of treatment; however, for incompletely resected, inoperable, or recurrent ABCs, radiation therapy has been posited to be a feasible therapeutic modality. However, evidence on the possible role of radiation therapy in the management of ABCs remains in its infancy. This short review discusses what is currently known about the pathophysiology, natural history, epidemiology, and clinical presentation of ABCs. This will ultimately lead to a survey of the present literature on radiation therapy as used for ABCs.
| 10 |
Author(s):
Ludovica, Irina Mihaela, Vlad Mihai , Paolo.
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NUTRITIONAL SUPPORT INDICATIONS IN PATIENTS WITH GASTROESOPHAGEAL CANCER
Abstract
Nutritional support is an essential part of cancer care. Malnutrition is a common feature in cancer patients and has a negative impact on the quality of life and treatment tolerance. Patients with digestive cancers are at higher risk of malnutrition due to the gastrointestinal impairment caused by their disease. However, most of them have insufficient access to nutritional support.
Early identification of patients at risk of malnutrition is crucial in order to start an adequate nutritional support. Robust evidence showed that nutritional support can reduce length of hospitalisation, decrease treatment-related toxicity, and improve quality of life and physical function. Nutritional intervention can improve outcomes and help patients in the successful completion of oncological treatments by preventing malnutrition. The aim of this review is to provide a comprehensive overview of nutritional interventions for patients with gastroesophageal cancers.
