Using case reports to determine when liver bleeding occurs during disease progression in HELLP syndrome

TPS367 Background: Inhibitors of the programmed death-1 pathway (PD-1) are effective in clear cell renal cell cancer (ccRCC). Preclinical data and case reports suggest that denosumab, an inhibitor of Receptor Activator of Nuclear Factor κ-B Ligand (RANKL) signaling, could potentiate the anti-tumour effects of anti-PD1 inhibitors without overlapping toxicities. We aim to determine the activity and safety of combining denosumab and pembrolizumab in advanced ccRCC. Methods: This single arm, multi-center, phase II trial will recruit 70 participants with metastatic or unresectable ccRCC, progressing during or after treatment with vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors, and with no prior treatment with immunotherapy or denosumab. Participants will receive pembrolizumab 200mg IV every 3 weeks plus denosumab 120mg SC on days 1, 8 and 22 and then every 3 weeks until disease progression, prohibitive toxicity or maximum treatment of 24 months. Response will be assessed at weeks 12, 18, 24, then every 12 weeks until disease progression. Bloods for translational studies are collected at baseline, week 6 and on disease progression. The primary endpoint is objective tumour response rate (OTRR) per RECIST 1.1. Secondary endpoints include OTRR per iRECIST, progression free survival (PFS), time to OTRR, time to first skeletal related event, adverse events, and frequency of treatment delays/discontinuations. Correlative studies will include identification of prognostic and/or predictive biomarkers relating to immune and RANKL signaling. A sample size of 70 provides 90% power with a 1-sided type 1 error rate of 10% to distinguish the observed OTRR (and PFS at 6 months) from an OTRR of 40% (worthy of pursuit) versus 25% (not worthy of pursuit). 15 sites are open across Australia. As of September 23, 2020, 40 patients have been recruited. Clinical trial information: NCT03280667 .

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Spontaneous liver rupture in a pregnant woman associated with HELLP syndrome

Annaly khirurgicheskoy gepatologii = Annals of HPB surgery ◽

10.16931/1995-5464.20193132-138 ◽

2019 ◽

Vol 24 (3) ◽

pp. 132-138

Author(s):

T. M. Bunyatov ◽

I. A. Kozlov ◽

B. N. Gurmikov ◽

Yu. A. Stepanova ◽

V. S. Shirokov ◽

...

Keyword(s):

Hellp Syndrome ◽

Similar Case ◽

Case Reports ◽

Endovascular Embolization ◽

Syndrome Patient ◽

Liver Rupture ◽

Right Hepatic Artery ◽

Appropriate Treatment ◽

Threatening Condition ◽

Life Threatening

Spontaneous liver rupture is rare and highly dangerous, life-threatening condition occurring in 1–2% of pregnant women with preeclampsia and eclampsia. There are more than 100 similar case reports in the literature. It is believed that liver rupture is caused by HELLP syndrome as one of the signs of preeclampsia. The results of surgical treatment is still unsatisfactory. Appropriate treatment strategy is absent because of rareness of this condition. It is presented case report of a woman with spontaneous liver rupture associated with HELLP syndrome. Patient underwent perihepatic tamponade, endovascular embolization of right hepatic artery followed by right-sided hemihepatectomy.

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The natural history of HELLP syndrome: Patterns of disease progression and regression

American Journal of Obstetrics and Gynecology ◽

10.1016/0002-9378(91)91429-z ◽

1991 ◽

Vol 164 (6) ◽

pp. 1500-1513 ◽

Cited By ~ 200

Author(s):

James N. Martin ◽

Pamela G. Blake ◽

Kenneth G. Perry ◽

James F. McCaul ◽

L. Wayne Hess ◽

...

Keyword(s):

Natural History ◽

Disease Progression ◽

Hellp Syndrome ◽

History Of ◽

Syndrome Patterns

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Long-Term Response after 94 Cycles of Trabectedin in a Patient with Metastatic Leiomyosarcoma of the Lower Extremity

Case Reports in Oncology ◽

10.1159/000505393 ◽

2020 ◽

Vol 13 (1) ◽

pp. 113-119 ◽

Cited By ~ 2

Author(s):

Magda Cordeiro ◽

José Manuel Casanova ◽

Joana Rodrigues ◽

João Freitas ◽

Ruben Fonseca ◽

...

Keyword(s):

Quality Of Life ◽

Soft Tissue ◽

Lower Extremity ◽

Disease Progression ◽

Stable Disease ◽

Case Reports ◽

Soft Tissue Sarcomas ◽

Term Therapy

Leiomyosarcomas of the lower extremity are extremely rare disorders and account for 10–15% of limb soft tissue sarcomas. These tumours have poor prognosis and even in early stages, patients persist at high risk for local and distant relapse; consequently, the treatment of advanced leiomyosarcoma of the lower extremity embodies a substantial defy. We present the case of a 73-year-old man diagnosed with metastatic lower extremity leiomyosarcoma of the hallux soft tissue, and with bone, lung and lymph node metastasis. After core needle biopsy confirmation of high-grade fusocellular sarcoma, the patient underwent surgery of the primary tumour and received anthracycline-based chemotherapy. However, after a 7-month progression-free survival period, a CT revealed lung disease progression. Sequentially, the patient was treated with trabectedin (Yondelis®) at a dose of 1.5 mg/m2 resulting in complete remission of the lung metastasis and stable disease of the remaining lesions after 26 months of treatment. Afterwards, the patient started on maintenance therapy with trabectedin, resulting in long-lasting stable disease, as he was able to receive 94 cycles with very acceptable quality of life. Finally, in March 2019, the patient died of community-acquired pneumonia without objective progression disease. This clinical case reports the first patient ever treated with 94 cycles of trabectedin. Our results additionally confirm that trabectedin wields relevant oncostatic benefits with a manageable safety profile and without cumulative toxicities. Trabectedin properties enable a maintenance long-term therapy (until disease progression or unbearable toxicity), with a high impact on survival and with a preserved quality of life.

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Larotrectinib in a Patient With Advanced Pleomorphic Liposarcoma of the Uterus

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2021.7039 ◽

2021 ◽

Vol 19 (7) ◽

pp. 775-779

Author(s):

Anisley Valenciaga ◽

O. Hans Iwenofu ◽

Gabriel Tinoco

Keyword(s):

Genetic Testing ◽

Disease Progression ◽

First Generation ◽

Case Reports ◽

Smooth Muscle Actin ◽

Treatment Options ◽

Disease Recurrence ◽

Endometrial Biopsy ◽

Pleomorphic Liposarcoma ◽

First Case

Pleomorphic liposarcoma of the uterus (PLU) is an extremely rare disease with poor prognosis. Limited treatment options exist for these patients, and disease recurrence usually occurs rapidly within months of initial diagnosis. Few case reports of metastatic PLU are available in the literature. We describe a 70-year-old woman who presented with a large uterus and ovarian mass on imaging and negative serum tumor markers and endometrial biopsy. Staging revealed localized disease. Surgical resection revealed PLU on pathology. Immunohistochemistry was negative for smooth muscle actin (SMA), S100, and MDM2, and positive for CD10 and cyclin-D1. She was treated with adjuvant therapy and experienced disease recurrence in the liver at 15 months from surgery. Genetic testing of the metastasis showed IQGAP-NTRK3 gene fusion. She was given entrectinib but continued to show progression in the liver. Right partial hepatectomy was performed, showing positivity for CD10, BCL-1, MDM2, and SMA on tumor staining. Treatment was switched to pazopanib with disease progression in the neck. She was treated with larotrectinib last, showing no disease progression and adequate tolerance of therapy after 18 months of this treatment. This is the first case in the literature of metastatic PLU with NRTK3 fusion treated with sequential first-generation NRTK inhibitors. More case reports are needed to identify commonalities and therapeutic options. Genetic testing in all PLU cases is needed for targeted therapy approaches.

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A Case of Orbital Metastasis as Disease Progression of Anaplastic Lymphoma Kinase-Positive Lung Cancer Treated with Crizotinib

Case Reports in Oncology ◽

10.1159/000371719 ◽

2015 ◽

Vol 8 (1) ◽

pp. 21-24 ◽

Cited By ~ 2

Author(s):

Yoshihiko Sakata ◽

Kodai Kawamura ◽

Kazuya Ichikado ◽

Masakazu Yoshioka

Keyword(s):

Lung Cancer ◽

Adverse Events ◽

Disease Progression ◽

Anaplastic Lymphoma Kinase ◽

Kinase Inhibitor ◽

Case Reports ◽

Orbital Metastasis ◽

Visual Disorder ◽

Anaplastic Lymphoma ◽

Alk Positive

Orbital metastasis of lung cancer is rare. It often causes visual disorder. To date, there are only a few case reports. Crizotinib is an anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor that leads to responses in most patients with ALK-positive non-small-cell lung cancer. Visual disorder is one of the popular adverse events of crizotinib, but the symptom almost decreases over time. We report a case of orbital metastasis as the disease progression of ALK-positive lung cancer treated with crizotinib. It should be kept in mind that orbital metastasis can be the disease progression of lung adenocarcinoma with ALK translocation treated with crizotinib. When physicians encounter a patient receiving crizotinib with visual disorder, we must distinguish between adverse events and orbital metastasis.

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COVID-19 and Pregnancy: An Unusual Case with Multi-Systemic Failure

Case Reports in Obstetrics Gynecology and Reproductive ◽

10.31487/j.crogr.2020.02.04 ◽

2020 ◽

pp. 1-3

Author(s):

Corinne Hubinont ◽

Barta A ◽

Cheron AC ◽

Christophe JL ◽

Doucet F ◽

...

Keyword(s):

Liver Failure ◽

Hellp Syndrome ◽

Unusual Case ◽

Case Reports ◽

First Case ◽

Fetal Complications

In December 2019, a new strain of coronavirus, SARS-CoV-2, was discovered in Wuhan and quickly became responsible for a worldwide pandemic. The first case reports of COVID-19 in pregnant patients are reassuring and no severe maternal-fetal complications have been reported. We present a case of SARSCoV-2 infection during pregnancy presenting with renal and liver failure, suggesting similarity with pregnancy related HELLP syndrome and gestational cholestasis.

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Durable response after discontinuation of nivolumab therapy in the absence of disease progression or toxicity with two advanced NSCLC patients

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155219867131 ◽

2019 ◽

Vol 26 (3) ◽

pp. 761-767 ◽

Cited By ~ 2

Author(s):

Mesut Yilmaz ◽

Sermin Guven Mese

Keyword(s):

Disease Progression ◽

Immune Checkpoint ◽

Advanced Nsclc ◽

Checkpoint Inhibitors ◽

Case Reports ◽

Durable Response ◽

Programmed Cell Death 1 ◽

Different Types ◽

Line Setting ◽

Nsclc Patients

Background Nivolumab is an immune checkpoint inhibitor that selectively blocks the programmed cell death-1 (PD-1). Nowadays, immune checkpoint inhibitors such as nivolumab are used in the treatment of many different types of cancer. In prospective clinical trials, the duration of therapy with nivolumab has been defined as up to the time of progressive disease or treatment limiting toxicity. Case reports In this article, we present two advanced non-small cell lung cancer (NSCLC) patients that were treated with anti-PD-1 monotherapy in the second-line setting. They have received nivolumab for nine and five months, respectively. After discontinuation of immunotherapy agent because of socioeconomic reasons, they had a durable response. Management and outcome After the discontinuation of nivolumab in the absence of progression or toxicity, the clinic and radiologic response are still ongoing. Discussion Optimal duration of anti-PD-1 therapy has not been established. There are some reports that indicate the durable response for the patients who have interrupted immunotherapy because of toxicity. Here, we present two advanced NSCLC patients having a durable response after discontinuing the treatment in the absence of toxicity and disease progression. More extensive research is needed to determine which subgroups of patients treated with immunotherapy can cease treatment and maintain an ongoing response.

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Liver rupture in HELLP syndrome

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2013-0083 ◽

2015 ◽

Vol 4 (1) ◽

Author(s):

Katrin Jungfleisch ◽

Monica Fittschen ◽

Hans-Jürgen Rapp ◽

Henry Schäfer ◽

Franz Bahlmann

Keyword(s):

Hellp Syndrome ◽

Clinical Symptoms ◽

Case Reports ◽

Uneventful Recovery ◽

Caucasian Woman ◽

Liver Rupture ◽

Hepatic Hematoma ◽

Post Surgery ◽

Elevated Liver Enzymes ◽

Hepatic Subcapsular Hematoma

AbstractWe report on a 30-year-old Caucasian woman admitted to our clinic after 34 weeks of gestation because of a severe partial hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. A cesarean section was performed when her clinical symptoms and laboratory values worsened. Intraoperatively she was diagnosed with hepatic subcapsular hematoma and liver rupture. Surgical treatment, including perihepatic packing with sterile towels removed 2 days post-surgery, resulted in an uneventful recovery. The patient was discharged 26 days after admission. Case reports such as ours may contribute to the management of pregnancies complicated by hepatic hematoma and rupture of the liver capsule associated to HELLP syndrome.

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