Extremely Long Survival under Combined Immunotherapy in a Metastatic Functional Neuroendocrine Neoplasia Patient

2017 ◽  
Vol 106 (4) ◽  
pp. 381-388 ◽  
Author(s):  
Daniel Schmidt ◽  
Bertram Wiedenmann
Keyword(s):  
Advanced Disease ◽  
Residual Disease ◽  
Ki 67 ◽  
Neuroendocrine Neoplasia ◽  
Gastric Type ◽  
Tumor Load ◽  
Stage Ivb ◽  
Multimodality Approach ◽  
Combined Immunotherapy

Treatment and prognosis of neuroendocrine neoplasia depends on tumor size, stage, grade, resectability, and extent of distant metastasis. In most cases a multimodality approach including surgical, locally invasive procedures, peptide-guided radioreceptor therapy (PRRT), and medical therapies represent the mainstay of treatment in advanced disease. In the reported case, a 68-year-old man was diagnosed in 2010 with an initially functional (histamine) neuroendocrine tumor of gastric type III, G2, stage IVB, cT4cN1cM1 (hepatic, peritoneal, nodal, osseous), including a hepatic tumor load of 25%. Intensive multimodality approaches including combined immunotherapy (vaccination and PD-1/CTLA-4 blockade) led to a survival of 8 years until now with a high quality of life and minimal residual disease (only a single, small paragastric recurrence) despite the dedifferentiation of the tumor into a neuroendocrine carcinoma G3 (Ki-67 of 80%) including a nonfunctional stage.

scholarly journals Loss of cIAP1 in Endothelial Cells Limits Metastatic Extravasation through Tumor-Derived Lymphotoxin Alpha

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 599
Author(s):  
Lazaros Vasilikos ◽  
Kay Hänggi ◽  
Lisanne M. Spilgies ◽  
Samanta Kisele ◽  
Stefanie Rufli ◽  
...  
Keyword(s):  
Tumor Cell ◽  
Tumor Cells ◽  
Advanced Disease ◽  
Disease Stage ◽  
Stromal Compartment ◽  
Tumor Load ◽  
Smac Mimetics ◽  
Advanced Disease Stage ◽  
Lymphotoxin Alpha ◽  
Open Question

In this study, we determined whether Smac mimetics play a role in metastasis, specifically in circulation, tumor extravasation and growth in a metastatic site. Reports suggest inducing the degradation of IAPs through use of Smac mimetics, alters the ability of the tumor cell to metastasize. However, a role for the immune or stromal compartment in affecting the ability of tumor cells to metastasize upon loss of IAPs has not been defined. To address this open question, we utilized syngeneic tumor models in a late-stage model of metastasis. Loss of cIAP1 in the endothelial compartment, rather than depletion of cIAP2 or absence of cIAP1 in the hematopoietic compartment, caused reduction of tumor load in the lung. Our results underline the involvement of the endothelium in hindering tumor cell extravasation upon loss of cIAP1, in contrast to the immune compartment. Endothelial specific depletion of cIAP1 did not lead to cell death but resulted in an unresponsive endothelium barrier to permeability factors causing a decrease in tumor cell extravasation. Surprisingly, lymphotoxin alpha (LTA), and not TNF, secreted by the tumor cells, was critical for the extravasation. Using TCGA, we found high LTA mRNA expression correlated with decreased survival in kidney carcinoma and associated with advanced disease stage. Our data suggest that Smac mimetics, targeting cIAP1/2, reduce metastasis to the lung by inhibiting tumor cell extravasation.

scholarly journals Osteoarthritis in pet guinea pigs: an update on diagnosis, treatment and management

2021 ◽  
Vol 26 (6) ◽  
pp. 100-106
Author(s):  
Emma Keeble
Keyword(s):  
Quality Of Life ◽  
Early Diagnosis ◽  
Guinea Pigs ◽  
Advanced Disease ◽  
Early Stage ◽  
Clinical Signs ◽  
Nutritional Supplements ◽  
Lifestyle Changes ◽  
Early Age

This article reviews the current literature on osteoarthritis in pet and laboratory guinea pigs. The associated clinical signs, diagnosis and treatment of osteoarthritis in pet guinea pigs will be discussed, with options for analgesia detailed. This condition is thought to be common in pet guinea pigs, even from an early age in some genetic lines, although osteoarthritis often goes undiagnosed in this species until advanced disease is present, posing a major welfare concern. Increasing awareness of this condition in veterinary practitioners should aid early diagnosis in pets and help improve their quality of life. Prevention may be possible using oral protective nutritional supplements to slow down the progression of this disease at an early stage. Lifestyle changes are also discussed for the management of this condition in pet guinea pigs.

PATHOPHYSIOLOGY OF ONCOLOGICAL PAIN: REVIEW OF LITERATURE

2020 ◽  
Vol 7 (1) ◽  
pp. 59-61
Author(s):  
Lucas Yago Souza Schmidt ◽  
Ana Flávia de Oliveira Castro ◽  
João Gabriel Lopes Siqueira ◽  
Dowglas Pereira De Oliveira ◽  
Welma Rezende Fuso De Assis
Keyword(s):  
Cancer Metastasis ◽  
Advanced Disease ◽  
Primary Site ◽  
Anxiety And Depression ◽  
Review Of Literature ◽  
Biological Mechanisms ◽  
Related Factors ◽  
Educational Support ◽  
Health Team

Despite the contributions to the diagnosis and treatment of cancer, the disease continues to present an adverse effect on patients' quality of life, with pain being a frequent complaint, with a prevalence varying from 50 to 53% in cancer patients at all stages and up to 70 % in cases of advanced disease. Cancer pain ismanifested by the primary site of cancer, metastasis, bone involvement, proximity to the nervous system, production of pain-promoting chemicals, and patient-related factors such as anxiety and depression. Because it is subjective, not palpable, and an individual experience and difficult to evaluate, requires for the health team educational support, knowledge and instruments that contribute to their understanding, being the elucidation of its biological mechanisms object of this literature review.

Patients’ Awareness of Advanced Disease Status, Psychological Distress and Quality of Life Among Patients With Advanced Cancer: Results From the APPROACH Study, India

2021 ◽  
pp. 104990912110428
Author(s):  
Aanchal Satija ◽  
Sushma Bhatnagar ◽  
Semra Ozdemir ◽  
Eric Finkelstein ◽  
Chetna Maholtra ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Psychological Distress ◽  
Advanced Cancer ◽  
Cancer Diagnosis ◽  
Advanced Disease ◽  
Disease Status ◽  
Educational Background ◽  
Solid Cancer ◽  
Cross Sectional

Background: Prognostic disclosure to patients with advanced cancer facilitates treatment decisions and goals of care discussions. However, the perspectives of patients, families and physicians differ in this regard across different cultures. Non-disclosure of cancer diagnosis or prognosis is commonly observed in family-centric cultures such as India. Aim: To assess the prevalence of and factors associated with cancer patients’ awareness of advanced disease status; and its with quality of life and psychological distress. Methods: Patients for this cross-sectional questionnaire-based survey were recruited from oncology and palliative medicine clinics at a tertiary cancer hospital in India from January 2017 to June 2018. Patients aged ≥ 21 years, aware of cancer diagnosis and receiving oncology treatment for Stage IV solid cancer were included in the study after obtaining written informed consent. Results: Two hundred patients were enrolled, of which 146 (73%) were not aware of the stage of their malignancy and 9 (4.5%) believed that their disease was at stage I, II or III. Those who were aware of their advanced cancer stage had more years of education (9.9 years vs 8.1 years, p = .05) and had poorer spiritual wellbeing in the faith domain (adjusted difference −1.6, 95% confidence interval −3.1 to −0.1, p = .03) compared to those who were unaware. Conclusion: It is recommended that future studies may explore prognostic understanding in Indian patients according to their socio-cultural, spiritual and educational background.

Surgical Approach to Cervical Lymph Node Metastasis in Differentiated Thyroid Cancer

2002 ◽  
Vol 88 (3) ◽  
pp. S47-S48 ◽  
Author(s):  
M Goss ◽  
S D'Amico ◽  
A Mobiglia ◽  
A Sargiotto ◽  
M Deandrea
Keyword(s):  
Lymph Node ◽  
Residual Disease ◽  
Intraoperative Complications ◽  
Residual Tumor ◽  
Cervical Lymph Node Metastasis ◽  
Regional Lymph Nodes ◽  
Tumor Spread ◽  
Metastatic Lesions ◽  
Tissue Specimens

Background Precautionary locoregional lymph node dissection in thyroid carcinomas for diagnostic and/or staging purposes is useless both in differentiated (papillary and follicular) and undifferentiated forms. It is only indicated in medullary carcinomas because of their frequent spread to regional lymph nodes. The objective of lymphadenectomy is to contain tumor spread; however, the procedure may be associated with intraoperative complications and postoperative sequelae. In order to improve the therapeutic management of patients with thyroid carcinoma, diagnostic scintigraphy with 201Tl or 99mTc-sestamibi is used in the advanced and undifferentiated forms of this tumor. Methods We have treated a woman submitted three years previously to total thyroidectomy for papillary carcinoma (pT3) without subsequent radiometabolic treatment. On physical examination we noticed a swelling on the left side of the neck. The lesion was confirmed by ultrasonography, CT scan, and scintigraphic examination with 99mTc-sestamibi 24 hours before planned lymphadenectomy. During the surgical procedure we performed radiodetection to localize metastatic lesions. Results Intraoperative radiodetection may help to identify residual disease, which is often difficult to trace in the presence of post-surgical fibrosis. In our patient, histological examination of the removed tissue specimens demonstrated that intraoperative radiolocalization had been highly accurate. The eradication of residual disease was confirmed by scintigraphic follow-up after 12 months. Discussion and conclusions Scintigraphy with 99mTc-sestamibi has been proposed as a means to localize metastatic spread and possible residual disease after a supposedly radical thyroidectomy. Surgical eradication of all residual tumor guarantees the best disease control without having to resort to radiometabolic therapy. This approach will reduce the incidence of iatrogenic comorbidity and consequently improve the patients' quality of life.

scholarly journals Quality of Response in Acute Myeloid Leukemia: The Role of Minimal Residual Disease

Cancers ◽  
2019 ◽  
Vol 11 (10) ◽  
pp. 1417
Author(s):  
Maurillo ◽  
Bassan ◽  
Cascavilla ◽  
Ciceri
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Residual Disease ◽  
Current Evidence ◽  
Tailored Therapy ◽  
Factors Associated ◽  
Minimal Residual ◽  
Acute Myeloid

: In the acute myeloid leukemia (AML) setting, research has extensively investigated the existence and relevance of molecular biomarkers, in order to better tailor therapy with newly developed agents and hence improve outcomes and/or save the patient from poorly effective therapies. In particular, in patients with AML, residual disease after therapy does reflect the sum of the contributions of all factors associated with diagnosis and post-diagnosis resistance. The evaluation of minimal/measurable residual disease (MRD) can be considered as a key tool to guide patient’s management and a promising endpoint for clinical trials. In this narrative review, we discuss MRD evaluation as biomarker for tailored therapy in AML patients; we briefly report current evidence on the use of MRD in clinical practice, and comment on the potential ability of MRD in the assessment of the efficacy of new molecules.

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