scholarly journals Treatment of Leptomeningeal Carcinomatosis in a Patient with Metastatic Pancreatic Cancer: A Case Report and Review of the Literature

2018 ◽  
Vol 11 (2) ◽  
pp. 281-288 ◽  
Author(s):  
William Rainey Johnson ◽  
Brett J. Theeler ◽  
David Van Echo ◽  
Patrick Young ◽  
Mary Kwok
Keyword(s):  
Pancreatic Cancer ◽  
Systemic Chemotherapy ◽  
Systemic Disease ◽  
Leptomeningeal Carcinomatosis ◽  
Metastatic Pancreatic Cancer ◽  
Leptomeningeal Disease ◽  
First Case ◽  
History Of ◽  
The Central Nervous System

Pancreatic cancer is the fourth leading cause of cancer-related death with a median survival of 3–11 months when metastatic. We present a patient with metastatic pancreatic cancer and an exceptional response to initial systemic chemotherapy with FOLFIRINOX (fluorouracil, leucovorin, irinotecan, and oxaliplatin). Despite evidence of disease control on body imaging, he developed symptomatic leptomeningeal disease and brain metastases 29 months into treatment. He received aggressive treatment with capecitabine and irinotecan, intrathecal topotecan, and eventually bevacizumab. He did well for 36 weeks on this regimen until developing sepsis. This patient significantly outlived his expected survival and, moreover, did so with very good quality of life. This case demonstrates the natural history of pancreatic cancer progressing to involve the central nervous system when systemic disease is otherwise responsive to chemotherapy. It is the first case to demonstrate the potential effectiveness of intrathecal topotecan in combination with systemic chemotherapy for the treatment of leptomeningeal metastases of pancreatic cancer.

scholarly journals Metastatic Pancreatic Cancer with BRAF and P53 Mutations: Case Report of Therapeutic Response to Doublet Targeted Therapy

2020 ◽  
Vol 13 (3) ◽  
pp. 1239-1243
Author(s):  
Shenthol Sasankan ◽  
Lorraine Rebuck ◽  
Gloria Darrah ◽  
Moises Harari Turquie ◽  
Ian Rabinowitz
Keyword(s):  
Pancreatic Cancer ◽  
Case Report ◽  
Targeted Therapy ◽  
Therapeutic Response ◽  
Case Reports ◽  
Clinical History ◽  
P53 Mutation ◽  
Metastatic Pancreatic Cancer ◽  
First Case ◽  
History Of

We report on the clinical history of a 49-year-old female with metastatic pancreatic cancer. She was initially treated with standard chemotherapy as per current guidelines. She was found to have both a BRAF and P53 mutation, and received dabrafenib and trametinib with deep responses, both radiographically and biochemically (CA19-9). Her response has been more clinically relevant than responses in previous case reports of patients with BRAF-positive pancreatic cancer treated with targeted therapy. To the best of our knowledge, this is the first case report showing a dramatic therapeutic response to combination therapy with dabrafenib and trametinib in metastatic pancreatic cancer.

scholarly journals CMET-34. IMPROVEMENT OF LEPTOMENINGEAL DISEASE FOLLOWING INFECTIOUS MENINGITIS

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi59-vi59 ◽  
Author(s):  
Nicholas Metrus ◽  
Carolos Kamiya ◽  
Shiao-Pei Weathers ◽  
Christa Seligman ◽  
Barbara O’Brien
Keyword(s):  
Median Survival ◽  
Post Infection ◽  
Systemic Disease ◽  
Cancer Center ◽  
Cns Infection ◽  
Leptomeningeal Disease ◽  
History Of ◽  
Md Anderson ◽  
To Receive ◽  
Systemic Therapies

Abstract INTRODUCTION The incidence of leptomeningeal disease (LMD) is increasing, due to better imaging, earlier diagnosis and improved systemic disease control. However, many of the systemic therapies do not cross the blood brain barrier (BBB) and, despite treatment with radiation and/or intrathecal (IT) chemotherapy, median survival is approximately 4-6months in solid tumors complicated by LMD. Repeated IT injections increase the risk of CNS infection. Preclinical models have shown that infectious meningitis transiently modifies the BBB. METHODS Our series consisted of 6 LMD patients (5 breast cancer primary, 1 lung cancer primary) treated on IT chemotherapy at MD Anderson Cancer Center between 2013 and 2018, who subsequently developed infectious meningitis. Three patients had history of parenchymal metastases in addition to LMD and four had history of radiation to brain and/or spine. LMD was confirmed by cytology and/or imaging. All were treated with IT topotecan. RESULTS CSF cultures were positive for Proprionobacterium acnes in three patients, Pseudomonas aeruginosa in two, and Raoultella ornithinolytica in one, who died shortly thereafter. Antibiotic regimens were variable. Three patients went on to receive IT chemotherapy post-infection (two never discontinued IT chemotherapy throughout infection). Those that had IT chemotherapy post-infection cleared CSF and imaging findings of LMD or maintained stability of radiographic LMD burden until death. No patients died directly from LMD. One patient, who developed infection after Ommaya placement and was never initiated on IT chemotherapy, still cleared his CSF of malignant cells. Excluding the patient who died shortly after meningitis diagnosis, the average time from meningitis diagnosis to death was 8.8 months and the average median survival from LMD diagnosis to death was 14 months. CONCLUSION Our findings support further evaluating the safety and timing of IT chemotherapy with active infectious meningitis and the potential synergistic benefit of increased immunogenicity and chemotherapy in LMD.

Emerging concepts in combination chemotherapy for metastatic pancreatic cancer: A systematic review of randomized controlled trials.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 228-228
Author(s):  
Basile M. Njei ◽  
Ivo C. Ditah ◽  
Alexei Shimanovsky ◽  
Priscilla Owusu ◽  
John W Birk
Keyword(s):  
Quality Of Life ◽  
Pancreatic Cancer ◽  
Overall Survival ◽  
Combination Therapy ◽  
Adverse Events ◽  
Combination Chemotherapy ◽  
Metastatic Pancreatic Cancer ◽  
Controlled Trials ◽  
Randomized Controlled

228 Background: Even though gemcitabine monotherapy is commonly used as first-line treatment for metastatic pancreatic cancer, many novel treatment approaches have focused on combination chemotherapy. FOLFIRINOX, a combination of 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin, has recently been shown to improve survival compared to gemcitabine. However, it is unclear whether survival benefits are counterbalanced by a poor quality of life due to the adverse effects. The aim of this study was to review emerging strategies that enhance treatment of patients with metastatic pancreatic cancer. Methods: Two authors independently conducted a comprehensive search of the Cochrane library PUBMED, and published proceedings from major oncologic and gastrointestinal cancer meetings from January 1980 to July 2012. Only published randomized controlled trials were eligible for inclusion. Our primary outcome measures were: progression-free survival (PFS), overall survival (OS) and serious adverse events (grade 3 or 4). Results: Thirty-one studies involving 7,957 patients were included in the analysis. There was an overall statistically significant increase in OS (RR 1.10, 95% CI 1.03-1.30) and PFS (RR 1.27, 95% CI 1.14-1.46) for the gemcitabine-based combination therapy group versus the gemcitabine monotherapy group. Subgroup analysis showed that only patients with fluoropyrimidine and platinum containing regimens showed prolonged survival: RR 1.33, 95% CI 1.04-1.76 and RR 1.38, 95% CI 1.08-1.76, respectively. The most common severe adverse event (neutropenia) was found in 45% of patients treated with FOLFIRINOX. Conclusions: Overall, gemcitabine in combination with fluoropyrimidine or platinum containing regimens can improve overall survival in patients with metastatic pancreatic cancer compared to gemcitabine alone. Even though, FOLFIRINOX therapy is associated with better survival outcomes than gemcitabine, the prolonged survival comes at the cost of poorer quality of life due to a higher incidence of adverse events. More data is needed from studies involving novel combination therapy such as hedgehog pathway inhibitors and radio-immunotherapy.

scholarly journals Spinal subarachnoid haemorrhage secondary to spinal rheumatoid vasculitis: a case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yeqing Xiao ◽  
Jie Yang ◽  
Jian Xia ◽  
Yunhai Liu ◽  
Qing Huang ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Central Nervous System ◽  
Subarachnoid Haemorrhage ◽  
Therapeutic Effects ◽  
Rheumatoid Vasculitis ◽  
Low Disease Activity ◽  
Case Presentation ◽  
First Case ◽  
History Of ◽  
The Central Nervous System

Abstract Introduction Spinal subarachnoid haemorrhage is extremely rare in cases of subarachnoid haemorrhage and possesses servere characteristics. Additionally, spinal rheumatoid vasculitis is rare for spinal subarachnoid haemorrhage. The pathogenesis is unknown. Case presentation A 52-year-old woman with a 10-year history of seropositive rheumatoid arthritis was managed with leflunomide and celecoxib, and stable low disease activity was achieved. The patient had also been diagnosed with spinal subarachnoid haemorrhage secondary to isolated spinal rheumatoid vasculitis and obtained good therapeutic effects. Conclusion This is the first case to describe spinal subarachnoid haemorrhage secondary to isolated spinal vasculitis in a patient with rheumatoid arthritis, which provides more proof of anomalous neovascularization in the central nervous system in rheumatoid arthritis.

scholarly journals Isolated neuroparacoccidioidomycosis as a pseudotumoral lesion in the absence of systemic disease

2020 ◽  
Vol 11 ◽  
pp. 151
Author(s):  
Ricardo Salemi Riechelmann ◽  
Leonardo Henrique Rodrigues ◽  
Tiago Marques Avelar ◽  
Paulo Adolfo Xander ◽  
Guilherme Henrique da Costa ◽  
...  
Keyword(s):  
Parietal Lobe ◽  
Paracoccidioides Brasiliensis ◽  
Systemic Disease ◽  
Brain Magnetic Resonance Imaging ◽  
Antifungal Drugs ◽  
Histopathological Analysis ◽  
History Of ◽  
The Central Nervous System ◽  
Expansive Lesion ◽  
Head Computed Tomography

Background: Paracoccidioidomycosis (PCM) is a systemic, progressive, noncontagious, and often chronic disease caused by the fungus Paracoccidioides brasiliensis that rarely affects the central nervous system (CNS). The condition is usually treated using antifungal drugs, and some cases may require surgery. Case Description: A 55-year-old man, a smoker, without known comorbidities, was referred to the neurosurgery team with a history of a single epileptic seizure a week before hospital admission followed by progressive right- sided hemiparesis. Head computed tomography and brain magnetic resonance imaging showed an intra-axial expansive lesion affecting the left parietal lobe, associated with extensive edema and a regional compressive effect producing slight subfalcine herniation that was initially managed as an abscess. After the failure of antibiotic treatment, the patient underwent a neurosurgical procedure for excision of the lesion. Histopathological analysis revealed that it was PCM and there was no evidence of impairment of other systems due to the disease. Conclusion: PCM can be a serious, debilitating disease and is potentially fatal. Although isolated CNS involvement is rare, it must be considered, especially in endemic areas, as late diagnosis and treatment severely decreases good outcome rates.

Multifocal Intradural Extramedullary Pilocytic Astrocytomas of the Spinal Cord: A Case Report and Review of the Literature

Neurosurgery ◽  
2016 ◽  
Vol 80 (2) ◽  
pp. E178-E184 ◽  
Author(s):  
Azam Basheer ◽  
Richard Rammo ◽  
Steven Kalkanis ◽  
Michelle M. Felicella ◽  
Mokbel Chedid
Keyword(s):  
Spinal Cord ◽  
Pediatric Population ◽  
Previous History ◽  
Ataxic Gait ◽  
First Case ◽  
Pilocytic Astrocytomas ◽  
History Of ◽  
The Central Nervous System ◽  
Intradural Extramedullary ◽  
Brain Involvement

Abstract BACKGROUND AND IMPORTANCE: Pilocytic astrocytoma (PA) is among the most common of the central nervous system gliomas in the pediatric population; however, it is uncommon in adults. PAs of the spinal cord in adults are even rarer, with only a few cases found in the literature. We report here the first case in the literature of multifocal intradural extramedullary spinal cord PAs in an adult. CLINICAL PRESENTATION: Our patient is a 56-yr-old female who presented with loss of balance and an ataxic gait. Multiple extramedullary spinal cord tumors were identified intraoperatively, the lesions completely resected, and all diagnosed as PAs. CONCLUSION: This case illustrates a unique instance of multifocal intradural extramedullary spinal cord PAs in an adult with no previous history of PA during childhood, no known familial syndromes, and no brain involvement.

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