scholarly journals Prolonged Survival of a Patient with Advanced-Stage Combined Hepatocellular-Cholangiocarcinoma

2020 ◽  
Vol 14 (3) ◽  
pp. 658-667
Author(s):  
Sven H. Loosen ◽  
Nadine T. Gaisa ◽  
Maximilian Schmeding ◽  
Christoph Heining ◽  
Sebastian Uhrig ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Primary Liver Cancer ◽  
Advanced Stage ◽  
Rare Type ◽  
Treatment Protocols ◽  
Genetic Landscape ◽  
Standardized Treatment ◽  
Genomic Studies ◽  
Combined Hepatocellular Cholangiocarcinoma

Combined hepatocellular-cholangiocarcinoma (cHCC/CCA) represents a rare type of primary liver cancer with a very limited prognosis. Although just recently genomic studies have contributed to a better understanding of the disease’s genetic landscape, therapeutic options, especially for advanced-stage patients, are limited and often experimental, as no standardized treatment protocols have been established to date. Here, we report the case of a 38-year-old male patient who was diagnosed with extensive intrahepatic cHCC/CCA in an otherwise healthy liver without signs of chronic liver disease. An interdisciplinary stepwise therapeutic approach including locoregional liver-targeted therapy, systemic chemotherapy, liver transplantation, surgical pulmonary metastasis resection, and next-generation sequencing-based targeted therapy led to a prolonged overall survival beyond 5 years with an excellent quality of life. This case report comprises several provocative treatment decisions that are extensively discussed in light of the existing literature on this rare but highly aggressive malignancy.

scholarly journals Checkpoint Inhibition Causing Complete Remission of Metastatic Combined Hepatocellular-Cholangiocarcinoma after Hepatic Resection

2020 ◽  
Vol 13 (1) ◽  
pp. 478-484 ◽  
Author(s):  
Magnus Rizell ◽  
Fredrik Åberg ◽  
Mats Perman ◽  
Lars Ny ◽  
Liselotte Stén ◽  
...  
Keyword(s):  
Liver Cancer ◽  
Complete Remission ◽  
Pulmonary Metastases ◽  
Primary Liver Cancer ◽  
Cancer Recurrence ◽  
Checkpoint Inhibition ◽  
Rare Type ◽  
Serum Alpha Fetoprotein ◽  
Combined Hepatocellular Cholangiocarcinoma ◽  
Third Line

Combined hepatocellular-cholangiocarcinoma (CHC) is a rare type of primary liver cancer, speculated to arise from hepatic progenitor cells, and with a worse prognosis than hepatocellular carcinoma (HCC). Serum alpha-fetoprotein (AFP) levels may be one prognostic factor. It has been suggested that checkpoint inhibition might be useful in the treatment of HCC where there is an increased expression of PD-1 and PD-L1 in the microenvironment. Its effect on CHC is unknown. We report a case with a large CHC, which was radically resected, but the 53-year-old female patient subsequently developed pulmonary metastases. Histology demonstrated low-differentiated CHC without microsatellite instability. Treatment with sorafenib was started but was stopped due to angioedema. Under subsequent gemcitabine/cisplatin treatment, the metastatic disease progressed with rising AFP levels. A third-line treatment with pembrolizumab was then started, 2 mg/kg b.w. i.v. every third week for 6 months. This resulted in a radiologically complete remission of the pulmonary metastases and AFP levels were normalized (<10 μg/L) from a level of 1,790 μg/L before treatment. The patient developed immune-related adverse events (AEs) including diarrhea and hepatitis. These AEs were successfully treated with prednisolone and mycophenolate mofetil, and they were eventually resolved. There are no signs of cancer recurrence neither in the liver nor in the lungs at 33 months after the start of the checkpoint inhibition treatment, and the patient is doing well. Further study is urgently needed on the role of checkpoint inhibition therapy in liver cancer.

scholarly journals Hormonal Treatment Strategies Tailored to Non-Binary Transgender Individuals

2020 ◽  
Vol 9 (6) ◽  
pp. 1609 ◽  
Author(s):  
Carlotta Cocchetti ◽  
Jiska Ristori ◽  
Alessia Romani ◽  
Mario Maggi ◽  
Alessandra Daphne Fisher
Keyword(s):  
Treatment Strategies ◽  
Hormonal Treatment ◽  
Well Being ◽  
Clinical Approach ◽  
Treatment Protocols ◽  
Treatment Regimens ◽  
Transgender Persons ◽  
Standardized Treatment ◽  
Current Guidelines

Introduction: To date no standardized hormonal treatment protocols for non-binary transgender individuals have been described in the literature and there is a lack of data regarding their efficacy and safety. Objectives: To suggest possible treatment strategies for non-binary transgender individuals with non-standardized requests and to emphasize the importance of a personalized clinical approach. Methods: A narrative review of pertinent literature on gender-affirming hormonal treatment in transgender persons was performed using PubMed. Results: New hormonal treatment regimens outside those reported in current guidelines should be considered for non-binary transgender individuals, in order to improve psychological well-being and quality of life. In the present review we suggested the use of hormonal and non-hormonal compounds, which—based on their mechanism of action—could be used in these cases depending on clients’ requests. Conclusion: Requests for an individualized hormonal treatment in non-binary transgender individuals represent a future challenge for professionals managing transgender health care. For each case, clinicians should balance the benefits and risks of a personalized non-standardized treatment, actively involving the person in decisions regarding hormonal treatment.

scholarly journals New therapies for alopecia areata

2021 ◽  
Vol 97 (5) ◽  
pp. 251-258
Author(s):  
Adriána Evelin Csernus ◽  
◽  
Rolland Gyulai
Keyword(s):  
Quality Of Life ◽  
Alopecia Areata ◽  
Therapeutic Strategies ◽  
European Medicines Agency ◽  
Treatment Protocols ◽  
The Past ◽  
Emerging Therapies ◽  
Standardized Treatment ◽  
New Treatment

Over the past few years, better understanding of the explicit pathomechanism of alopecia areata provides new treatment opportunities for effective therapy of the disease, which may revolutionize therapeutic strategies. This exceedingly heterogeneous disease with unpredictable outcome, severely affects the quality of life. Currently, there are no standardized treatment protocols approved by the European Medicines Agency (EMA), resulting a challenge for the therapists in the choice of treatment.In this paper, the authors summarize recent and emerging therapies for severe cases of alopecia areata.

Primary Peritoneal Serous Psammocarcinoma: a Case Report

2015 ◽  
Vol 24 (2) ◽  
pp. 253-256 ◽  
Author(s):  
Răzvan Dan Togănel ◽  
Ioan Şimon ◽  
Adriana Zolog ◽  
Răzvan Simescu ◽  
Angela Cozma ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Posterior Wall ◽  
Ca 125 ◽  
Low Grade ◽  
Abdominal Girth ◽  
Treatment Protocols ◽  
Standardized Treatment ◽  
Pelvic Peritonectomy ◽  
Optimal Debulking ◽  
Douglas Pouch

Background: Psammocarcinomas (PCas) are rare epithelial tumors, usually originating in the ovaries or the peritoneum. These tumors are morphologically characterized by extensive psammomatous calcifications, invasiveness and low-grade cytological features.Case report: We present the case of a 54-year-old woman who was referred to our department with an umbilical tumor and increasing abdominal girth. The patient had had an umbilical hernia for more than 20 years. The CA 125 level was normal. The CT scan showed small peritoneal nodules at the level of the Douglas pouch, including the posterior wall of the uterus, and the entire colon, as well as large nodules located on the caecum and the sigmoid colon. We performed partial enterectomy, total colectomy with ileo-rectal anastomosis, omentectomy, total histerectomy and bilateral adnexectomy, pelvic peritonectomy of the Douglas pouch. Pathology findings were consistent with F.I.G.O. stage IIIC peritoneal PCa. The patient received adjuvant chemotherapy with Taxol and Carboplatin. To date, twelve months after surgery, the follow-up shows no evidence of disease.Conclusion: Standardized treatment protocols are hindered by the rarity of the PCas. However, literature concludes that optimal debulking is mandatory, whereas the efficacy of adjuvant chemotherapy remains to be elucidated.

scholarly journals “Randomized trial of physical activity on quality of life and lung cancer biomarkers in patients with advanced stage lung cancer: a pilot study”

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Brett C. Bade ◽  
Geliang Gan ◽  
Fangyong Li ◽  
Lingeng Lu ◽  
Lynn Tanoue ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Lung Cancer ◽  
Randomized Trial ◽  
Cancer Biomarkers ◽  
Advanced Stage ◽  
Home Based ◽  
Advanced Stage Lung Cancer ◽  
Stage Lung Cancer

Abstract Background Lung cancer survivors need more options to improve quality of life (QoL). It is unclear to what extent patients with advanced stage disease are willing to participate in home-based physical activity (PA) and if these interventions improve QoL. The goal of our study was to determine interest in participating in our 3-month home-based walking regimen in patients with advanced stage lung cancer. We used a randomized design to evaluate for potential benefit in PA and patient-reported outcomes. Methods We performed an open-label, 1:1 randomized trial in 40 patients with stage III/IV non-small cell lung cancer (NSCLC) evaluating enrollment rate, PA, QoL, dyspnea, depression, and biomarkers. Compared to usual care (UC), the intervention group (IG) received an accelerometer, in-person teaching session, and gain-framed text messages for 12 weeks. Results We enrolled 56% (40/71) of eligible patients. Participants were on average 65 years and enrolled 1.9 years from diagnosis. Most patients were women (75%), and receiving treatment (85%) for stage IV (73%) adenocarcinoma (83%). A minority of patients were employed part-time or full time (38%). Both groups reported low baseline PA (IG mean 37 (Standard deviation (SD) 46) vs UC 59 (SD 56) minutes/week; p = 0.25). The IG increased PA more than UC (mean change IG + 123 (SD 212) vs UC + 35 (SD 103) minutes/week; p = 0.051)). Step count in the IG was not statistically different between baseline (4707 step/day), week 6 (5605; p = 0.16), and week 12 (4606 steps/day; p = 0.87). The intervention improved EORTC role functioning domain (17 points; p = 0.022) with borderline improvement in dyspnea (− 13 points; p = 0.051) compared to UC. In patients with two blood samples (25%), we observed a significant increase in soluble PD-1 (219.8 (SD 54.5) pg/mL; p < 0.001). Conclusions Our pilot trial using a 3-month, home-based, mobile health intervention enrolled over half of eligible patients with stage III and IV NSCLC. The intervention increased PA, and may improve several aspects of QoL. We also identified potential biomarker changes relevant to lung cancer biology. Future research should use a larger sample to examine the effect of exercise on cancer biomarkers, which may mediate the association between PA and QoL. Clinical trial registration Clinicaltrials.gov (NCT03352245).

Guideline for the management of long tunnelled external ventricular drains in chronic hydrocephalus

2021 ◽  
Vol 30 (7) ◽  
pp. 416-421
Author(s):  
Phillip Correia Copley ◽  
John Emelifeonwu ◽  
Pasquale Gallo ◽  
Drahoslav Sokol ◽  
Jothy Kandasamy ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Nursing Care ◽  
Pilocytic Astrocytoma ◽  
Parental Education ◽  
Chronic Hydrocephalus ◽  
Treatment Protocols ◽  
New Approach ◽  
Viable Treatment

This article reports on the journey of a child with an inoperable hypothalamic-origin pilocytic astrocytoma causing hydrocephalus, which was refractory to treatment with shunts, and required a new approach. With multidisciplinary support, excellent nursing care and parental education, the child's hydrocephalus was managed long term in the community with bilateral long-tunnelled external ventricular drains (LTEVDs). This article describes the patient's journey and highlights the treatment protocols that were created to achieve this feat. Despite the difficulties in initially setting up these protocols, they proved successful and thus the team managing the patient proposed that LTEVDs are a viable treatment option for children with hydrocephalus in the context of inoperable tumours to help maximise quality of life.

scholarly journals Nanotechnology as an Anti-Infection Strategy in Periprosthetic Joint Infections (PJI)

2021 ◽  
Vol 6 (2) ◽  
pp. 91
Author(s):  
Pier Francesco Indelli ◽  
Stefano Ghirardelli ◽  
Ferdinando Iannotti ◽  
Alessia Maria Indelli ◽  
Gennaro Pipino
Keyword(s):  
Joint Infection ◽  
Treatment Strategies ◽  
High Morbidity ◽  
Treatment Protocols ◽  
Joint Infections ◽  
Prevention And Treatment ◽  
Efficient Control ◽  
Cement Joint ◽  
Clay Nanotubes

Background: Periprosthetic joint infection (PJI) represents a devastating consequence of total joint arthroplasty (TJA) because of its high morbidity and its high impact on patient quality of life. The lack of standardized preventive and treatment strategies is a major challenge for arthroplasty surgeons. The purpose of this article was to explore the potential and future uses of nanotechnology as a tool for the prevention and treatment of PJI. Methods: Multiple review articles from the PubMed, Scopus and Google Scholar databases were reviewed in order to establish the current efficacy of nanotechnology in PJI preventive or therapeutic scenarios. Results: As a prevention tool, anti-biofilm implants equipped with nanoparticles (silver, silk fibroin, poly nanofibers, nanophase selenium) have shown promising antibacterial functionality. As a therapeutic tool, drug-loaded nanomolecules have been created and a wide variety of carrier materials (chitosan, titanium, calcium phosphate) have shown precise drug targeting and efficient control of drug release. Other nanotechnology-based antibiotic carriers (lipid nanoparticles, silica, clay nanotubes), when added to common bone cements, enhanced prolonged drug delivery, making this technology promising for the creation of antibiotic-added cement joint spacers. Conclusion: Although still in its infancy, nanotechnology has the potential to revolutionize prevention and treatment protocols of PJI. Nevertheless, extensive basic science and clinical research will be needed to investigate the potential toxicities of nanoparticles.

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