Complete response to immunotherapy in sinonasal undifferentiated carcinoma

2021 ◽  
pp. 030089162110269
Author(s):  
Nerina Denaro ◽  
Marco Merlano ◽  
Gianmauro Numico ◽  
Ornella Garrone ◽  
Paolo Bossi
Keyword(s):  
Multidisciplinary Approach ◽  
Advanced Disease ◽  
Locally Advanced ◽  
Complete Response ◽  
Undifferentiated Carcinoma ◽  
Sinonasal Undifferentiated Carcinoma ◽  
Report Data ◽  
Previously Treated ◽  
Aggressive Tumor ◽  
Generation Sequencing

Sinonasal undifferentiated carcinoma (SNUC) is an uncommon aggressive tumor. Locally advanced disease is usually diagnosed at presentation. Multidisciplinary approach is essential and aims to ensure optimal trimodal strategy. Induction chemotherapy is preferred in order to select patients who will benefit from chemoradiotherapy or surgery. Immunotherapy is not indicated in patients with recurrent SNUC. We describe an impressive response in a young man previously treated with radiotherapy and chemotherapy and demolitive surgery who had metastatic bone and lung disease. We also report data on PD-L1, next-generation sequencing, and neutrophil/platelets ratio.

scholarly journals A multimodality approach to sinonasal undifferentiated carcinoma: a single institute experience

2016 ◽  
Vol 131 (1) ◽  
pp. 19-25 ◽  
Author(s):  
S Bhasker ◽  
S Mallick ◽  
R Benson ◽  
V Bhanuprasad ◽  
A Sharma ◽  
...  
Keyword(s):  
Advanced Disease ◽  
Locally Advanced ◽  
Progression Free Survival ◽  
Undifferentiated Carcinoma ◽  
Radiotherapy Planning ◽  
Free Survival ◽  
Definitive Radiotherapy ◽  
Sinonasal Undifferentiated Carcinoma ◽  
Number Of Patients ◽  
Multimodality Approach

AbstractBackground:Sinonasal undifferentiated carcinoma is a rare aggressive tumour arising from the Schneiderian epithelium lining the sinonasal tract. Although considered the cornerstone of therapy, surgical resection can only be performed in a limited number of patients. This report describes the experience of treating sinonasal undifferentiated carcinoma with a multimodality approach.Method:The treatment charts of sinonasal undifferentiated carcinoma patients treated at a tertiary care centre from 2004 to 2012 were retrospectively reviewed.Results:A total of 16 sinonasal undifferentiated carcinoma patients with a median age at diagnosis of 47.5 years (range 8–65 years) were included: 19 per cent had neck nodal metastasis at presentation. Four patients (25 per cent) underwent surgery: of these, two had post-operative radiotherapy, one had pre-operative radiotherapy and one had adjuvant chemotherapy alone. Six patients (38 per cent) received definitive radiotherapy: five had received neoadjuvant chemotherapy to reduce tumour size and help in radiotherapy planning, while four (25 per cent) received palliative radiotherapy. The median follow up was 10.4 months (range 1–42.5 months). The estimated median progression-free survival time was 29.3 months. One- and three-year progression-free survival rates were 77 per cent and 41 per cent, respectively.Conclusion:Surgery is the best treatment option for sinonasal undifferentiated carcinoma, although most patients require post-operative radiotherapy for advanced disease and close tumour margins. Definitive radiotherapy with or without chemotherapy may be suitable for patients with inoperable locally advanced disease. Elective nodal irradiation to address the high nodal involvement rates should be considered to improve the survival rate.

Induction Therapy Prior to Surgical Resection for Patients Presenting with Locally Advanced Esthesioneuroblastoma

2020 ◽  
Author(s):  
Kevin C. Miller ◽  
John P. Marinelli ◽  
Jeffrey R. Janus ◽  
Ashish V. Chintakuntlawar ◽  
Robert L. Foote ◽  
...  
Keyword(s):  
Induction Therapy ◽  
Multidisciplinary Approach ◽  
Advanced Disease ◽  
Frozen Section ◽  
Locally Advanced ◽  
Patient Records ◽  
Term Survival ◽  
Positive Margins ◽  
Definitive Surgery

AbstractEsthesioneuroblastoma (ENB) is a rare olfactory malignancy that can present with locally advanced disease. At our institution, patients with ENB in whom the treating surgeon believes that a margin-negative resection is initially not achievable are selected to undergo induction with chemotherapy with or without radiotherapy prior to surgery. In a retrospective review of 61 patient records, we identified six patients (10%) treated with this approach. Five of six patients (83%) went on to definitive surgery. Prior to surgery, three of five patients (60%) had a partial response after induction therapy, whereas two of five (40%) had stable disease. Microscopically margin-negative resection was achieved in four of five (80%) of the patients who went on to surgery, while one patient had negative margins on frozen section but microscopically positive margins on permanent section. Three of five patients (60%) recurred after surgery; two of these patients died with recurrent/metastatic ENB. In summary, induction therapy may facilitate margin-negative resection in locally advanced ENB. Given the apparent sensitivity of ENB to chemotherapy and radiotherapy, future prospective studies should investigate the optimal multidisciplinary approach to improve long-term survival in this rare disease.

Radio-Chemotherapy of Vulvar Cancer

1998 ◽  
Vol 84 (2) ◽  
pp. 250-251 ◽  
Author(s):  
Roberto Zucali ◽  
Francesco Raspagliesi ◽  
Rado Kenda ◽  
Laura Lozza ◽  
Silvia Tana ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Vulvar Cancer ◽  
Locally Advanced ◽  
Complete Response ◽  
Pathological Examination ◽  
Locally Advanced Tumors ◽  
Cure Rates ◽  
Radio Chemotherapy ◽  
Advanced Tumors

Surgery alone, more or less demolitive, is the treatment of choice of vulvar cancers. Cure rates are high for early cancers only, while locally advanced tumors with or without inguinal adenopathies and recurrences have a bad prognosis. The excellent results of concurrent chemo-radiotherapy of anal cancers suggested to adopt the same approach for locally advanced vulvar cancers. The shrinkage of the tumor allowed surgery, often less demolitive than usual, and the pathological examination demonstrated an overall complete response in 40% of cases. Survival has been improved through this multidisciplinary approach. Patients not suitable for surgery obtained important remissions and an improved quality of life. Clinical experience at the Istituto Tumori of Milano is presented.

Phase II study of cemiplimab in patients (pts) with advanced cutaneous squamous cell carcinoma (CSCC): Longer follow-up.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 10018-10018 ◽  
Author(s):  
Danny Rischin ◽  
Nikhil I. Khushalani ◽  
Chrysalyne D. Schmults ◽  
Alexander David Guminski ◽  
Anne Lynn S. Chang ◽  
...  
Keyword(s):  
Median Duration ◽  
Objective Response ◽  
Locally Advanced ◽  
Complete Response ◽  
Curative Surgery ◽  
Data Set ◽  
Duration Of Response ◽  
Treatment Naïve ◽  
Previously Treated

10018 Background: Cemiplimab monotherapy achieves clinically meaningful activity in pts with advanced CSCC (metastatic [mCSCC] or locally advanced [laCSCC] not amenable to curative surgery or curative radiation) and has a safety profile consistent with other anti–PD-1 agents. Based on initial data (median follow-up of 9.4 months in the pivotal study, NCT02760498), cemiplimab (cemiplimab-rwlc in the US) was approved for the treatment of pts with advanced CSCC. Historical data shows median overall survival (OS) of approximately 15 months with conventional chemotherapy or EGFR inhibitors (ASCO 2019, e21033). We present ~1-year additional follow-up from the largest prospective data set in advanced CSCC. Methods: Pts received cemiplimab 3 mg/kg Q2W (Group [Gp] 1; mCSCC; Gp 2, laCSCC) or cemiplimab 350 mg Q3W (Gp 3, mCSCC). The primary endpoint was objective response rate (ORR; complete response + partial response) per independent central review (ICR). Data presented here are per investigator review (INV); ICR data will be available at the meeting. Results: 193 pts were enrolled (Gp 1, n = 59; Gp 2, n = 78; Gp 3, n = 56). 128 pts had received no prior anti-cancer systemic therapy, 65 pts were previously treated. As of Oct 11, 2019 (data cut-off), median duration of follow-up was 15.7 months (range: 0.6–36.1) among all pts; 18.5 months (range: 1.1–36.1) for Gp 1, 15.5 months (range: 0.8–35.0) for Gp 2, and 17.3 months (range: 0.6–26.3) for Gp 3. ORR per INV was 54.4% (95% CI: 47.1–61.6) for all pts; 50.8% (95% CI: 37.5–64.1) for Gp 1, 56.4% (95% CI: 44.7–67.6) for Gp 2, and 55.4% (95% CI: 41.5–68.7) for Gp 3. ORR per INV was 57.8% (95% CI: 48.8–66.5) among treatment-naïve pts and 47.7% (95% CI: 35.1–60.5) among previously treated pts. Median duration of response (DOR) has not been reached (observed DOR range: 1.8–34.2 months). In responding pts, estimated proportion of pts with ongoing response at 24 months was 76.0% (95% CI: 64.1–84.4). Median OS has not been reached. Estimated OS at 24 months was 73.3% (95% CI: 66.1–79.2). The most common treatment-emergent adverse events (TEAEs) by any grade were fatigue (34.7%), diarrhea (27.5%), and nausea (23.8%). The most common grade ≥3 TEAEs were hypertension (4.7%) and anemia and cellulitis (each 4.1%). Conclusions: For pts with advanced CSCC, cemiplimab achieves ORRs, DOR and survival superior to what has been reported with other agents. Clinical trial information: NCT02760498.

Sinonasal Undifferentiated Carcinoma: Case Series and Review of the Literature

Neurosurgery ◽  
2000 ◽  
Vol 47 (3) ◽  
pp. 750-755 ◽  
Author(s):  
Judith Gorelick ◽  
Donald Ross ◽  
Lawrence Marentette ◽  
Mila Blaivas
Keyword(s):  
Nasal Cavity ◽  
Surgical Resection ◽  
Paranasal Sinuses ◽  
Locally Advanced ◽  
Case Series ◽  
Undifferentiated Carcinoma ◽  
Intracranial Extension ◽  
System Response ◽  
Review Of The Literature ◽  
Sinonasal Undifferentiated Carcinoma

ABSTRACT OBJECTIVE AND IMPORTANCE We report on four cases of sinonasal undifferentiated carcinoma (SNUC), a relatively newly described clinicopathological entity of the nasal cavity and paranasal sinuses. SNUC tends to present with advanced-stage disease, often with intracranial invasion, and requires an aggressive treatment approach that includes surgical resection. A review of the literature identified several reports of SNUC in pathology and otolaryngology journals since its initial description in 1986, but no report has yet appeared in the neurosurgery literature. CLINICAL PRESENTATION Four patients presented with various symptoms related to the nose and/or orbit, including one or more of the following: obstruction, epistaxis, decreased visual acuity, diplopia, and pain. All patients were noted to have masses in the nasal cavity or paranasal sinuses, with or without intracranial extension. INTERVENTION All four patients underwent multimodal treatment with chemotherapy, radiotherapy (60–65 Gy), and aggressive surgical resection via a combined bifrontal craniotomy and a subcranial approach to the anterior cranial fossa. Three of four patients died as a result of their disease, an average of 15 months after diagnosis. Only one patient remains alive, although with metastatic intracranial disease, at 24 months after diagnosis. CONCLUSION SNUC is a rare neoplasm with a poor prognosis despite an aggressive multimodal approach to treatment. On the basis of our experience, we advocate radical resection as part of the initial combined therapy for patients who present with locally advanced, nonmetastatic disease but we suggest reserving surgery for patients with early brain invasion until there has been a radiographically proven central nervous system response to adjuvant therapy.

Rectal Cancer Complete Response Outcomes in a Community-Based Hospital Comparable with Large Cancer Centers When Multidisciplinary Approach to Rectal Cancer is Used

2019 ◽  
Vol 85 (5) ◽  
pp. 530-538 ◽  
Author(s):  
Andrew J. Geiser ◽  
Ahmed Al-Khamis ◽  
Supriya Patel ◽  
Jeremy Sugrue ◽  
Daniel J. Borsuk ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Multidisciplinary Approach ◽  
Tertiary Care ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Adjuvant Chemoradiotherapy ◽  
Community Based

Achievement of pathologic complete response (pCR) in patients with locally advanced rectal cancer correlates with improved prognosis relative to non-pCR counterparts. Such correlations are not well established in the context of a community-based hospital. This study aims to examine pCR rates, recurrences, and survival data for locally advanced rectal cancer patients in community settings. A single-center retrospective chart review was performed at a community-based hospital. Study population consisted of 119 patients with locally advanced rectal cancer treated with neo-adjuvant chemoradiotherapy, followed by surgical resection. Patients with a history of metastasis, inflammatory bowel disease, hereditary cancer syndromes, concurrent or prior malignancy, and emergent surgery were excluded. Twenty-four patients (20.2%) achieved pCR. Across both groups, all demographics and perioperative characteristics were comparable. The five-year survival was 73.7 per cent in the non-pCR group and 95.8 per cent in the pCR group ( P = 0.0243). At five years, 27.7 per cent of the non-pCR group had a recurrence, as compared with none in the pCR group ( P = 0.0018). Based on our study, we believe that a multidisciplinary approach to rectal cancer used at a community-based hospital can achieve oncological outcomes and survival benefits similar to those of larger academic tertiary care institutions.

A phase II trial of docetaxel and cisplatin combination in patients with locally advanced undifferentiated carcinoma of nasopharyngeal type (UCNT): Study update

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 5579-5579
Author(s):  
M. Yamouni ◽  
K. A. Benhadji ◽  
Y. Beldjilali ◽  
I. Lahfa ◽  
D. Yekrou ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stable Disease ◽  
Tumor Response ◽  
Performance Status ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Complete Response ◽  
Undifferentiated Carcinoma ◽  
Stage Ivb ◽  
Grade 3

5579 Background: The standard treatment of locally advanced undifferentiated carcinoma of nasopharyngeal type (UCNT) is cisplatin based chemotherapy followed by locoregional radiotherapy. The purpose of this study is to assess the antitumor activity and toxicity of a new neoadjuvant chemotherapy regimen combining docetaxel (D) and cisplatin (C). Patients and Methods: Previously untreated patients (pts) with histologically diagnosed locally advanced UCNT (Stages IVa and IVb TNM/UICC 1997) received D 75 mg/m2 and C 75 mg/m2 both on day 1, cycles were repeated every 21 days. Every pts received three cycles in a neoadjuvant setting before radiotherapy (4 to 6 weeks after the third cycle of DC). Pts were evaluated by clinical examination, CT scan of nasopharynx and nasofibroscopy with biopsy. Primary end point was tumor response. Secondary end points were disease free survival (DFS), toxicity and overall survival. Results: 75 pts were enrolled in this trial, 54 males and 21 females with a median age of 41 years (range 18–69), WHO performance status of 0–1 in 71 pts and 2 in 4 pts. 19 pts had stage IVa and 56 pts had stage IVb. Toxicity, tumor response and survival over tree years were assessable in 75 pts. After 225 cycles, grade 3 & 4 toxicity (NCI-CTC 2.0) were: neutropenia (12%), febrile neutropenia (2%), anemia (1%), nausea and vomiting (23%), diarrhea (8%), mucositis (1%), reversible alopecia (70%). Two pts had onycolysis. Response rates for the 75 pts were: complete pathologic response 37% (28 pts), partial response 52% (39 pts), stable disease 8% (6 pts) and progression 3% (2 pts). The overall response rate was 89%. 74 pts (98%) had complete response after radiotherapy and one patient had stable disease. 31 patients had recurrence: 25 locoregional, and 6 metastatic (3 with bone metastasis, 2 hepatic metastasis and 1 cerebral metastasis). DFS and overall survival at 3 years were respectively 57% and 65%. Conclusion: DC chemotherapy followed by radiation therapy is an effective regimen for the treatment of advanced UCNT. This treatment has an acceptable safety profile. These data need to be compared to concurrent chemoradiotherapy to assess the best strategy for the management of advanced UCNT. [Table: see text]

Phase II trial of combination docetaxel and cisplatin in patients with locally advanced nasopharyngeal carcinoma

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6044-6044
Author(s):  
M. Yamouni ◽  
K. A. Benhadji ◽  
Y. Beldjilali ◽  
I. Lahfa ◽  
H. Khellafi ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Stable Disease ◽  
Tumor Response ◽  
Performance Status ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Complete Response ◽  
Undifferentiated Carcinoma ◽  
Stage Ivb ◽  
Grade 3

6044 Background: The standard treatment of locally advanced nasopharyngeal carcinoma is cisplatin-based chemotherapy followed by locoregional radiotherapy. The purpose of this study is to assess the antitumor activity and toxicity of a new neoadjuvant chemotherapy regimen combining docetaxel (D) and cisplatin (C). Methods: Previously untreated patients (pts) with histologically diagnosed locally advanced nasopharyngeal carcinoma (stages IVA and IVB, TNM/UICC 1997) received D 75 mg/m2 and C 75 mg/m2 both on day 1, with cycles repeated every 21 days. All pts received three cycles in a neoadjuvant setting before radiotherapy (4 to 6 weeks after the third cycle of DC, 65–70 Gy 5 fractions/week). Pts were evaluated by clinical examination, CT scan of the nasopharynx, and nasofibroscopy with biopsy. The primary end point was tumor response. Secondary end points were disease-free survival (DFS), toxicity, and overall survival (OS). Results: 93 pts (65 male, 28 female) were enrolled. Median age was 42 years (range 18–69), WHO performance status was 0–1 in 87 pts and 2 in 6 pts. 75 pts (81%) had an undifferentiated carcinoma of nasopharyngeal type (UCNT) and 18 pts (19%) a differenciated carcinoma of the nasopharynx. 31 pts had stage IVA disease and 62 pts had stage IVB. Toxicity, tumor response, and survival at 5 years (median follow up 49.5 months) were assessable in 90 pts. After 270 cycles, grade 3–4 toxicities (WHO) were: neutropenia (12 %), febrile neutropenia (2%), anemia (1%), nausea and vomiting (23%), diarrhea (8%), mucositis (1%), reversible alopecia (70%). Two pts had onycholysis. Response rates for the 90 pts were: complete response 32.2% (29 pts), partial response 54.4% (49 pts), stable disease 11.1% (10 pts), and progressive disease 2.2% (2 pts). The overall response rate (ORR) was 86.6% and 89% amongst the UCNT. After radiotherapy, 88 pts had a complete response and one patient had stable disease. DFS and OS at 5 years were 52% and 55%, respectively. Conclusions: DC chemotherapy followed by radiation therapy is an effective regimen for the treatment of advanced UCNT and has an acceptable safety profile. These data need to be compared with concurrent chemoradiotherapy to assess the best strategy for the management of advanced UCNT. No significant financial relationships to disclose.

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