scholarly journals Lung Adenocarcinoma with Paraneoplastic Hyper-Eosinophilia Not Responding To Pembrolizumab

2021 ◽  
Vol 15 ◽  
pp. 117954842110301
Author(s):  
Hisham Wehbe ◽  
Maria Kozah ◽  
Salwa A Koubaissi
Keyword(s):  
Lung Adenocarcinoma ◽  
Progressive Disease ◽  
Checkpoint Inhibitors ◽  
Fatal Outcome ◽  
Newly Diagnosed ◽  
Rapid Disease Progression ◽  
Therapy Initiation ◽  
Case Summary ◽  
Metastatic Lung ◽  
Pre Treatment

Background: Paraneoplastic hyper-eosinophilia associated with metastatic lung adenocarcinoma is a rare finding and has been associated with a poor prognosis when present. Early hyper-eosinophilia appearing following non-small cell lung cancer (NSCLC) treatment with immune checkpoint inhibitors (ICI) has been previously reported with contradictory outcomes. Case summary: We present the case of an elderly man with newly diagnosed metastatic lung adenocarcinoma and baseline hyper-eosinophilia, treated with pembrolizumab, and showing evidence of significant and rapid disease progression suggestive of hyper-progressive disease, worsening baseline hyper-eosinophilia, and a fatal outcome within 1 month of therapy initiation. Conclusion: Pre-treatment hyper-eosinophilia could represent a predictive factor of an unfavorable response to ICI treatment in cases of NSCLC. Additional similar cases are needed to draw a more conclusive relationship.

Successful empirical erlotinib treatment of a mechanically ventilated patient newly diagnosed with metastatic lung adenocarcinoma

Lung Cancer ◽  
2014 ◽  
Vol 86 (1) ◽  
pp. 102-104 ◽  
Author(s):  
Joaquim Bosch-Barrera ◽  
Elia Sais ◽  
Carol Lorencio ◽  
Rut Porta ◽  
Angel Izquierdo ◽  
...  
Keyword(s):  
Lung Adenocarcinoma ◽  
Newly Diagnosed ◽  
Mechanically Ventilated ◽  
Metastatic Lung

Checkpoint inhibitor therapy, with and without radiation, in diffuse large B cell lymphoma: A single-center analysis.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e19059-e19059
Author(s):  
Stephanie Yoon ◽  
Mohammad Zahid ◽  
Pooja Phull ◽  
Jordan Senchak ◽  
Richard I. Fisher ◽  
...  
Keyword(s):  
Progressive Disease ◽  
Checkpoint Inhibitors ◽  
Single Agent ◽  
B Cell Lymphoma ◽  
Clinical Results ◽  
Cell Of Origin ◽  
Mhc I ◽  
Pet Ct ◽  
Checkpoint Inhibitor Therapy ◽  
Pre Treatment

e19059 Background: Single agent checkpoint inhibitors (CPI) in NHLs have resulted in modest successes. Exceptions include RT, PCNS and testicular lymphomas, where higher activity is seen. As a single agent, CPI response rates range from 10-40% in relapsed refractory (RR) DLBCL, with few CRs and short response durations. In a cohort of RR DLBCL patients at our institution, we sought to identify clinical features that defined responders and non-responders. Methods: Between 9/2016 and 7/2018, 13 pts with DLBCL/RT, treated with a CPI, either on trial or as off-label therapy, with at minimum 1 infusion/cycle were included. Pathology specimens confirming DLBCL/RT were reviewed at FCCC. All pts had measurable disease by CT or PET/CT prior to CPI and had an evaluable response. Cell of origin was determined by Hans IHC. Results: Almost half (6/13) of pts achieved a response to CPI. Notably all responders had either concurrent or pre-treatment XRT. All 3 RT patients responded to CPI and continued to allo transplant. P3 and P6 both developed GVHD post allo, resulting in a demise in P3. No GC subtype pts responded nor had prior/ concurrent XRT with CPI. In 2 pts responses are ongoing, > 1 yr, and 1 RT pt remains in CR. Conclusions: XRT, prior or concurrent with CPI , was associated with durable responses in RR DLBCL. Patients with bulky ( > 7cm), rapidly progressive disease (8/13 cases) may require a 'debulking' strategy for CPI efficacy. An abscopal effect achieved with XRT/CPI combinations, may be impactful RR NHL. Analysis of PDL1/2 and MHC I/II, with other biomarkers, are underway. These clinical results warrant validation in a larger cohort, therefore a prospectively designed study is planned for 2019 in RR DLBCL/RT. [Table: see text]

scholarly journals Preoperative clinical and tumor genomic features associated with pathologic lymph node metastasis in clinical stage I and II lung adenocarcinoma

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Raul Caso ◽  
James G. Connolly ◽  
Jian Zhou ◽  
Kay See Tan ◽  
James J. Choi ◽  
...  
Keyword(s):  
Lung Adenocarcinoma ◽  
Clinical Stage ◽  
Multivariable Analysis ◽  
Multivariable Logistic Regression Model ◽  
Genomic Features ◽  
Genome Doubling ◽  
Whole Genome Doubling ◽  
Metastatic Lung ◽  
Treatment Naïve ◽  
Patients At Risk

AbstractWhile next-generation sequencing (NGS) is used to guide therapy in patients with metastatic lung adenocarcinoma (LUAD), use of NGS to determine pathologic LN metastasis prior to surgery has not been assessed. To bridge this knowledge gap, we performed NGS using MSK-IMPACT in 426 treatment-naive patients with clinical N2-negative LUAD. A multivariable logistic regression model that considered preoperative clinical and genomic variables was constructed. Most patients had cN0 disease (85%) with pN0, pN1, and pN2 rates of 80%, 11%, and 9%, respectively. Genes altered at higher rates in pN-positive than in pN-negative tumors were STK11 (p = 0.024), SMARCA4 (p = 0.006), and SMAD4 (p = 0.011). Fraction of genome altered (p = 0.037), copy number amplifications (p = 0.001), and whole-genome doubling (p = 0.028) were higher in pN-positive tumors. Multivariable analysis revealed solid tumor morphology, tumor SUVmax, clinical stage, SMARCA4 and SMAD4 alterations were independently associated with pathologic LN metastasis. Incorporation of clinical and tumor genomic features can identify patients at risk of pathologic LN metastasis; this may guide therapy decisions before surgical resection.

scholarly journals Diffuse Cystic Metastases in the Lung after Nivolumab Treatment in a Patient with Non-Small Cell Lung Cancer: A Case Report

2021 ◽  
pp. 34-38
Author(s):  
Satoshi Muto ◽  
Yuki Ozaki ◽  
Takuya Inoue ◽  
Naoyuki Okabe ◽  
Yuki Matsumura ◽  
...  
Keyword(s):  
Lung Adenocarcinoma ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Lung Metastases ◽  
Sialyl Lewis X ◽  
Ground Glass ◽  
Cystic Lesions ◽  
Positron Emission ◽  
Ground Glass Nodules

Although diffuse cysts in the lung can be found in many diseases, they are uncommon in metastatic lung adenocarcinoma. They are even more unusual after the administration of immune checkpoint inhibitors. A case of lung adenocarcinoma that developed diffuse cysts in the lungs during treatment with nivolumab is reported. The patient was a 60-year-old woman with postoperative recurrent lung adenocarcinoma in mediastinal lymph nodes and pleural dissemination. After first-line treatment with cisplatin, pemetrexed, and bevacizumab, computed tomography (CT) showed disease progression. Treatment was then switched to nivolumab. After 5 courses of nivolumab, CT showed multiple ground-glass nodules in her lungs. After 4 more courses of nivolumab, the ground-glass nodules increased in size, and cystic air spaces appeared in their centers. The patient did not have any symptoms. Laboratory tests showed no evidence of infection or nivolumab-induced pneumonitis. Sialyl Lewis X-i antigen increased, and positron emission tomography showed abnormal uptake of 18F-fluorodeoxyglucose in these lesions. Considering this evidence, the cystic lesions were diagnosed as multiple lung metastases. Various differential diagnoses should be considered when diffuse cystic lesions are found in the lungs after the administration of immune checkpoint inhibitors.

scholarly journals ACT-03 Clinical outcome and radiological findings of patients with recurrent glioblastomas treated by bevacizumab

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii8-ii8
Author(s):  
Hajime Handa ◽  
Ichiyo Shibahara ◽  
Takuichiro Hide ◽  
Toshihiro Kumabe
Keyword(s):  
Clinical Outcome ◽  
Arterial Spin Labeling ◽  
Progressive Disease ◽  
Study Cohort ◽  
Newly Diagnosed ◽  
Radiological Findings ◽  
Double Positive ◽  
Median Period ◽  
High Age ◽  
Brain Barriers

Abstract Object: Seven years have passed since the approval of bevacizumab (BEV) in Japan. We retrospectively reviewed the clinical outcome and radiological findings of patients with recurrent glioblastomas (GB) treated by BEV. Method: We reviewed 116 patients, including 27 cases of newly diagnosed GB and 89 cases of recurrent GB, treated by BEV during the study period between 2013 June and 2019 September. Cumulatively, 116 patients received 1672 cycles of BEV. Among those, we focused on 74 patients with newly diagnosed GB treated by BEV at recurrence to examine clinical characteristics, outcome, and radiological findings of T2-circumscribed or double-positive proposed by Nowosieski et al. or Bahr et al., respectively. Result: The study cohort comprised median age of 66.8 years (range 10 to 81), median KPS of 60% (range, 20 to 100), median cycles of administration 11(1 to 59), median period of treatment 172 days (0 to 1413), median post-BEV survivals 266 days, and overall survival 693 days. Patients without progressive disease at 6 months post-BEV MRI (n = 23) presented favorable post-BEV survival of 713 days than those with progressive disease (n = 8) (p=0.0003). The radiological findings varied by patients, tumor lesions, and sequential imaging; thus, it was difficult to correlate with survival. Our data implied that the T2-circumscribed lesion was accompanied by no enhancement at T1 but hyperperfused at arterial spin labeling imaging, indicating that blood-brain barriers were intact and vascularization is activated. Conclusion: Although our cohort included patients with relatively high age, some had prolonged post-BEV survival. T2-circumscribed or double-positive was not useful to predict the survival; however, MRI at 6 months post-BEV can be an indicator for two years of post-BEV survival.

Chiasmatic optic glioma treated with chemotherapy

1985 ◽  
Vol 63 (6) ◽  
pp. 862-866 ◽  
Author(s):  
Jeffrey G. Rosenstock ◽  
Roger J. Packer ◽  
Larissa Bilaniuk ◽  
Derek A. Bruce ◽  
Jerri-Lynne Radcliffe ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Young Children ◽  
Progressive Disease ◽  
Actinomycin D ◽  
Initial Therapy ◽  
Optic Glioma ◽  
Newly Diagnosed ◽  
Content Type ◽  
Novel Approach ◽  
Clinical Stabilization

✓ Chiasmatic optic glioma is a rare tumor with an erratic natural history, usually seen in young children. A prior study from this institution demonstrated that these lesions were frequently lethal, despite initial clinical stabilization following radiation therapy, and that visual, intellectual, and late endocrinological disabilities were prevalent. A novel approach was developed in 1977, when an initial clinical response to vincristine was recorded in a child with a recurrent optic glioma. Since then, all children with recurrent optic glioma and all children aged 6 years old and under with newly diagnosed optic glioma have been offered a program of initial therapy with vincristine and actinomycin D for six cycles over 18 months. The four children with recurrent tumor who were treated with that regimen remain clinically stable 13 to 115 months after chemotherapy. Twelve children (eight under 24 months old) with newly diagnosed optic glioma have been treated with this program, and three are still on therapy. Four developed progression while on therapy, and five remain stable from 1 to 60 months posttherapy. The four children who developed progressive disease have been treated with radiation therapy and remain stable. Six of the 12 children showed shrinkage of their tumor on computerized tomography while receiving chemotherapy. This program may serve as an alternative to initial radiation therapy in young children.

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