scholarly journals Systemic Treatment in Advanced Phyllodes Tumor of the Breast: A Multi-institutional European Retrospective Case-series Analyses

2021 ◽  
Author(s):  
Elena Palassini ◽  
Olivier Mir ◽  
Giovanni Grignani ◽  
Bruno Vincenzi ◽  
Hanneke Gelderblom ◽  
...  
Keyword(s):  
Kinase Inhibitors ◽  
Systemic Treatment ◽  
Case Series ◽  
Phyllodes Tumor ◽  
Median Number ◽  
Advanced Breast ◽  
High Rate ◽  
High Dose ◽  
Retrospective Case ◽  
Systemic Treatments

Abstract Background: We aimed at investigating outcome of systemic treatments in advanced breast PT. Methods: All cases of advanced breast PT treated with systemic treatments from 1999 to 2019, in one of the referral sarcoma centres involved in the study, were retrospectively reviewed. Results: 56 female patients were identified. Median age was 52 (range 25-76) years. Patients re-ceived a median number of 2 systemic treatments (range 1-4). Best responses according to RECIST were: 1 (3.7%) CR, 11 (40.7%) PR, 6 (22.2%) SD, 9 (33.3%) PD with anthracyclines plus ifosfamide (AI); 2 (16.7%) PR, 4 (33.3%) SD, 6 (50.0%) PD with anthracycline alone; 3 (18.8%) PR, 4 (25.0%) SD, 9 (56.3%) PD with high-dose ifosfamide given as a continuous infusion (HD-IFX); 3 (20.0%) SD, 12 (80.0%) PD with a gemcitabine-based regimen (with 2 patients not evaluable); 1 (8.3%) PR, 2 (16.7%) SD, 9 (75.0%) PD with trabectedin (with 1 patient not evaluable); 1 (16.7%) PR, 1 (16.7%) SD, 4 (66.7%) PD with tyrosine-kinase inhibitors (TKI). The median PFS were: 5.7 (IQR, 2.5-9.1) months with AI; 3.2 (IQR, 2.2-5.0) months with anthracycline alone; 3.4 (IQR, 1.4-6.7) months with HD-IFX; 2.1 (IQR, 1.4-5.2) months with gemcitabine-based chemotherapy; 1.8 (IQR, 0.7-6.6) months with trabectedin; 3.4 (IQR, 3.1-3.8) months with TKI. With a median follow-up of 35.3 (IQR, 17.6-66.9) months, OS from the start of first-line systemic treatment was 15.2 (IQR, 7.6-39.6) months. Conclusion: In this series of advanced PT (to our knowledge, the largest reported so far), AI was associated with a high rate of responses, however with a median PFS of 5.7 months. Other systemic treatments were poorly active.

scholarly journals Systemic Treatment in Advanced Phyllodes Tumor of the Breast: A Multi-Institutional European Retrospective Case-Series Analyses

2021 ◽  
Author(s):  
Elena Palassini ◽  
Olivier Mir ◽  
Giovanni Grignani ◽  
Bruno Vincenzi ◽  
Hans Gelderblom ◽  
...  
Keyword(s):  
Kinase Inhibitors ◽  
Systemic Treatment ◽  
Case Series ◽  
Phyllodes Tumor ◽  
Median Number ◽  
Advanced Breast ◽  
High Rate ◽  
High Dose ◽  
Retrospective Case ◽  
Systemic Treatments

Abstract Background: We aimed at investigating outcome of systemic treatments in advanced breast PT. Methods: All cases of advanced breast PT treated with systemic treatments from 1999 to 2019, in one of the referral sarcoma centres involved in the study, were retrospectively reviewed. Results: 56 female patients were identified. Median age was 52 (range 25-76) years. Patients re-ceived a median number of 2 systemic treatments (range 1-4). Best responses according to RECIST were: 1 (3.7%) CR, 11 (40.7%) PR, 6 (22.2%) SD, 9 (33.3%) PD with anthracyclines plus ifosfamide (AI); 2 (16.7%) PR, 4 (33.3%) SD, 6 (50.0%) PD with anthracycline alone; 3 (18.8%) PR, 4 (25.0%) SD, 9 (56.3%) PD with high-dose ifosfamide given as a continuous infusion (HD-IFX); 3 (20.0%) SD, 12 (80.0%) PD with a gemcitabine-based regimen (with 2 patients not evaluable); 1 (8.3%) PR, 2 (16.7%) SD, 9 (75.0%) PD with trabectedin (with 1 patient not evaluable); 1 (16.7%) PR, 1 (16.7%) SD, 4 (66.7%) PD with tyrosine-kinase inhibitors (TKI). The median PFS were: 5.7 (IQR, 2.5-9.1) months with AI; 3.2 (IQR, 2.2-5.0) months with anthracycline alone; 3.4 (IQR, 1.4-6.7) months with HD-IFX; 2.1 (IQR, 1.4-5.2) months with gemcitabine-based chemotherapy; 1.8 (IQR, 0.7-6.6) months with trabectedin; 3.4 (IQR, 3.1-3.8) months with TKI. With a median follow-up of 35.3 (IQR, 17.6-66.9) months, OS from the start of first-line systemic treatment was 15.2 (IQR, 7.6-39.6) months. Conclusion: In this series of advanced PT (to our knowledge, the largest reported so far), AI was associated with a high rate of responses, however with a median PFS of 5.7 months. Other systemic treatments were poorly active.

scholarly journals ETMR-08. INTERNATIONAL CONSENSUS PROTOCOL FOR EMBRYONAL TUMOR WITH MULTILAYER ROSETTES

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii324-iii324
Author(s):  
Derek Hanson ◽  
Nicolas Andre ◽  
Susan Chi ◽  
Mariella Filbin ◽  
Michael Fisher ◽  
...  
Keyword(s):  
Induction Chemotherapy ◽  
Clinical Investigation ◽  
Case Series ◽  
High Dose ◽  
Consensus Protocol ◽  
Retrospective Case ◽  
International Consensus ◽  
Small Series ◽  
Dismal Prognosis ◽  
Biological Studies

Abstract Embryonal tumors with multilayer rosettes (ETMR) are rare and highly-aggressive central nervous system (CNS) neoplasms which occur primarily in young children and carry a dismal prognosis. To date, no large clinical investigations have been conducted to determine the optimal therapy for ETMR. Data from retrospective case series suggest that our most aggressive standard therapies are not sufficient for cure in the majority of cases. New treatment approaches incorporating pre-clinical data and the known biology of ETMR are therefore urgently needed. A German drug screen using the patient-derived ETMR BT183 cell line and its xenograft revealed anti-tumor activity of topotecan, doxorubicin, and actinomycin D; three agents used infrequently for treating infant CNS tumors. Additional results from a small series of ETMR patients suggest that optimization of induction chemotherapy using these active agents may improve response and survival outcomes. In 2019, an international panel of pediatric neuro-oncology experts convened to advance therapy for ETMR. A consensus protocol was developed incorporating maximal safe surgical resection, induction chemotherapy with active pre-clinical agents, intrathecal chemotherapy, radiotherapy, and high-dose chemotherapy. This international consensus protocol represents the first prospective clinical investigation specific to ETMR and will be available through a treatment registry globally and as a clinical trial at select centers. The study aims to improve survival by providing aggressive, optimized therapy for ETMR and will serve as a platform to explore new biologically-promising agents. The investigation will also provide valuable prospective outcome data and correlative biological studies to serve as baseline comparators for future clinical trials.

scholarly journals Tumor Reduction with Pazopanib in a Patient with Recurrent Lumbar Chordoma

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Maurício Fernando Silva Almeida Ribeiro ◽  
Micelange Carvalho de Sousa ◽  
Samir Abdallah Hanna ◽  
Marcos Vinicius Calfat Maldaun ◽  
Ceci Obara Kurimori ◽  
...  
Keyword(s):  
Kinase Inhibitors ◽  
Systemic Treatment ◽  
Treatment Options ◽  
Axial Skeleton ◽  
Low Grade ◽  
Complete Excision ◽  
Systemic Treatments ◽  
Tumor Reduction ◽  
Comprehensive Genomic Profiling ◽  
Multifocal Recurrence

Introduction. Chordomas are rare malignancies of bone origin that occur in the axial skeleton, typically the skull base and lumbar/sacral regions. Although often classified as low-grade neoplasms, its locally infiltrative behavior may result in significant morbidity and mortality. Optimal surgical resection may be curative, but up to 50% of the cases relapse within 5 years, and currently there are no systemic treatments approved in this setting. A large proportion of these tumors express stem-cell factor receptor (c-KIT) and platelet-derived growth factor receptors (PDGFRs), providing a rationale for the use of tyrosine-kinase inhibitors (TKIs). Case report. A 27-year-old male presented with recurrent chordoma of the lumbar spine 4 years after initial diagnosis. Salvage therapies in the interval included repeat resections and radiation therapy. He ultimately developed multifocal recurrence not amenable to complete excision or reirradiation. A comprehensive genomic profiling assay was performed and revealed nondrugable alterations. Decision was made to proceed with systemic treatment with pazopanib 800 mg/day, resulting in tumor reduction (−23.1% reduction in size) and prolonged disease control. Conclusion. For this patient with a multiple recurrent chordoma and limited treatment options, pazopanib resulted in sustained clinical benefit following initial tumor reduction.

scholarly journals Invasive aspergillosis complicating treatment with tyrosine kinase inhibitors

2019 ◽  
Vol 12 (1) ◽  
pp. e226121 ◽  
Author(s):  
Tajwar Nasir ◽  
Claudia Lee ◽  
Alexandra SC Lawrence ◽  
Jeremy S Brown
Keyword(s):  
Tyrosine Kinase ◽  
Invasive Aspergillosis ◽  
Tyrosine Kinase Inhibitors ◽  
Kinase Inhibitors ◽  
Case Series ◽  
High Dose ◽  
Effective Management ◽  
Traditional Risk Factors ◽  
Tki Treatment ◽  
Systemic Corticosteroid Therapy

We describe three cases of pulmonary aspergillosis (PA) in three patients without traditional risk factors for invasive aspergillosis infection, such as prolonged neutropenia or high dose systemic corticosteroid therapy. All three patients developed PA while taking tyrosine kinase inhibitors (TKI) and sustained greater clinical improvement once TKI were withdrawn. Our case series supports the theory TKI treatment can increase susceptibility to PA without causing neutropenia. Recognition that TKI treatment may predispose to invasive aspergillosis will allow for rapid recognition of affected patients and more effective management of future cases.

scholarly journals Limited Open Reduction and Internal Fixation of Calcaneal Fractures

2019 ◽  
Vol 41 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Anne K. Bremer ◽  
Lukas Kraler ◽  
Lars Frauchiger ◽  
Fabian G. Krause ◽  
Martin Weber
Keyword(s):  
Wound Healing ◽  
Internal Fixation ◽  
Open Reduction ◽  
Case Series ◽  
Functional Results ◽  
High Rate ◽  
Calcaneal Fractures ◽  
Retrospective Case ◽  
Level Of Evidence

Background: The treatment of displaced intra-articular calcaneal fractures remains a challenge and the optimal approach is still controversial. The main reason to avoid the extended lateral approach is the high complication rate due to wound healing problems. We report on 16 years of experience with a standardized limited open reduction and internal fixation technique. Methods: Between 2001 and 2017, we prospectively followed 240 consecutive patients operatively treated for a displaced intra-articular calcaneal fracture. Patients with open, multiple, bilateral, extra-articular, and Sanders IV fractures and those lost to follow-up were excluded. A lateral subtalar approach was used, with a cast for 8 weeks and full weightbearing allowed after 12 weeks. Follow-up examinations were scheduled until 24 months. Subjective and clinical assessment included gait abnormality, subtalar and ankle range of motion, and stability and alignment. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was calculated. Alignment was analyzed on standard radiographs. In total, 131 patients were excluded. The remaining 109 patients were followed for a minimum of 24 months (34.4 ± 14.2 [range, 24-102] months). Results: The mean AOFAS score was 87 ± 13 (range, 32-100). “Excellent” and “good” results, as well as hindfoot motion with “normal/mild” and “moderate” restrictions, were seen in 80% of patients. Early reoperations were performed for insufficient reduction (2 patients), delayed wound healing (debridement, 3 patients), and hematoma (1 patient). Late revisions were arthrodesis (3 patients), medializing calcaneal osteotomy (1 patient), and implant removal (53 patients; 49%). Conclusion: The presented approach has remained unmodified for 16 years and resulted in consistently good functional results. The main disadvantage was the high rate of heel screw removal. Level of Evidence: Level IV, retrospective case series.

Central serous chorioretinopathy associated with high-dose follistatin-344: a retrospective case series

2020 ◽  
Vol 40 (11) ◽  
pp. 3155-3161
Author(s):  
Umut Dağ ◽  
Mehtap Çağlayan ◽  
Hasan Öncül ◽  
Mehmet Fuat Alakuş
Keyword(s):  
Central Serous Chorioretinopathy ◽  
Case Series ◽  
High Dose ◽  
Retrospective Case ◽  
Retrospective Case Series

High-dose Ifosfamide (HDIFX) as a 14-day continuous infusion (ci) in advanced adult soft tissue sarcoma (STS): A single- institution retrospective case series analysis

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 10067-10067
Author(s):  
P. Coco ◽  
E. Fumagalli ◽  
R. Bertulli ◽  
P. Dileo ◽  
F. Grosso ◽  
...  
Keyword(s):  
Continuous Infusion ◽  
Synovial Sarcoma ◽  
Standard Dose ◽  
Tumor Resection ◽  
Case Series ◽  
Practical Reasons ◽  
High Dose ◽  
Single Institution ◽  
Retrospective Case ◽  
Portable Pump

10067 Background: High-dose IFX (≥12 g/sqm) is active even in STS patients pretreated with standard-dose IFX, though with substantial toxicity. Prolonged continuous infusion, through a portable pump, may be an alternative way of administration. A Phase II study thereof is ongoing in Italy, but some pts have been treated off the study, either prior to its start or for practical reasons. Such consecutive pts seen at a single institution have been retrospectively reviewed. Methods: Between July 2001 and September 2006, 45 adult patients (M:F = 25:20; mean age 47 yrs; PS 0–1) with progressing advanced/metastatic STS, all previously treated with anthracyclines and standard-dose IFX, were given ciHDIFX, at the dose of 14 g/sqm as a 14-day continuous infusion every 4 weeks, using two portable infusional devices, with equidose Mesna, lasting 7 days each. Diagnosis was leyomiosarcoma in 12 patients, synovial sarcoma in 9, liposarcoma in 5, and other histological types in 19. Disease was advanced inoperable in 6 pts, and metastatic in 39. The total number of cycles was 176 (median number per pt: 4). Results: A PR was seen in 5 pts (synovial sarcoma, 2; leyomiosarcoma, 1, liposarcoma, 1; chondrosarcoma, 1), and SD in 22 (>6 mos in 12), for a clinical benefit rate = 37%. PFS at 6 months was 35%. Median PFS was 11 mos in pts with PR and 6 in those with SD. Median PFS was 8 months in 9 patients undergoing complete tumor resection. Most common side effects were nausea (G1–2 in 14 pts) and asthenia (G1–2 in 15 pts). G2 anemia was seen in 8 pts, G2 neutropenia in 6. One pt with a single kidney had a reversible G2 hypercreatininemia. No grade 3–4 toxicity were recorded. Conclusions: In this series, ciHDIFX was associated with a PR and 6-mos PFS rate in the range of active second-line agents in advanced STS. This regimen was exceedingly well tolerated. No significant financial relationships to disclose.

Causative agents of liver abscess in HIV-seropositive patients: a 10-year case series in Thai hospitalized patients

2005 ◽  
Vol 35 (2) ◽  
pp. 115-115 ◽  
Author(s):  
Viroj Wiwanitkit
Keyword(s):  
Liver Abscess ◽  
Case Series ◽  
Gastrointestinal Disorder ◽  
High Rate ◽  
Amoebic Liver Abscess ◽  
Case Review ◽  
Retrospective Case ◽  
Gram Negative ◽  
Positive Bacterial Culture ◽  
Hiv Seropositive

Liver abscess is an important tropical gastrointestinal disorder. HIV seropositive patients show relative immunosuppression and are more susceptible to infection, including liver abscess. This retrospective case review was made on 23 patients who were diagnosed as HIV seropositive with liver abscess in Bangkok, Thailand. We demonstrated the high rate of amoebic liver abscess in our series (17.4%) from fresh smear with five cases of tuberculosis and one case of Nocardosis. The rates of positive bacterial culture were 17.4% from blood and 47.8% from pus. Gram-negative aerobes were the major abscess pathogens in our series. Among Gram-negative aerobes, Klebsiella was the most significant microorganism, followed by Escherichia coli and Pseudomonas aeruginosa.

Efficacy of High-dose Steroids for Visual Acuity Improvement in Methanol-induced Toxic Optic Neuropathy

2019 ◽  
Vol 44 (2) ◽  
pp. 60
Author(s):  
Theresia Yinski ◽  
Syntia Nusanti
Keyword(s):  
Visual Acuity ◽  
Optic Neuropathy ◽  
Alcohol Intoxication ◽  
Age Distribution ◽  
Case Series ◽  
High Dose ◽  
Retrospective Case ◽  
Toxic Optic Neuropathy ◽  
Sudden Blindness

Introduction : Methanol-induced toxic optic neuropathy (TON) is defined as a visual impairment due to optic nerve damage by methanol poisoning. Not only is this disease entity underdiagnosed at times, this sudden blindness is also often diagnosed at a stage where recovery of vision is no longer possible. Materials and Methods : A literature search was conducted using PubMed, ClinicalKey, Google Scholar and ScienceDirect by combining the keywords ‘methanol’ or ‘methyl alcohol’, ‘intoxication’ or ‘poisoning’, ‘toxic optic neuropathy’, and ‘visual acuity’ with ‘high-dose steroid’. Results : The total amount of subjects in each article varied from 2 to 37, with mean age distribution of 26.34 to 55 years old, where most patients were male. The follow up duration varied from 1 week to 1 year. Four articles do not mention high-dose steroids treatment as therapy while the other four mention use of 1000 mg of intravenous methylprednisolone per day with divided doses of either 2x500 mg or 4x250 mg. Improvement percentages show 100% improvement in all studies that used high-dose steroids, while in the non-high-dose steroids studies the improvement percentages range from 33.33% to 90%. Summary : High-dose steroids are showing efficacy in improving visual acuity and reducing the inflammation in methanol-induced TON. The period of how fast the therapy takes effect is inconclusive, as the mean follow-up time differs widely per study. However, because most of the reviewed studies here are retrospective case series, a larger, more comprehensive study is required to acknowledge more of the efficacy profile.

Taxonomy of Pathogen Codetection in Pediatric Case Fatalities with Adenoviral Respiratory Infection

2021 ◽  
Vol 16 (05) ◽  
pp. 194-199
Author(s):  
Emily K. Ninmer ◽  
Claire Stewart ◽  
Matthew P. Sharron ◽  
Julia Noether Ashworth ◽  
Natalia Martinez-Schlurman ◽  
...  
Keyword(s):  
Respiratory Infection ◽  
Immune Status ◽  
Case Series ◽  
High Rate ◽  
Retrospective Case ◽  
Pediatric Case ◽  
Retrospective Case Series ◽  
High Degree

Abstract Objective The aim of this study was to determine the prevalence and taxonomy of pathogen codetection in pediatric case fatalities associated with adenoviral respiratory infection. Methods This retrospective case series included 107 pediatric case fatalities associated with adenoviral respiratory infection. Results We observed a high rate of pathogen codetection with broad diversity from both respiratory and nonrespiratory sources. We noted differences in codetection characteristics based on immune status; most notably that immunocompromised cases were more likely to have bacteremia and adenoviremia. Conclusions In pediatric case fatalities associated with adenoviral respiratory infection, we observed a high degree of pathogen codetection.

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