scholarly journals Nivolumab and Ipilimumab in the Treatment of Metastatic Uveal Melanoma: A Single-Center Experience

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Vidhya Karivedu ◽  
Ihab Eldessouki ◽  
Ahmad Taftaf ◽  
Zheng Zhu ◽  
Abouelmagd Makramalla ◽  
...  
Keyword(s):  
Partial Response ◽  
Clinical Outcome ◽  
Uveal Melanoma ◽  
Stable Disease ◽  
Checkpoint Inhibitors ◽  
Evaluation Criteria ◽  
Treatment Strategies ◽  
Case Series ◽  
Retrospective Case ◽  
Study Results

Background. Metastatic uveal melanoma (MUM) is associated with a poor prognosis, with a median overall survival (OS) of 4–15 months. Despite new insights into the genetic and molecular background of MUM, satisfactory systemic treatment approaches are currently lacking. The study results of innovative treatment strategies are urgently needed. Patients and Methods. This was a retrospective case series of 8 patients with MUM managed at the University of Cincinnati between January 2015 and January 2018. The immune-related Response Evaluation Criteria in Solid Tumors (irRECIST) 1.1 criteria were used for patient evaluation, and magnetic resonance imaging was used for evaluation at treatment checkpoints. Objective. To assess the clinical outcome of patients with MUM treated with a combination of checkpoint inhibitors. Results. The series included eight patients, six men and two women, with MUM. Their median age at MUM diagnosis was 69 (range, 55–77) years. All patients were treated with ipilimumab and nivolumab combination along with transarterial chemoembolization (TACE), followed by nivolumab maintenance and monthly TACE procedures. The majority of patients had a partial response or stable disease. Two of the patients had partial response, while four others had stable disease. Two other patients experienced disease progression. Conclusion. We report the outcomes of eight patients with MUM treated with the combination of ipilimumab and nivolumab. We report the clinical outcome and toxicity associated with this treatment approach. Further studies are warranted to explore immunotherapy in MUM. These findings support the consideration of immunotherapy in MUM.

Ultrasound Biomicroscopy Documented Anterior Uveal Melanoma Regression after Ruthenium-106 Plaque Therapy

2021 ◽  
pp. 1-9
Author(s):  
Biljana Kuzmanović Elabjer ◽  
Mladen Bušić ◽  
Andrej Pleše ◽  
Mirjana Bjeloš ◽  
Daliborka Miletić ◽  
...  
Keyword(s):  
Uveal Melanoma ◽  
Tumor Regression ◽  
Corneal Thickness ◽  
Case Series ◽  
Ultrasound Biomicroscopy ◽  
Close Monitoring ◽  
Single Institution ◽  
Retrospective Case ◽  
Caucasian Patients

<b><i>Introduction:</i></b> Ultrasound biomicroscopy (UBM) is the only widely used method for the evaluation of anterior uveal melanoma (AUM). <b><i>Objective:</i></b> Documentation of regression of AUM treated with ruthenium-106 (Ru-106) plaque types CCB and CCC using UBM. <b><i>Methods:</i></b> This single institution-based retrospective case series involved 10 Caucasian patients with AUM followed after brachytherapy with UBM from January 2014 until February 2019. The largest prominence of the tumor perpendicular to the sclera or the cornea (including scleral/corneal thickness) (<i>D</i>) and the largest basal dimension (<i>B</i>) were measured in millimeters with UBM for all patients prior to the brachytherapy and at 4-month interval follow-up. Tumor regression was calculated as a percentage of decrease in the initial <i>D</i> and <i>B</i> values. <b><i>Results:</i></b> The study involved 10 patients with a mean age of 64.4 years (yr) (range 46–80 yr). <i>D</i> ranged from 1.82 to 5.5 mm (median 2.99 mm) and <i>B</i> from 2.32 to 12.38 mm (median 4.18 mm). The apical radiation dose in all patients was 100 Gy. The median follow-up was 42.02 months. Regression for <i>D</i> was 21.11 ± 13.66%, 31.09 ± 14.66%, and 34.92 ± 19.86% at 1st, 2nd, and 3rd year of the follow-up, respectively, while for <i>B</i> it was 21.58 ± 16.05%, 28.98 ± 17.71%, and 32.06 ± 18.96%, respectively. Tumor recurrence was documented in 2/10 patients. <b><i>Conclusion:</i></b> The major regression of AUM, treated with Ru-106 plaque types CCB and CCC, was documented in the first 2 years after brachytherapy in our study group. In the following years, only minimal regression was documented that warns of the need for close monitoring and active search for local recurrences.

scholarly journals Deferiprone as adjunctive treatment for patients with invasive mucormycosis: A retrospective case series

2018 ◽  
Vol 10 (2) ◽  
Author(s):  
Maria N. Chitasombat ◽  
Pimjai Niparuck
Keyword(s):  
Mortality Rate ◽  
Treatment Strategies ◽  
Case Series ◽  
Hematologic Malignancies ◽  
Adjunctive Treatment ◽  
Combination Regimen ◽  
Retrospective Case ◽  
Day Range

Mucormycosis is a life-threatening disease requiring multimodal treatment with antifungals and surgery. The mortality rate remains high, prompting consideration of alternative treatment strategies. Deferiprone has in vitro activity against Mucorales, but its efficacy has never been evaluated in humans. Here, we retrospectively analyzed patients with confirmed mucormycosis who received deferiprone from 2011 to 2017. Five patients had hematologic malignancies and one was diabetic. The sites of infection included sinus-orbit-cerebral (67%), lung (17%), and disseminated infection (17%). Surgery was performed in 83% of cases and achieved local control for 33% of patients. A combination regimen of polyenes plus echinocandins was administered with stepdown treatment using posaconazole. The median duration of antifungal treatment was 86 days (range: 46-435 days) days. Deferiprone was given as adjunctive treatment with a median dose and duration of 100 mg/kd/day (range: 86.2-100 mg/kg/day) and 25 days (range: 15-215 days), respectively. Overall, deferiprone was well-tolerated. Successful outcomes were observed at 12-week follow-up for 67% of patients. The mortality rate at 180- day follow-up was 50%. Adjunctive therapy with deferiprone showed safety and tolerability.

scholarly journals Autotransplantation of mature impacted tooth to a fresh molar socket using a 3D replica and guided bone regeneration: two years retrospective case series

2019 ◽  
Author(s):  
Ye Wu ◽  
Jiaming Chen ◽  
Fuping Xie ◽  
Huanhuan Liu ◽  
Gang Niu ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Bone Regeneration ◽  
Case Series ◽  
Guided Bone Regeneration ◽  
Third Molars ◽  
Retrospective Case ◽  
Impacted Tooth ◽  
Probing Depth ◽  
One Year

Abstract Background: The aim of this study was to evaluate the clinical outcome of autotransplantation of mature third molars to fresh molar extraction sockets using 3D replicas. Methods: Ten patients underwent teeth autotransplantation with or without GBR. We observed the mobility, percussion, radiography examination, the probing depth and the masticatory function of the transplanted teeth during two years following up, which were transplanted into fresh molar sockets by using 3D replicas, and GBR when it is necessary. Results: The average extra-oral time of donor tooth had been shortened to 1.65 min when used the 3D replica. Some probing depth of the transplanted tooth were deeper than 3 mm at 4 or 5 weeks temporarily. And one patient felt slight sensitive when chewing with soft food at 4 weeks, then disappeared. The clinical examination of the autotransplantation teeth during one year follow-up showed no sign of failure. Conclusions: The tooth autotransplantation using 3D replica with or without GBR is an effective method which can reduce the extra-oral time of the donor teeth and may result in less failure.

scholarly journals Management of Advanced Medullary Thyroid Carcinoma with Vandetanib: Case Series

2021 ◽  
Vol 5 (1) ◽  
pp. 01-07
Author(s):  
Andrés Flórez R
Keyword(s):  
Partial Response ◽  
Adverse Events ◽  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Stable Disease ◽  
Case Series ◽  
Medullary Thyroid ◽  
The Mean ◽  
Grade 3

Objective: To describe the tumor response and adverse events in patients with advanced medullary thyroid carcinoma (MTC) treated with vandetanib at the National Cancer Institute in Bogotá, Colombia. Materials and Methods: Case series including five patients with advanced MTC treated with vandetanib from April 2011 to August 2018 and a minimum follow-up of 6 months. Results: 5 patients met the inclusion criteria, including 3 women. The mean age was 49 years. A total of 4 patients underwent total thyroidectomy prior to starting vandetanib. The main indication for vandetanib was progression of liver metastasis (4 patients). Regarding treatment response, 3 patients presented stable disease, 1 patient showed partial response, and 1 had disease progression. The mean treatment duration was 16.5 months. Grade 3 or 4 adverse events were observed in three patients, 1 with diarrhea, 1 with hypertension, and 1 with rash. All symptoms improved with dose reduction or temporary suspension of vandetanib. Conclusions: The management of advanced MTC with vandetanib allows for prolonged disease control (stable disease or partial response). Although adverse events are frequent, most are mild and severe cases are manageable.

Improved prognostic precision in uveal melanoma through a combined score of clinical stage and molecular prognostication

2021 ◽  
Author(s):  
Andrew W. Stacey ◽  
Vaidehi S. Dedania ◽  
Miguel Materin ◽  
Hakan Demirci
Keyword(s):  
Uveal Melanoma ◽  
Risk Score ◽  
Clinical Stage ◽  
Case Series ◽  
Clinical Staging ◽  
Molecular Testing ◽  
Total Risk ◽  
Retrospective Case ◽  
Simple Method ◽  
Kaplan Meier

Introduction: Prognosis of uveal melanoma (UM) is assessed using clinical staging or molecular testing. Two modalities often used for prognostication are the American Joint Committee on Cancer (AJCC) staging and a tumor gene expression profile (GEP), the outcomes of which are often discordant. This paper discusses a Total Risk Score created to combine the discordant information from both sources. Methods: A retrospective case series was conducted of all patients presenting with UM over six years to two referral centers. Each tumor was classified using the AJCC and the GEP. A Total Risk Score was calculated for each patient using results from both AJCC and GEP. Kaplan-Meier analysis of metastasis free-survival was used to compare groups. Results: A total of 294 patients were included in the study. Kaplan-Meier estimates showed significant curve separation between individual AJCC and GEP risk groups. The combined Total Risk Score provided an accurate estimate of prognosis that incorporated results from both AJCC and GEP. Conclusions: Clinical staging and molecular prognostication of UM can be discordant. There is important information provided by each system that is not provided by the other. The Total Risk Score provides a simple method to combine information from both the AJCC stage and the GEP class in order to provide patients and care teams with a more complete understanding of metastatic risk.

Risk factors for corneal epithelial wound healing: Can sex play a role?

2021 ◽  
pp. 112067212110667
Author(s):  
Giulia Coco ◽  
Kevin J. Hamill ◽  
Lee D. Troughton ◽  
Stephen B. Kaye ◽  
Vito Romano
Keyword(s):  
Risk Factors ◽  
Wound Healing ◽  
Treatment Strategies ◽  
Case Series ◽  
Healing Time ◽  
Retrospective Case ◽  
Corneal Epithelial ◽  
Female Patients ◽  
Epithelial Wound Healing ◽  
Wound Healing Time

Purpose To determine if sex is associated with corneal epithelial wound healing time in patients with persistent corneal epithelial defects (PCEDs). Methods Retrospective case series on patients with PCED from November 2014 to January 2019. Records of 127 patients with diagnosis of PCED were reviewed. Patients with an epithelial defect that lasted more than two weeks in the absence of an active corneal infection were included. Main outcome was corneal epithelial wound healing time. Results 55 patients (29 males) with a mean age of 65.3 ± 16.5 years were included. No difference was found between female and male patients in terms of risk factors, age, treatment strategies or intervals between visits (median of 15 days in females and 12 days in males; p = 0.24). Median duration of the PCED was 51 days (IQR 32-130), with a median number of 5 clinical visits (IQR 4-8). Female patients had significantly longer healing times (p = 0.004) and a corresponding increase in the number of clinical visits (median of 7 visits vs. 5 clinical visits in males, p = 0.012). Conclusion Results from this study suggest female patients with PCED might have a longer corneal epithelial wound healing duration and may therefore require earlier intervention.

scholarly journals Combined lenvatinib and pembrolizumab as salvage therapy in advanced adrenal cortical carcinoma

2020 ◽  
Vol 8 (2) ◽  
pp. e001009
Author(s):  
Sara Bedrose ◽  
Kevin Charles Miller ◽  
Lina Altameemi ◽  
Mohamed S Ali ◽  
Sameh Nassar ◽  
...  
Keyword(s):  
Systemic Therapy ◽  
Salvage Therapy ◽  
Checkpoint Inhibitors ◽  
Single Agent ◽  
Case Series ◽  
Progression Free Survival ◽  
Adrenal Cortical Carcinoma ◽  
Retrospective Case ◽  
First Case ◽  
Platinum Based Chemotherapy

BackgroundThere is no effective systemic therapy for metastatic adrenal cortical carcinoma (ACC) after failure of platinum-based chemotherapy. The efficacies of single-agent oral multikinase inhibitors (MKIs) or salvage immune checkpoint inhibitors (CPIs) have been very limited. It is unknown whether combining CPIs, such as pembrolizumab (PEM), with other therapies, such as MKIs, could yield higher response rates in ACC, yet this combination has shown promise in other cancers. Herein, we describe the first case series using PEM in combination with the MKI lenvatinib (LEN) in patients with progressive, metastatic ACC.MethodsA retrospective case series describing the use of LEN/PEM as salvage therapy in patients with progressive/metastatic ACC.ResultsEight patients were treated with the LEN/PEM combination therapy. Half were female, and the median age at time of diagnosis was 38 years (range 21–49). Three (37.5%) patients had hormonally active ACC. The median number of prior lines of systemic therapy was 4 (range 2–9). Six (75%) patients had had disease progression on prior CPIs and five (62.5%) patients had progressed on prior MKI therapy. The median progression-free survival was 5.5 months (95% CI 1.8–not reached) and median duration of therapy was 8.5 months (range 2–22). Two (25%) patients had a partial response, one (12.5%) patient had stable disease, and five (62.5%) patients had progressive disease. None of the eight patients stopped therapy because of adverse events.ConclusionsIn our small cohort of heavily pretreated patients with ACC, the combination of LEN/PEM was associated with objective responses in a subset of patients without significant toxicity. This combination should be formally investigated in phase II clinical trial with robust correlative studies to identify predictors for response.

scholarly journals Clinical Characteristics of Severe COVID-19 in China: A Case Series and Meta-analysis

2021 ◽  
Author(s):  
Geling Teng ◽  
Hua Hu ◽  
Xia Wang ◽  
Junsheng Wang ◽  
Hongmei Zhang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Bacterial Infections ◽  
Clinical Signs ◽  
Treatment Strategies ◽  
Case Series ◽  
Imaging Features ◽  
Chest Tightness ◽  
Retrospective Case

Abstract Background: There have been inconsistent reports regarding the unique manifestations of severe coronavirus disease 2019 (COVID-19) occurring in China. This study analyzed the clinical manifestation of 13 severe COVID-19 cases at a single institution and compared the data to previously reported characteristics of severe COVID-19 in China. Methods: This retrospective case study included patients with severe COVID-19 who were admitted to the isolation ward of the Shandong Chest Hospital from January 2020 to February 2020. The clinical signs and symptoms, laboratory examination results, imaging features, treatment strategies, and patient prognoses were summarized. A database search was then conducted for studies published through December 2020 documenting characteristics of severe COVID-19 cases in China. The pooled results for severe COVID-19 patients in China were calculated by using the random-effects model.Results: A total of 4 severe and 9 critical patients were included from Shandong Chest Hospital. The average patient age was 55.3 (range 23-88) years, and 61.5% of patients were male. Chest computed tomography for all patients showed multiple lesions as ground-glass shadows in both lungs. All patients presented bacterial infection and various degrees of liver and myocardial injury. The treatment strategies for patients included antibiotics, immunoglobulin, and glucocorticoids, and mechanical ventilation was used in all patients for respiratory failure. Two patients died, and 11 recovered. In the pooled data for severe COVID-19 patients, the most common comorbidities were hypertension, diabetes mellitus, and coronary heart disease. The common signs in these patients were fever, cough, fatigue, chest tightness, and a leukocyte count > 10. Conclusions: Older males with hypertension, diabetes mellitus, and coronary heart disease may be at higher risk of developing severe COVID-19. Patients should be assessed for concomitant bacterial infections. Cardiac and liver enzymes, fever, cough, fatigue, chest tightness, and leukocytosis should be monitored for signs of disease progression.

scholarly journals Intraocular Schwannoma: Case Series of 28 Patients and Literature Review

2021 ◽  
Author(s):  
Yue-Ming Liu ◽  
Li Dong ◽  
Xiao-Lin Xu ◽  
He-Yan Li ◽  
Qiong Yang ◽  
...  
Keyword(s):  
Literature Review ◽  
Uveal Melanoma ◽  
Light Transmission ◽  
Case Series ◽  
Visual Field Loss ◽  
Common Symptom ◽  
Retrospective Case ◽  
Melanoma Tumor ◽  
Intraocular Tumor ◽  
Age Range

Abstract Background: Intraocular schwannoma is a rare intraocular tumor, which is often misdiagnosed. We aimed to analyze the demographics and clinical characteristics of patients with intraocular schwannoma.Methods: Retrospective case series were collected from May 2005 to July 2021 in Beijing Tongren Hospital. Then a literature review was also performed.Results: A total of 28 patients were diagnosed with intraocular schwannoma histopathologically. The median age (range) of the included patients was 39 (12-64) years old, among whom half subjects were female. The most common symptom was visual loss (75.0%), followed by visual field loss (10.7%). Intraocular schwannoma presented as nonpigmented mass, which occurred mainly in ciliary body (42.9%), followed by choroid (32.1%) and ciliochoroid (25.0%).16 patients (57.1%) were clinically misdiagnosed as uveal melanoma. Tumor excision was performed for all patients and increased light transmission was detected in half cases. In the consecutive follow-up (median: 6.0 years, range: 0.5-16.0 years), no recurrence or metastasis case was detected.Conclusions: Intraocular schwannoma is a rare benign intraocular tumor. It usually presents as nonpigmented mass, which is easily misdiagnosed as nonpigmented uveal melanoma.

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