scholarly journals Rapid Progression of Intracranial Dural Metastases in a Patient with Carcinoma of Unknown Primary Site

2019 ◽  
Vol 12 (2) ◽  
pp. 666-670 ◽  
Author(s):  
Hiroyuki Takeda ◽  
Rintaro Ohe ◽  
Tadahisa Fukui ◽  
Shuhei Suzuki ◽  
Sho Nakamura ◽  
...  
Keyword(s):  
Bone Metastases ◽  
Primary Site ◽  
Unknown Primary ◽  
Rapid Progression ◽  
Primary Cancer ◽  
Tumor Biopsy ◽  
Platinum Based Chemotherapy ◽  
Multiple Bone Metastases ◽  
Dural Metastases ◽  
Sacral Bone

Dural metastases are uncommon in cancer patients, but can have as much of an effect on the lives of patients as brain metastases. Dural metastases are most commonly associated with primary cancers of the breast, prostate, and lung, and it is rare that the primary site of the tumor is unknown. In this study, we encountered a 51-year-old woman who had developed multiple bone tumors, with no known primary cancer lesion. A tumor biopsy of the sacral bone revealed non-keratinizing squamous cell carcinoma; the patient was therefore diagnosed as having multiple bone metastases of an unknown primary cancer. Magnetic resonance imaging revealed cranial metastases and partial thickening of the dura with suspected dura metastases. Platinum-based chemotherapy reduced the bone metastases and the thickened dura. However, as resistance to chemotherapy developed, invasions progressed rapidly and diffusely throughout the dura. This was accompanied by the development of dysarthria, visual impairments, and delirium. The patient died 10 months after being diagnosed with dural metastases. This report provides information on the clinical course and prognosis of patients with dural metastases of unknown primary cancer. Furthermore, it may help to construct a treatment strategy for dural metastases.

scholarly journals Survival of patients with synchronous brain metastases: an epidemiological study in southeastern Michigan

2000 ◽  
Vol 9 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Ajith J. Thomas ◽  
Jack P. Rock ◽  
Christine C. Johnson ◽  
Linda Weiss ◽  
Gordon Jacobsen ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Median Survival ◽  
Cancer Diagnosis ◽  
Systemic Disease ◽  
Primary Source ◽  
Primary Site ◽  
Unknown Primary ◽  
Primary Cancer ◽  
Significant Difference ◽  
Frequent Site

Object It has been suggested that synchronous brain metastases (that is, those occurring within 2 months of primary cancer diagnosis) are associated with a shorter survival time compared with metachronous lesions (those occurring greater than 2 months after primary cancer diagnosis). In this study the authors used data obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program to determine the incidence of synchronous brain metastases and length of survival of patients in a defined population of southeastern Michigan residents. Methods Data obtained in 2682 patients with synchronous brain metastases treated from 1973 to 1995 were reviewed. Study criteria included patients in whom at least one brain metastasis was diagnosed within 2 months of the diagnosis of primary cancer and those with an unknown primary source. The incidence per 100,000 increased fivefold, from 0.69 in 1973 to 3.83 in 1995. The most frequent site for the primary cancer was the lung (75.4%). The second largest group (10.7%) consisted of patients in whom the primary site was unknown. The median survival length was 3.3 months. There was no significant difference in the median survival in patients with primary lung/bronchus and those with an unknown primary site (3.2 months and 3.4 months, respectively). Conclusions Patients who present with synchronous lesions have a poor prognosis, and the predominant cause of death, in greater than 90% of cases, is related to systemic disease; however, despite poor median survival lengths, certain patients will experience prolonged survival.

Survival of patients with synchronous brain metastases: an epidemiological study in southeastern Michigan

2000 ◽  
Vol 93 (6) ◽  
pp. 927-931 ◽  
Author(s):  
Ajith J. Thomas ◽  
Jack P. Rock ◽  
Christine C. Johnson ◽  
Linda Weiss ◽  
Gordon Jacobsen ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Median Survival ◽  
Cancer Diagnosis ◽  
Systemic Disease ◽  
Primary Site ◽  
Unknown Primary ◽  
Primary Cancer ◽  
Content Type ◽  
Significant Difference ◽  
Fine Print

Object. It has been suggested that synchronous brain metastases (that is, those occurring within 2 months of primary cancer diagnosis) are associated with a shorter survival time compared with metachronous lesions (those occurring more than 2 months after primary cancer diagnosis). In this study the authors used data obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results program to determine the incidence of synchronous brain metastases and length of survival of patients in a defined population of southeastern Michigan residents.Methods. Data obtained in 2682 patients with synchronous brain metastases treated between 1973 and 1995 were reviewed. Study criteria included patients in whom at least one brain metastasis was diagnosed within 2 months of the diagnosis of primary cancer and those with an unknown primary source. The incidence per 100,000 population increased fivefold, from 0.69 in 1973 to 3.83 in 1995. The most frequent site for the primary cancer was the lung (75.4%). The second largest group (10.7%) consisted of patients in whom the primary site was unknown. The median length of survival was 3.2 months. There was no significant difference in the median survival of patients with primary lung/bronchus and those with an unknown primary site (3.3 months and 3.2 months, respectively).Conclusions. Patients who present with synchronous lesions have a poor prognosis, and the predominant cause of death, in more than 90% of cases, is related to systemic disease; however, despite poor median survival times, certain patients will experience prolonged survival.

scholarly journals Pembrolizumab plus platinum-based chemotherapy for unfavorable cancer of unknown primary site: Case report

2020 ◽  
Vol 60 ◽  
pp. 31-35 ◽  
Author(s):  
Teppei Kamada ◽  
Hiroshi Ishiguro ◽  
Shinya Okada ◽  
Hideyuki Takeuchi ◽  
Junji Takahashi ◽  
...  
Keyword(s):  
Case Report ◽  
Cancer Of Unknown Primary ◽  
Primary Site ◽  
Unknown Primary ◽  
Unknown Primary Site ◽  
Platinum Based Chemotherapy

Evaluating the hidden biology of cancer of unknown primary (CUP) in comparison to known metastatic disease.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e12549-e12549
Author(s):  
Malek Bassam Hannouf ◽  
Salah Mahmud ◽  
Eric Winquist ◽  
Muriel Brackstone ◽  
Gregory S Zaric
Keyword(s):  
Tumour Size ◽  
Primary Tumour ◽  
Cancer Of Unknown Primary ◽  
Primary Site ◽  
Unknown Primary ◽  
Primary Cancer ◽  
Phenotypic Characteristics ◽  
Wilcoxon Rank Sum Test ◽  
Pathologic Features ◽  
Tumour Characteristics

e12549 Background: No consensus exists yet on whether CUP is a group of metastatic tumours with undetected primary sites or a unique clinicopathological entity with distinct genetic and phenotypic characteristics. We aimed to characterize the clinical and pathologic features of a cohort of CUP patients who had their latent primary site subsequently detected during their life or at autopsy in comparison to a cohort of patient presented with metastatic known primary cancers at initial diagnosis. Methods: We used historical snapshot files available in the Manitoba Cancer Registry (MCR) to identify all patients diagnosed with histologically or cytologically confirmed metastatic tumours in Manitoba during the period from January 1, 2002 to December 31, 2012. We linked all identified patients with their updated tumour-specific files available in the MCR for the purpose of identifying our two study cohorts. The first cohort included all patients who were initially diagnosed with CUP and who had their latent primary cancer identified and confirmed using either histology, cytology or autopsy at least 2 months after their initial CUP diagnosis. The second cohort included all patients initially diagnosed with a metastatic known primary cancer and whose cancer diagnosis did not change during lifetime or at autopsy. Information on patient and tumour characteristics was obtained from the MCR. Results: Out of 16,085 patients diagnosed with metastatic tumours, 2654 (%16.5) patients were initially diagnosed with CUP and 13,431 (84.5%) patients diagnosed with metastases of a known primary cancer. Out of the CUP group, 1033 (39%) patients had their latent primary site subsequently detected. Distribution of primary sites did not differ significantly between CUP patients who had their latent primary detected and patients diagnosed with metastases of a known primary cancer (p=0.44, Wilcoxon rank sum test). With the exception of tumour size, all other patient and tumour characteristics did not differ significantly between the two study cohorts across primary tumour sites. Conclusions: The clinical and pathologic features of CUP patient do not appear to be fundamentally different from those with metastatic known primary cancers.

Blood-based biomarker analysis in high PD-L1 expressing NSCLC treated with PD-1/PD-L1 based therapy with or without the addition of platinum-based chemotherapy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. TPS9126-TPS9126
Author(s):  
Mary J. Fidler ◽  
Victoria Meucci Villaflor ◽  
Amol Rao ◽  
Balazs Halmos ◽  
Erin Marie Bertino ◽  
...  
Keyword(s):  
Group Performance ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Rapid Progression ◽  
Blood Draw ◽  
Tumor Biopsy ◽  
Platinum Based Chemotherapy ◽  
Biomarker Analysis ◽  
Early Progression ◽  
Treatment Naïve

TPS9126 Background: Immunotherapy directed against the programmed death-1 / ligand-1 (PD-1/L1) axis has revolutionized the treatment of advanced non-small cell lung cancer (aNSCLC). Tumor PD-L1 is currently the only biomarker validated for predicting patient response to front line PD-1/L1 directed immunotherapy, yet 20% of patients with ≥50% PD-L1 expression die within six months of starting therapy (Reck et al. 2016). Blood-based agents such as autoantibodies and circulating inflammatory biomarkers have stratified patient outcomes on anti-PD-1/L1 immunotherapy in preliminary studies (Tarhoni, Kollipara et al. 2019; Tarhoni, Fidler et al. 2019). Moreover, a serum-based proteomic test that uses mass spectrometry and machine learning to provide three classifications (Good, Intermediate and Poor) has stratified non-treatment naïve aNSLCC patients treated with nivolumab based on their outcomes (Mueller et al. 2020) and identified a subset of patients who progressed rapidly. This study will evaluate these blood-based biomarkers as predictors of response and early progression in patients with >50% PD-L1 positive aNSCLC treated with immunotherapy regimens. Methods: This is a prospective, observational, multicenter study (NCT04676386) designed to assess biomarkers (serum and plasma) as predictive of early progression in 390 patients with aNSCLC treated with anti-PD 1/PD-L1 immunotherapy with or without platinum-based chemotherapy. Key eligibility criteria are treatment naïve aNSCLC with tumor biopsy PD-L1 tumor proportion score > 50%, Eastern Cooperative Oncology Group performance status (ECOG PS) 0-2, and ability to consent to participate. Prior to enrollment, tumor specimens will be tested for PD-L1 expression according to participating centers’ standard operating procedures. For each treatment cohort of 195 patients, enrollment will proceed in sub-cohorts to ensure a population with 20% patients with ECOG PS2 and a total of 40 patients with squamous cell carcinoma per treatment arm. Patients will be followed for a maximum of 3 years. Blood draw for biomarker assessment will be performed prior to treatment initiation, start of 3rd cycle and investigator assessed progression. Biomarker analysis will be performed retrospectively. As a secondary objective, this study will evaluate proteomic test performance in predicting early overall survival (OS) and rapid progression, and in stratifying patient survival and response. Exploratory analyses will correlate baseline and serial circulating protein analytes and autoantibodies with the proteomic test, response measures (RECIST 1.1) and toxicities. Enrollment opened in February 2021. Clinical trial information: NCT04676386.

Neoadjuvant nivolumab (N) plus weekly carboplatin (C) and paclitaxel (P) in resectable locally advanced head and neck cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 6583-6583
Author(s):  
Ralph Zinner ◽  
Jennifer M Johnson ◽  
Madalina Tuluc ◽  
Joseph M. Curry ◽  
Adam Luginbuhl ◽  
...  
Keyword(s):  
Head And Neck ◽  
Primary Endpoint ◽  
Locally Advanced ◽  
Pathologic Response ◽  
Primary Site ◽  
Stage Iii ◽  
Unknown Primary ◽  
Scanning System ◽  
Viable Tumor ◽  
Platinum Based Chemotherapy

6583 Background: Despite multimodality standard therapy, patients (pts) with resectable locally advanced squamous cell carcinoma of the head and neck (LA SCCHN) are at high risk for recurrence. Pts with pathologic complete response (pCR) or major pathologic response (MPR) to neoadjuvant chemotherapy have improved overall survival. PD-1 checkpoint inhibitors are approved in combination with platinum-based chemotherapy in the 1st-line treatment of recurrent/metastatic SCCHN. We hypothesize the addition of N to wkly carboplatin C and P will increase the pCR rate at the primary site compared to historical controls. Methods: This is an investigator-initiated trial for pts with newly diagnosed (AJCC 8th) stage III-IV HPV- (oral cavity (OC), oropharynx (OP), hypopharynx (HP), and larynx (L) or stage II-III HPV+ OP SCCHN without distant metastasis who are surgical candidates. Neoadjuvant chemo starting d1 is C AUC 2 IV wkly x 6 plus P 100 mg/m2 IV wkly x 6 plus N 240 mg IV q 2 wks x 3 with surgery on wk 8. The primary endpoint is pCR at the primary site. To estimate pathologic response, the resected pathology specimens are cut >1 section/cm. Using the Aperio Digital scanning system, slides are imaged, and then annotated by at least 2 pathologists for viable tumor vs. treatment effect with areas automatically calculated to yield the percentage of viable tumor. Our primary endpoint will be reached if 11/37 planned pts have a pCR at the primary site. Results: From 11/17-12/19, 27 pts received the study regimen and had surgery (1/27 had an unknown primary; thus, inevaluable for the primary endpoint). Of 27 pts, median age was 59 (46-83), women 31%, HPV+ 15%, OC 73%, OP 19%, HP 7%, L 4%; stage III 33%, stage IVA 67%. Gd 3 toxicities were in 37% pts; 1 pt febrile neutropenia, 3pts anemia, 1pt diarrhea, 1pt cellulitis and 1pt rash. Four pts had gd 3-4 neutropenia. Dose reductions were in 2 pts, and 4 pts had 1 wkly dose dropped. All 27 pts went to surgery, none with PD by CT; all with negative margins. One pt died with rapid recurrence; no other recurrences (median f/u 13 mos). Our primary endpoint was met; 11/26 (42%) pts (excluding pt with unknown primary) had a pCR at the primary site. 9/23 (39%) HPV- pts, had a pCR. MPR or pCR was 18/26 (69%) and in HPV- pts, 15/23 (65%). 2/11 pts had microscopic residual disease in 1 LN each. Conclusions: The combination of N and wkly PC was well tolerated. The primary endpoint of pCR at the primary site in > 11/37 pts was met with the 27th pt. Accrual continues. Exploratory outcomes assessing markers of immune bias in tumor tissue and plasma are in process. Clinical trial information: NCT03342911 .

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