Phenotype of acute liver failure in inapparent small cell lung cancer

2020 ◽  
Vol 74 (5) ◽  
pp. 404-409
Author(s):  
Xénia Faktorová ◽  
Terézia Staškovanová ◽  
Katarína Bilíková ◽  
Richard Hokša ◽  
Tomáš Tvrdík ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Primary Tumour ◽  
Small Cell ◽  
Rapid Progression ◽  
Small Cell Lung ◽  
Elevated Liver Enzymes

Acute liver failure is defined by the manifestation of liver failure from 7th to 21st day in a previously healthy liver. The most frequent causes are viral hepatitis B, A, E, drug or toxin-induced hepatotoxicity (Amanita phalloides), rarely Wilson’s disease, autoimmune hepatitis, HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome, or vascular causes (Budd-Chiari syndrome, hypoxic hepatitis). We present a 71-year- -old female patient with metabolic syndrome admitted to hospital with cholestasis, progression of weakness, abdominal pain, and breathlessness. Because of suspected pleuropneumonia, the treatment with ceftriaxone/metronidazole was initiated. Due to cholestasis progression and suspicion of drug-induced liver toxicity, the treatment was stopped on 5th day. Imaging methods (ultrasonography, CT, magnetic resonance imaging) found multiple small liver lesions, suspected metastatic involvement, which was not confirmed by positron emission tomography – computed tomography. Due to the rapid progression of the patient’s condition with the onset of icterus, ascites, encephalopathy, a liver bio­psy was not done. The patient died on the 17th day of hospitalization. The primary tumour was not detected during her life, and not by pathological section. The diffuse metastasis of small cell lung cancer (SCLC) in the liver was found by histological post mortem examination. The case report suggests high invasiveness of SCLC with a possibility of unusual manifestation in a form of acute hepatic failure.

scholarly journals Prediction of microscopic metastases in patients with metachronous oligo-metastases after curative treatment of Non-Small Cell Lung Cancer

2019 ◽  
Author(s):  
H.B. Wolff ◽  
L. Alberts ◽  
E.A. Kastelijn ◽  
N.E. Verstegen ◽  
S.Y. El Sharouni ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Primary Tumour ◽  
Small Cell ◽  
Small Cell Lung ◽  
Curative Intent ◽  
Patient Level Data ◽  
Patient Level ◽  
Level Data

AbstractMetachronous oligo-metastatic disease is variably defined as one to five metastases detected after a disease-free interval and treatment of the primary tumour with curative intent. Oligo-metastases in non-small cell lung cancer (NSCLC) are often treated with curative intent. However additional metastases are often detected later in time, and 5-year survival is low. Burdensome surgical treatment in patients with undetected metastases may be avoided if patients with high versus low-risk of undetected metastases can be separated.Because there is no clinical data on undetected metastases available, a microsimulation-model of the development and detection of metastases in 100.000 stage I NSCLC patients with a controlled primary tumour was constructed. The model uses data from the literature as well as patient-level data. Calibration was used for unobservable model parameters. Metastases can be detected by a scheduled scan, or an unplanned scan when the patient develops symptoms. The observable information at time of detection is used to identify subgroups of patients with different risk of undetectable metastases. We identified size and number of detected oligo-metastases, as well as presence of symptoms to be the most important risk predictors. Based on these predictors, patients could be divided into a low-risk and a high-risk group having a model-based predicted probability of 8.1% and 89.3% to have undetected metastases, respectively.Currently, the model is based on a synthesis of literature data and individual patient-level data that was not collected for the purpose of this study. Optimisation and validation of the model is necessary to allow clinical usability. We describe the type of data that needs to be collected to update our model, as well as the design of such validation study.

scholarly journals Successful Treatment of Afatinib-Refractory Non-Small Cell Lung Cancer with Uncommon Complex EGFR Mutations Using Pembrolizumab: A Case Report

2019 ◽  
Vol 12 (2) ◽  
pp. 564-567
Author(s):  
Yuri Taniguchi ◽  
Momoko Yamamoto ◽  
Hiroaki Ikushima ◽  
Sayaka Ohara ◽  
Hideyuki Takeshima ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Clinical Stage ◽  
Nsclc Patient ◽  
Growth Factor Receptor ◽  
Small Cell ◽  
Egfr Mutations ◽  
Rapid Progression ◽  
Small Cell Lung

Although there has been significant progress in immune-checkpoint inhibitor (ICI) treatment, it remains controversial whether they should be used in the treatment of epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC). We herein report the case of an NSCLC patient with uncommon complex EGFR mutations (G719S and L861Q) who was refractory to afatinib treatment but who showed a good response to pembrolizumab treatment. A 65-year-old female ex-smoker was diagnosed with right upper lobe NSCLC (clinical stage IVB; cT2bN3M1c). She had received afatinib for two months, but her disease showed rapid progression. Pembrolizumab treatment was initiated because more than 75% of her tumor cells expressed PD-L1. Her tumor responded well to pembrolizumab treatment and it remained effective for more than 1 year. Our case suggests that pembrolizumab treatment is a treatment option for NSCLC patients with uncommon EGFR mutations and high PD-L1 expression levels who are refractory to EGFR-TKI treatment.

Single-agent carboplatin in extensive disease small-cell lung cancer patient with liver failure

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Alessandro Di Federico ◽  
Elisa Andrini ◽  
Monia Sisi ◽  
Giacomo Nuvola ◽  
Giuseppe Lamberti ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patient ◽  
Liver Failure ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Lung Cancer Patient ◽  
Single Agent ◽  
Small Cell ◽  
Small Cell Lung ◽  
Extensive Disease

PD-L1 expression in resected non-small cell lung cancer: variation between primary tumour and nodal metastases

Lung Cancer ◽  
2019 ◽  
Vol 127 ◽  
pp. S25 ◽  
Author(s):  
A. Haragan ◽  
J. Gosney ◽  
J.K. Field ◽  
M. Davies ◽  
C. Escriu ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Primary Tumour ◽  
Small Cell ◽  
Nodal Metastases ◽  
Small Cell Lung

scholarly journals Conformance Assessment of PD-L1 Expression Between Primary Tumour and Nodal Metastases in Non-Small-Cell Lung Cancer

2019 ◽  
Vol Volume 12 ◽  
pp. 11541-11547
Author(s):  
Haipeng Xu ◽  
Xueyan Chen ◽  
Dong Lin ◽  
Jing Zhang ◽  
Chao Li ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Primary Tumour ◽  
Small Cell ◽  
Nodal Metastases ◽  
Small Cell Lung

Early ctDNA response assessment for prediction of platinum sensitivity in small cell lung cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 9067-9067
Author(s):  
Yonina R. Murciano-Goroff ◽  
Angela B. Hui ◽  
Jacob J. Chabon ◽  
Everett J Moding ◽  
Emily S. Lebow ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Rapid Progression ◽  
Small Cell Lung ◽  
Early Assessment ◽  
Blood Draw ◽  
Platinum Sensitivity ◽  
Pre Treatment

9067 Background: Small cell lung cancer (SCLC) is an aggressive disease, characterized by inevitable chemotherapy resistance and rapid progression. We hypothesized that circulating tumor DNA (ctDNA) analysis can rapidly identify sensitivity to platinum-based therapy. Methods: Patients with SCLC at Memorial Sloan Kettering Cancer Center underwent serial plasma collections, including prior to the start of treatment and prior to Cycle 2 Day 1 of therapy (C2D1). Tumor mutations were identified from pre-treatment biopsies by MSK-IMPACT and/or pre-treatment plasma by CAncer Personalized Profiling by deep Sequencing (CAPP-Seq). Median variant allele fraction (VAF) of all mutations was monitored on subsequent blood draws using CAPP-Seq. Progression free survival (PFS) was measured from the time of first pre-treatment blood draw. Results: Plasma was collected from 19 patients treated with carboplatin and etoposide, including three who received concurrent atezolizumab. Seven were female, and mean age was 64.5 years. ctDNA was detected in 17 patients (89%), including in the two patients in our series with limited stage disease. The most common mutations were in TP53 and RB1 in 14 and 6 patients, respectively. Fourteen patients had available plasma at C2D1. At baseline prior to treatment, median VAF did not differ significantly between radiologic responders and non-responders (9.4% versus 30.3%, p = 0.35). After one cycle of chemotherapy, the VAF percent decrease was significantly more in responders versus non-responders (-96.9% versus -10.3%, p < 0.001). Median VAF was therefore significantly lower by C2D1 in patients who responded compared to non-responders (0.51% versus 27.2%, p = 0.02). Those who ultimately responded to therapy all had a > 2 fold decrease in VAF by C2D1. With a median follow-up of 180 days, PFS was significantly longer in patients with > 2 fold decrease in VAF by C2D1 (6.4 versus 1.9 months, log rank p < 0.001). Conclusions: A 2-fold decrease in plasma VAF by C2D1 predicted platinum-sensitivity in SCLC and was associated with longer PFS. ctDNA may permit early assessment of benefit and expedite alternative treatment options for those without significant decrease in median VAF after one cycle of therapy.

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