Abstract

Checkpoint inhibitors (CPIs), such as nivolumab, have transformed the treatment paradigm for patients with metastatic non‑small cell lung cancer (mNSCLC) and metastatic renal cell carcinoma (mRCC). The combination of CPIs and radiotherapy (RT) constitutes a multimodal treatment approach that may work synergistically and facilitate augmented systemic responses. The aim of the present retrospective study was to assess the efficacy and safety of continuation of nivolumab treatment with the addition of RT in patients with mNSCLC and mRCC who develop oligometastatic disease progression on single‑agent nivolumab. All patients with mNSCLC and mRCC who received nivolumab at the Department of Oncology, Prince Sultan Military Medical City (Riyadh, Saudi Arabia) between November 2016 and April 2018 were identified. The records of patients who developed oligometastatic disease progression during nivolumab treatment and were subsequently treated with RT, with nivolumab continued beyond disease progression, were retrospectively reviewed. Details of RT, clinical outcomes and toxicity data were collected. Of the 96 patients who received nivolumab, 22 received multiple courses of RT. A total of 39 sites were irradiated: Bone (n=15), lung (n=9), brain (n=8), adrenal gland (n=2), renal bed (n=2), skin (n=1), ethmoid sinus (n=1) and scalp (n=1). Partial response and complete response were noted at 25 (64%) and 3 (8%) sites, respectively. Stable disease was noted at 6 sites (15%) and disease progression was noted at 5 sites (13%). The median time on nivolumab from the date of the first fraction of RT was 4.5 months (range, 1.5‑29 months) for patients with mNSCLC and 5 months (range, 1‑38.5 months) for patients with mRCC. No patients developed grade 3‑4 toxicities. Grade 2 pneumonitis was noted in 3 patients receiving lung RT. The addition of RT appeared to initiate a response and prolong the duration of nivolumab treatment. Therefore, the combination of nivolumab and RT was found to be well tolerated, with response rates exceeding those in published studies of nivolumab monotherapy.

• Abstract

Abstract

Intracardiac metastases in the absence of inferior vena cava involvement is a rare occurrence in patients with metastatic renal cell carcinoma (mRCC). There is limited evidence regarding the efficacy and safety of standard treatment modalities for mRCC patients with intracardiac metastases. Presence of intracardiac metastases is known to indicate poor prognosis and may potentially increase risk of treatment-related complications. Recent advances in RCC management have integrated nivolumab, a programmed death-1 (PD-1) receptor inhibitor, as a preferred treatment option in the second-line setting after failure of prior anti-angiogenic therapy; or in combination with ipilimumab, an anti-Cytotoxic T-lymphocyte antigen-4 antibody as first-line therapy for intermediate to poor risk patients with mRCC. The efficacy and toxicity of nivolumab in patients with mRCC and intracardiac metastases has never been reported previously. We herein present the first reported case of mRCC with intracardiac metastasis and a resultant excellent response to nivolumab treatment and discuss the imaging techniques and treatment options for this rare presentation.

© 2018 The Author(s). Published by S. Karger AG, Basel

Abstract   Background:  Lung  cancer  is  the  main  cause of  cancer  deaths  worldwide.  It is  important to identify  the prognostic  factors  of  this  disease  which  leads  to  low  survival  times  despite  the  advancing  treatment  modalities.  Aim: To  investigate  the  role  of  clincopathological  parameters  and  treatment  modality  as  a  prognostic  factors  affecting survival  of  patients  with  advanced non-small cell  lung  cancer  (NSCLC).  Methods:  We retrospectively  reviewed  the clinical  records  of  patients  with  inoperable  stage  III/IV  NSCLC,  who  were  treated  at  the  department  of  Clinical Oncology,  Assiut  University  Hospital  between  2009 and 2014.  The  association  between  the  demographic  and clinical  characteristics  and  survival  of  these patients  was  analyzed.  Results:  A  total of  69  patients  (32  stage  III& 39 stage  IV)  were  identified  and  included  in this  study.  Sex  (males  vs.  females,  p=0.04),  Eastern  cooperative  Oncology group performance  status  (0 vs.  1 vs.  2,  p=0.001),  smoking  habit  (never  vs.  current  vs.  former,  p=0.001),  stage  (IIIA vs.  IIIB  vs.  IV,  p=0.008)  and the  initial  treatment  (no  vs.  chemotherapy  vs.  concurrent  chemoradiotherapy,  p=0.001) were found  to  be factors  affecting  survival  in  univariate  analyses.  Sex  and  histological  subtype did  not  affect survival.  Performance status,  stage and  initial  treatment  were determined  as  the independent  prognostic  factors affecting  survival in  multivariate  analyses.  Conclusion:  Performance  status,  stage  and  initial treatment  with concurrent  chemoradiotherapy  in  eligible patients  were prognostic  factors  affecting  overall survival  of  patients  with advanced  NSCLC. Keywords:  non-small  cell  lung cancer,  prognostic  factors,  survival 

Double primary malignancies could be divided into two categories, depending on the interval between tumor diagnoses. A secondary malignancy could be defined as a new cancer that has occurred as a result of previous treatment with radiation or chemotherapy. Second primary malignancy can occur at any age but it’s commonly at old age. A 46 premenopausal female patient presented to our outpatient clinic complaining from a mass in her right breast, routine metastatic work-up for distant metastasis declared multiple hepatic metastases, RT renal mass, and bone metastases. Palliative radiotherapy to tender and weight bearing sites followed by 4 cycles of systemic chemotherapy FEC regimen were received. Tru-cut needle biopsy from renal mass detected renal cell carcinoma of clear cell type, the patient started sunitinib and tamoxifen with bisphosphonate (Zoledronic acid), assessment of the response revealed reduction of the size and number of HFLs, and the size of renal mass, so the patient was decided to do cytoreductive nephrectomy and then continued on TAM and sunitinib. Collectively, due to the rising incidence of multiple primary malignancies, further studies should be done not only for better clinical evaluation and treatments but also for accurate determination of possible causes, pathogenesis, effective managements and screening programs.

Keywords:

Renal Cell Carcinoma, Breast Cancer, PET/CT, Double Malignancies

Triple-negative breast cancer (TNBC) has a very high rate of recurrence. Our aim is to investigate the efficacy of bevacizumab, platinum and paclitaxel as first-line in metastatic TNBC (mTNBC). This study included 54 female patients with mTNBC. They received bevacizumab, carboplatin and paclitaxel every 21 day for six cycles then who progressed shifted to second-line chemotherapy and the responders continue another two cycles. The median progression-free survival (PFS) was 27 months [95% confidence interval (CI), 17.019-36.981]. There were two factors that affect PFS; visceral only metastasis (hazard ratio, 0.23; P = 0.05) and performance status 0 (hazard ratio = 0.16; P = 0.02) with C-index 0.77. The median overall survival (OS) was 55 months (95% CI, 38.973-71.027). There were two factors that affect OS; type of presentation (hazard ratio = 7.91; P = 0.02) and performance status 0 (hazard ratio = 0.12; P = 0.01) with C-index 0.73. In the final evaluation, three factors have their print on achieving either stable disease (SD) or complete response (CR). Patients having ≤3 sites of metastasis odds ratio (OR) 3.92 (P = 0.02), patients with visceral only metastasis OR was 13.20 (P = 0.001), those with performance status 0 had the highest OR 19.5 (P = 0.001) and the percentage of this prediction was 64.8, 70.4 and 70.4%, respectively. Bevacizumab, carboplatin and paclitaxel were well tolerated, continuation of bevacizumab is recommended as long as SD or CR responses are obtained and tolerated.