ONCOCASE

Impressive response to eribulin in endocrine- and chemotherapy-resistant metastatic breast cancer

Summary

We present the case of an 81-year-old woman with a past history of hormone receptor-positive breast cancer of the left breast, who underwent mastectomy followed by radiotherapy in 1989 and who was treated with five years of adjuvant tamoxifen. Ten years later she experienced a local relapse and was treated with different lines of endocrine and chemotherapy without any success. After discussion of her case in a multidisciplinary team, eribulin was proposed. Eribulin is a new type of microtubule dynamics inhibitor and is a synthetic analogue of halichondrin B, which was isolated from a marine sponge. It has been tested in patients with locally recurrent or metastatic disease and has shown a survival benefit when compared to treatment of physician’s choice (TPC; any single-agent chemotherapy or hormonal or biological treatment approved for the treatment of cancer, radiotherapy or symptomatic treatment). In the international Phase III Eisai Metastatic Breast Cancer Study Assessing Physician’s Choice Versus Eribulin (EMBRACE) trial. The total median overall survival for women treated with eribulin was 13.1 months compared to 10.7 months for TPC. These results could potentially establish eribulin as a new treatment standard for this particular group of patients.

(BELG J MED ONCOL 2013;7:27–30)

Giant cell tumour of the jaw: a new hope for a difficult-to-treat disease

Recurrent giant cell tumour of the bone is a difficult to treat and mutilating disease. A patient with a recurrent giant cell tumour of the jaw is reported. He received multiple treatments with surgery and bisphosphonates. Due to progressive disease he was treated with denosumab with good result. An overview of giant cell tumour of the bone is given. (BELG J MED ONCOL 2012;6:201–203)

Treatment of non-small cell lung carcinoma with gefitinib: a case report

Targeted therapy for non-small cell lung carcinoma (NSCLC) is a possible treatment option for patients with tumours expressing an activating mutation of the epidermal growth factor receptor (EGFR). Gefitinib is an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) that was approved for treatment of EGFR mutation-positive NSCLC in Europe in 2009. In Belgium, gefitinib was only approved as a monotherapy for EGFR mutation-positive NSCLC stage IIIB-IV, whatever the line of treatment. When treatment was initiated, limited data were available relating to the use of TKIs for treating Caucasian patients with EGFR mutation-positive NSCLC. Thus, information on EGFR TKI use, in the real-life clinical setting and particularly in Caucasian patients and patients with brain metastases is still needed. Here, we report the case of a patient with NSCLC and brain metastases being treated with gefitinib.

After twelve months of treatment, the chest and brain scans still showed improvement with lung function normalising and the patient reporting a good quality of life. As this patient was not previously treated with chemotherapy, there is still an opportunity of treating her later, when the tumour becomes resistant to gefinitib, with cisplatinum-pemetrexed. This is still possible because she remains chemotherapy-naive, which is required to request reimbursement in Belgium of that type of chemotherapy. (BELG J MED ONCOL 2012;6:169–175)

Panniculitis in a patient with pancreatic acinar cell carcinoma

We describe the case of a 75 year old woman who was diagnosed with pancreatic acinar cell carcinoma after she presented with subcutaneous nodules on the lower legs compatible with panniculitis. This case illustrates the need for a thorough search for internal disease in case of panniculitis to diagnose potentially life-threatening illness in an early stage. (BELG J MED ONCOL 2012;6:124–128)

Diagnosis and management of urogenital schistosomiasis in a young adult; a case report

Schistosomiasis is rarely diagnosed in Western European countries. However, due to the popularity of exotic vacations, more and more western patients can get infected by schistosomiasis. Awareness of this disease is important, as an infection can lead to non-transitional cell bladder carcinoma in the long run (squamous cell carcinoma; SCC). In this article, we present a rare case of urogenital schistosomiasis in a 27-year old Belgian male. Extensive patient history together with eosinophil count and bladder biopsy, is the key to making the diagnosis. Medical treatment with praziquantel is often sufficient. (BELG J MED ONCOL 2012;6:97–101)

Sarcoidosis in a metastatic melanoma patient treated with the CTLA-4 inhibitory monoclonal antibody ipilimumab

A female patient with stage IV-M1c (lymph node and breast metastases), chemorefractory melanoma was treated with the CTLA-4 inhibitory monoclonal antibody ipilimumab. At first evaluation following induction treatment, a marked increase in the volume and strong uptake of 18FDG in her lymphadenopathies (including new adenopathies), a marked enlargement of her spleen and interstitial lung infiltrates were observed. Non-necrotising granulomas were discovered on transbronchial biopsy and cytology on broncho-alveolar lavage established the diagnosis of sarcoidosis. There was a marked clinical and 18FDG-PET/CT documented response following 6 weeks of corticotherapy. At later follow-up, progression of melanoma metastasis in the subdiaphragmatic lymph node metastases was documented. (BELG J MED ONCOL 2012;6:58–62)

Sunitinib reduces physical activity (assessed with a pedometer) in a patient with metastatic kidney cancer: a case study

This report describes the case of a patient with metastatic renal cell carcinoma that was treated with sunitinib (50 mg, 4/2 schedule). Daily blood pressure and physical activity were measured during 12 consecutive cycles of treatment. Average blood pressure recordings showed an upward trend during all the on-periods of sunitinib administration and a downward trend during all the 2-week off-periods. Interestingly, physical activity, assessed with a pedometer, demonstrated a highly significant opposite pattern. This case study demonstrates for the first time that physical activity can be temporarily reduced by sunitinib treatment and that a pedometer could serve as a valuable (mechanical) marker to assess this side effect of sunitinib treatment. Moreover, since its negative correlation with hypertension, it might also serve as a marker for sunitinib efficacy.

(BELG J MED ONCOL 2012;6:22–25)