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Nakasone ES, Bustillos HC, Gui X, Konnick EQ, Sham JG, Cohen SA. Multidisciplinary Approach for the Management of Metastatic Poorly Differentiated Neuroendocrine Carcinoma of the Pancreas: A Case Report of an Exceptional Responder. Pancreas 2024; 53:e487-e491. [PMID: 38460151 DOI: 10.1097/mpa.0000000000002322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2024]
Abstract
ABSTRACT Poorly differentiated pancreatic neuroendocrine carcinomas (pNECs) are rare, highly aggressive neoplasms. Frequently metastatic at diagnosis, prognosis is poor with median overall survival estimated to be less than 1 year. Although multidisciplinary management, including systemic medications and locoregional therapies aimed at reducing and preventing symptoms caused by mass effect, is the mainstay of treatment for patients with metastatic well-differentiated pancreatic neuroendocrine tumors, rapid progression, organ dysfunction, and poor performance status often preclude initiation of even single-modality palliative chemotherapy for patients with metastatic pNEC, limiting the use of and recommendation for multidisciplinary management.We describe the case of a 51-year-old male patient diagnosed with pNEC metastatic to liver and lymph nodes presenting with impending cholestatic liver failure for whom we were able to successfully initiate and dose-escalate cytotoxic chemotherapy with excellent radiographic response. After multidisciplinary review of his case, the patient underwent pancreaticoduodenectomy and hepatic wedge biopsies, with pathology demonstrating a pathologic complete response to chemotherapy in both the pancreas and liver. Surveillance scans at 2 years from initial diagnosis and 1 year from surgery remain without evidence of locoregional or distant recurrence, highlighting the importance and utility of multidisciplinary management in select cases.
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Affiliation(s)
| | - Hannah C Bustillos
- Clinical Pharmacy, University of Washington/Fred Hutchinson Cancer Center
| | - Xianyong Gui
- Departments of Laboratory Medicine and Pathology
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Bahçeci A, Kötek Sedef A, Işik D. The prognostic values of prognostic nutritional index in extensive-stage small-cell lung cancer. Anticancer Drugs 2022; 33:e534-e540. [PMID: 34407045 DOI: 10.1097/cad.0000000000001169] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We aimed to assess the prognostic and predictive significance of pretreatment Prognostic Nutritional Index (PNI) in extensive-stage small-cell lung cancer (ES-SCLC) patients treated with first-line chemotherapy. We designed this study to evaluate the prognostic role of PNI in 147 ES-SCLC patients treated with platinum-based combination regimen between 2011 and 2018. Kaplan-Meier survival analyses and Cox proportional hazard models were used to examine the effects of basal PNI on overall survival (OS). The median age of the patients was 61 (range 38-81). The cutoff value for PNI was determined for whole group and patients were dichotomized into high (≥49.17) and low (<49.17). Seventy-eight (53.1%) patients had low PNI score and 69 (46.9%) patients had high PNI score. Patients with the high PNI score had better OS than those with low PNI (13 versus 12 months, respectively, and P = 0.03). The relationship between PNI score and OS was more prominent in patients over 65 years of age (13 versus 10 months, respectively, and P = 0.03). Progression-free survival of patients with complete response to first-line treatment was statistically significantly better than the other patients (8 versus 7 months, respectively, and P = 0.02). Similarly, OS was statistically significantly better than the other patients (15 versus 8 months, respectively, and P = 0.001). The results of our study show that PNI score is useful in evaluating the OS of patients with ES-SCLC. PNI is a cost-effective prognostic marker and should therefore be included in routine clinical practice.
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Affiliation(s)
| | - Ayşe Kötek Sedef
- Department of Radiation Oncology, Dr. Ersin Arslan Education and Research Hospital, Gaziantep, Turkey
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Noronha V, Ravind R, Patil VM, Mokal S, Joshi A, Menon N, Kapoor A, Mahajan A, Janu A, Nakti D, Shah L, Shah S, Prabhash K. The role of chemotherapy in patients with small cell lung cancer and poor performance status. Acta Oncol 2020; 59:1520-1527. [PMID: 32924733 DOI: 10.1080/0284186x.2020.1819562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND There are limited data on the role of chemotherapy in patients with small cell lung cancer (SCLC) and poor performance status (PS). METHODS This was a retrospective analysis of a prospective observational study in patients with SCLC and PS 3 or 4. We recorded the initial therapy, symptom improvement, response rate, overall survival (OS), and the impact of various factors on OS. RESULTS From June 2010 to August 2019, we enrolled 234 patients; 185 (79%) with PS 3 and 49 (21%) PS 4. Initial therapy was best supportive care (BSC) in 49 patients (21%), standard full dose chemotherapy in 31 (13%), and attenuated chemotherapy in 154 (66%). In 89% patients treated with attenuated chemotherapy, symptom-relief occurred at a median of 3 days (IQR, 1-7). Grade 3 and higher toxicities developed in 60% patients treated with initial attenuated chemotherapy, commonly hyponatremia in 39%, neutropenia in 16%, anemia in 11%, and infection in 10%. Grade 3 and higher toxicities as a result of standard chemotherapy occurred in 89% patients treated with upfront standard full dose chemotherapy compared to 69% of patients who received initial attenuated chemotherapy with subsequent treatment escalation. Overall, there were 6 (2.6%) toxic deaths. The response rate to chemotherapy was 77%. The median OS of the patients who received any chemotherapy was significantly longer at 6 months (95% CI, 4.8-7.2) compared to 1 month (95% CI, 0.4-1.6 months) in patients who were managed with BSC, p < 0.001; hazard ratio, 0.39 (95% CI, 0.27-0.56). The disease stage, lactate dehydrogenase level, and receipt of chemotherapy significantly impacted survival. CONCLUSION Chemotherapy prolongs survival in patients with SCLC and poor PS. Administering an initial attenuated chemotherapy regimen followed by standard full-dose chemotherapy when the PS improves may lower toxicity and improve tolerance.
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Affiliation(s)
- Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rahul Ravind
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vijay M. Patil
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Smruti Mokal
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Clinical Research Secretariat, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Akhil Kapoor
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Abhishek Mahajan
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Radiodiagnosis, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
| | - Amit Janu
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Radiodiagnosis, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
| | - Dipti Nakti
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Leena Shah
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Srushti Shah
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
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Janssen-Heijnen MLG. How safe is chemotherapy and chemoradiation in elderly patients with small-cell lung cancer? Lung Cancer Manag 2014. [DOI: 10.2217/lmt.13.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Maryska LG Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands and Department of Epidemiology, Maastricht University Medical Center, GROW School for Oncology & Developmental Biology, Maastricht, The Netherlands
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Abstract
The incidence and mortality of small-cell lung cancer worldwide make this disease a notable health-care issue. Diagnosis relies on histology, with the use of immunohistochemical studies to confirm difficult cases. Typical patients are men older than 70 years who are current or past heavy smokers and who have pulmonary and cardiovascular comorbidities. Patients often present with rapid-onset symptoms due to local intrathoracic tumour growth, extrapulmonary distant spread, paraneoplastic syndromes, or a combination of these features. Staging aims ultimately to define disease as metastatic or non-metastatic. Combination chemotherapy, generally platinum-based plus etoposide or irinotecan, is the mainstay first-line treatment for metastatic small-cell lung cancer. For non-metastatic disease, evidence supports early concurrent thoracic radiotherapy. Prophylactic cranial irradiation should be considered for patients with or without metastases whose disease does not progress after induction chemotherapy and radiotherapy. Despite high initial response rates, most patients eventually relapse. Except for topotecan, few treatment options then remain. Signalling pathways have been identified that might yield new drug targets.
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Affiliation(s)
- Jan P van Meerbeeck
- Department of Respiratory Medicine and Lung Oncological Network, Ghent University Hospital, Ghent, Belgium.
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