Adenocarcinoma of the lung presenting as thrombotic thrombocytopenic purpura

Acquired thrombotic thrombocytopenic purpura (TTP) usually presents as severe microangiopathic hemolytic anemia (MAHA) and thrombocytopenia in a previously healthy individual. It occurs in approximately three in one million adults and 1 in 10 million children annually. The incidence is increased in females and blacks. Diagnosing TTP and initiating therapy with plasma exchange is a must to avoid preventable complications. Acquired thromotic microangiopathy has been linked to collagen vascular diseases, use of certain medications, organ transplants, infections, pregnancy and cancer. We report a rare case of a 56-year-old African American male diagnosed with TTP who found to have an asymptomatic adenocarcinoma of the lung. Prompt cancer management resulted in completed remission of the thrombotic microangiopathy.

Sunitinib in the treatment of advanced solid tumors

Sunitinib is an oral multikinase inhibitor that blocks the vascular endothelial growth factor receptor (VEGFR), platelet-derived growth factor receptor (PDGFR) alpha and beta, c-kit, and other receptors. These attributes have proven to be efficacious in the treatment of metastatic renal cell carcinoma (RCC), unresectable gastrointestinal stromal tumors (GIST), and well-differentiated advanced pancreatic neuroendocrine tumors (PNET). Though activity has been reported in other tumor types, phase III trials have not yet demonstrated improved survival outcomes in these cancers. Most side effects including hypertension, hand-foot syndrome, and diarrhea are generally well manageable. This review will detail the preclinical data leading up to the results of the pivotal phase III clinical trials that have led to the widespread use of sunitinib in advanced RCC, GIST, and PNET.

Immune thrombocytopenia as a paraneoplastic syndrome in patients with nasopharyngeal cancer

BACKGROUND

Nasopharyngeal cancer (NPC) presenting with thrombocytopenia is rare. This report details 2 cases of NPC with grade III thrombocytopenia as a paraneoplastic syndrome.

METHODS

We present 2 cases of NPC in whom grade III thrombocytopenia was diagnosed concurrently at presentation. One patient underwent definitive intensity-modulated radiation therapy (IMRT) in combination with concurrent cetuximab, the other with cisplatin. Both patients received adjuvant chemotherapy composed of docetaxel and cisplatin.

RESULTS

The cause of their grade III thrombocytopenia was diagnosed as immunologic in origin. Prednisone was administered before IMRT, and their peripheral platelet counts recovered to normal levels. Their platelet counts fell below normal levels several times during their treatment. However, their radiotherapy and chemotherapy had never been interrupted due to thrombocytopenia.

CONCLUSION

Grade III thrombocytopenia is a rare paraneoplastic syndrome in patients with NPC. These patients can tolerate the aggressive definitive management of radiotherapy and chemotherapy with supportive care.

Patient-based strategy for systemic treatment of metastatic renal cell carcinoma

There were only a few options 3 years ago to treat metastatic renal cell carcinoma (mRCC), a disease with a very poor prognosis. With the approval of targeted therapies for mRCC since December 2005, this situation has changed dramatically. Currently, oncologists can choose between several promising options to improve the longevity and quality of their patients' lives. A widely accepted treatment scheme for targeted therapies in mRCC does not yet exist. Based on a selective literature search, drawing on studies with six targeted therapies for mRCC, and including data from the latest American Society of Clinical Oncology (ASCO) and European Society for Medical Oncology (ESMO) Annual Meetings, this review introduces the available therapies, evaluates patient-specific criteria for their application and suggests an algorithm for a patient-based treatment scheme. Clinical experiences with sequential therapies are summarized and potential combination therapies discussed. In conclusion, the crucial criteria of the treatment scheme we propose are the tumor burden and the disease pace, as well as the quality of life of a patient. These define whether tumor control or tumor remission should be the primary therapeutic goal. This scheme suggests which kind of therapeutic sequence to pursue to optimize patient care in mRCC.

Sunitinib

Sunitinib is an oral multikinase inhibitor that blocks the vascular endothelial growth factor receptor (VEGFR), platelet-derived growth factor receptor (PDGFR) alpha and beta, c-kit, and other receptors. These attributes have proven to be efficacious in the treatment of metastatic renal cell carcinoma (RCC) and unresectable gastrointestinal stromal tumors (GIST). Most side effects, including hypertension, hand-foot syndrome, and diarrhea are generally well manageable. Clinical trials are underway to determine the efficacy of sunitinib in other tumor types including metastatic breast, colorectal, and lung cancers. This chapter will detail the preclinical data leading to the results of the pivotal phase III clinical trials that have led to the widespread use of sunitinib in metastatic RCC and advanced GIST.