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Mahadevia H, Ponvilawan B, Al-Obaidi A, Buckley J, Subramanian J, Bansal D. Exceptional synergistic response of PARP inhibitor and immune checkpoint inhibitor in esophageal adenocarcinoma with a germline BRCA2 mutation: a case report. Ther Adv Med Oncol 2024; 16:17588359241242406. [PMID: 38559611 PMCID: PMC10981852 DOI: 10.1177/17588359241242406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
Immune checkpoint inhibitors (ICIs) and poly (ADP-ribose) polymerase (PARP) inhibitors have shown efficacy in various tumors. A significant therapeutic challenge with either ICIs or PARP inhibitors as monotherapy is treatment failure from intrinsic primary resistance or the development of secondarily acquired resistance after a period of responsiveness. The combination of PARP inhibitors and ICIs could mitigate this by potentiating treatment response. We describe an 83-year-old male patient who initially presented with abdominal pain, and weight loss along with alternating constipation and diarrhea. Imaging and biopsy revealed metastatic esophageal adenocarcinoma. Genomic testing revealed germline BRCA2 mutation. The patient initially underwent a few cycles of chemoimmunotherapy. However, due to intolerance to chemotherapy, the patient's case was discussed at a multidisciplinary molecular tumor board. He was switched to PARP inhibitor olaparib and ICI nivolumab. This combination led to a durable complete response. A combination of poly-ADP ribose polymerase inhibitor (PARPi) plus ICI may work in synergy through various mechanisms including enhanced neoantigen expression, release of immune-activating cytokines, and increased programmed death-ligand 1 expression. This may culminate in accentuated efficacy outcomes with a manageable safety profile. This exceptional response with ICI and PARPi in our case is consistent with the synergistic value of this combination, and prospective studies are warranted to definitively characterize clinical utility.
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Affiliation(s)
- Himil Mahadevia
- Department of Internal Medicine, University of Missouri–Kansas City, Kansas City, MO, USA
| | - Ben Ponvilawan
- Department of Internal Medicine, University of Missouri–Kansas City, Kansas City, MO, USA
| | - Ammar Al-Obaidi
- Department of Hematology and Oncology, University of Missouri–Kansas City, Kansas City, MO, USA
| | - Jennifer Buckley
- Department of Radiology, Saint Luke’s Hospital, Kansas City, MO, USA
| | | | - Dhruv Bansal
- Department of Hematology and Oncology, Saint Luke’s Cancer Institute, 4401 Wornall Road, Kansas City, MO 64111, USA
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2
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Mahadevia H, Al-Obaidi A, Cossor F. The aggravating fury rituximab obliterated. Haematologica 2024. [PMID: 38268447 DOI: 10.3324/haematol.2023.284309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Indexed: 01/26/2024] Open
Abstract
Not available.
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Affiliation(s)
- Himil Mahadevia
- Department of Internal Medicine, University of Missouri - Kansas City, 2411 Holmes St, Kansas City, MO - 64108; Department of Hematology/Oncology, Mayo Clinic in Florida, 4500 San Pablo Rd S, Jacksonville, FL - 32224
| | - Ammar Al-Obaidi
- Department of Hematology/Oncology, University of Missouri - Kansas City, 2411 Holmes St, Kansas City, MO - 64108
| | - Furha Cossor
- Department of Hematology/Oncology, Saint Luke's Cancer Institute, Saint Luke's Hospital of Kansas City, 4401 Wornall Rd, Kansas City, MO - 64111.
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3
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Bader A, Begemann M, Al-Obaidi A, Habib MH, Anwer F, Raza S. Ocular complications of antineoplastic therapies. Future Sci OA 2023; 9:FSO871. [PMID: 37485446 PMCID: PMC10357395 DOI: 10.2144/fsoa-2022-0081] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/15/2023] [Indexed: 07/25/2023] Open
Abstract
Ocular complications of antineoplastic agents can have a profound effect on the quality of life of cancer patients. New oncologic treatments like monoclonal antibodies, immunotherapies, antibody-drug conjugates, checkpoint inhibitors and growth factor receptors have resulted in increased ocular complications. These ocular complications differs in respect to distinct mechanisms of actions and lead to significant challenges in the management of cancer patients. In this review, we reviewed literature, clinical studies and cases detailing ocular complications due to administration of antineoplastic agents and emphasized the need for communication between oncologists and ophthalmologists toward early detection and management of ocular complications.
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Affiliation(s)
- Abbas Bader
- University of Missouri Kansas City School of Medicine, 5000 Holmes St, Kansas City, MO 64110, USA
| | - Madeline Begemann
- Saint Luke's Hospital of Kansas City, 4401 Wornall Rd, Kansas City, MO 64111, USA
| | - Ammar Al-Obaidi
- Saint Luke's Hospital of Kansas City, 4401 Wornall Rd, Kansas City, MO 64111, USA
| | - Muhammad Hamza Habib
- Rutgers Cancer Institute of New Jersey, 195 Little Albany St, New Brunswick, NJ 08901, USA
| | - Faiz Anwer
- Cleveland Clinic Taussig Cancer Institute, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Shahzad Raza
- Cleveland Clinic Taussig Cancer Institute, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Al-Obaidi A, Mahadevia H, Syed Z, Raza S. A Challenging Case of Kaposi Sarcoma Inflammatory Cytokine Syndrome. Cureus 2023; 15:e42218. [PMID: 37605703 PMCID: PMC10439840 DOI: 10.7759/cureus.42218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
Kaposi Sarcoma Inflammatory Cytokine Syndrome (KICS) is a serious, uncommon disease that occurs in patients who are positive for HIV and human herpesvirus-8 (HHV-8). It is characterized by a constellation of clinical findings, including fever, weight loss, and fluid retention, as well as a lack of multicentric Castleman disease (MCD) features on histopathology and an elevated serum HHV-8 viral load. Diagnosis is often delayed, and treatment options are limited, culminating in high mortality rates. We hereby present a 32-year-old male patient with HIV who was untreated for a few years and came with fever, night sweats, pancytopenia, and widespread adenopathy. A thorough evaluation of opportunistic infections was unremarkable. Clinically MCD was suspected, but lymph node biopsy only showed Kaposi sarcoma (KS) with no characteristic features of MCD. However, with clinical deterioration, KICS was strongly suspected. Kaposi sarcoma immune reconstitution syndrome (KS-IRIS) was also a possibility as the patient was restarted on antiretroviral therapy. Rituximab was commenced, but the patient suffered a cardiac arrest and could not be revived. Alternative diagnosis must be explored in patients with HIV presenting with constitutional symptoms, cytopenia, and adenopathy after opportunistic infections and malignancies are ruled out. If they have KS with HHV-8 positivity and there is a lack of characteristic features of MCD in lymph node biopsy, prompt suspicion of KICS should be made, and treatment with rituximab and/or chemotherapy should be instituted rapidly. KS-IRIS is also possible if patients have recently received antiretroviral therapy and have a rapid decline in viral load and increase in CD4 counts (immunological recovery). HHV8 viral load levels may help to distinguish between these two inflammatory conditions.
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Affiliation(s)
- Ammar Al-Obaidi
- Hematology/Oncology, University of Missouri Kansas City, Kansas City, USA
| | - Himil Mahadevia
- Internal Medicine, University of Missouri Kansas City, Kansas City, USA
| | - Zain Syed
- Biomedical Engineering, Case Western Reserve University, Cleveland, USA
| | - Shahzad Raza
- Hematology and Medical Oncology, The Cleveland Clinic, Cleveland, USA
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5
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Qasim H, Al-Obaidi A, Khan A, Freter C. Ehrlichia-Induced Hemophagocytic Lymphohistiocytosis (HLH) With No Response to Doxycycline Treatment. Cureus 2023; 15:e42325. [PMID: 37614269 PMCID: PMC10443890 DOI: 10.7759/cureus.42325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2023] [Indexed: 08/25/2023] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening condition characterized by the persistent activation of antigen-presenting cells and multisystemic inflammation. Ehrlichiosis is a tick-born infection that primarily infects the white blood cells and can present with a variety of symptoms, including fever, fatigue, and multisystemic complications. Here, we present a 58-year-old female hospitalized for a urinary tract infection. Her hospital course was complicated by HLH, which was later discovered to be precipitated by an Ehrlichia chaffeensis infection. The patient did not respond to the doxycycline treatment, developed multiorgan failure, and passed away after a few weeks of treatment trials.
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Affiliation(s)
- Hana Qasim
- Internal Medicine, University of Missouri-Kansas City, Kansas City, USA
| | - Ammar Al-Obaidi
- Hematology/Oncology, University of Missouri-Kansas City, Kansas City, USA
| | - Abat Khan
- Internal Medicine, University of Missouri-Kansas City, Kansas City, USA
| | - Carl Freter
- Oncology, Saint Luke's Hospital of Kansas City, Saint Luke's Cancer Institute, Kansas City, USA
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Mahadevia H, Al-Obaidi A, Madan U, Cossor F. CLO23-049: An Unusual Case Presentation of Severe Idiopathic Multicentric Castleman Disease (iMCD). J Natl Compr Canc Netw 2023. [DOI: 10.6004/jnccn.2022.7170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Mahadevia H, Ponvilawan B, Sharma P, Al-Obaidi A, Qasim H, Koyi J, Anwer F, Raza S. Advancements and future trends of immunotherapy in light-chain amyloidosis. Crit Rev Oncol Hematol 2023; 183:103917. [PMID: 36696931 DOI: 10.1016/j.critrevonc.2023.103917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/05/2022] [Accepted: 01/20/2023] [Indexed: 01/23/2023] Open
Abstract
Light-chain (AL) amyloidosis is a type of plasma cell neoplasm with abnormal monoclonal immunoglobulin light-chain production and their subsequent deposition in tissues causing end-organ damage. In addition to existing treatments including autologous stem cell transplantation, there is a need for other approaches for eradicating abnormal plasma cells and amyloid tissue deposits. Treatment strategies of AL amyloidosis are mostly based on medications that are effective in multiple myeloma due to similar cell of origin. Daratumumab along with proteasome inhibitors and corticosteroids has become standard of care for AL amyloidosis. Another appealing approach is disassembling amyloid deposits with hope to potentially reverse the damage done by the disease. This was met with promising results for CAEL-101 and birtamimab. Although still in early stages, novel treatment options in pipeline, including antibody-drug conjugates, bispecific T-cell engagers, and chimeric antigen receptor T cell therapy may diversify the treatment armamentarium of AL amyloidosis in the future.
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Affiliation(s)
- Himil Mahadevia
- Department of Internal Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA.
| | - Ben Ponvilawan
- Department of Internal Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA.
| | - Parth Sharma
- Department of Internal Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA.
| | - Ammar Al-Obaidi
- Department of Hematology/Oncology, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA.
| | - Hana Qasim
- Department of Internal Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA.
| | - Jagadish Koyi
- Department of Internal Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA.
| | - Faiz Anwer
- Taussig Cancer Center, Cleveland Clinic, 10201 Carnegie Ave, Cleveland, OH 44106, USA.
| | - Shahzad Raza
- Taussig Cancer Center, Cleveland Clinic, 10201 Carnegie Ave, Cleveland, OH 44106, USA.
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Al-Jumayli M, Choucair K, Al-Obaidi A, Park R, Bansal A, Baranda J, Sun W, Saeed A. Pre-operative Carboplatin/Paclitaxel Versus 5-Fluorouracil (5-FU)-based Chemoradiotherapy for Older Adults With Esophageal Cancer. Anticancer Res 2022; 42:59-66. [PMID: 34969709 DOI: 10.21873/anticanres.15457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/16/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM This study aimed to compare the efficacy and tolerability of pre-operative platinum/5-fluorouracil (P5F) and carboplatin/paclitaxel (CP), in combination with radiation therapy in older adults with locally advanced, stage I-III esophageal cancer. PATIENTS AND METHODS We retrospectively reviewed 51 patients aged ≥70 years who underwent chemoradiotherapy followed by esophagectomy for stage I-III esophageal cancer between 2008 and 2018. Pathological complete response (pCR) and survival rates were compared across the two chemotherapy regimen arms. RESULTS Treatment completion (p=0.28), pCR (p=0.89), and partial response rates were similar across both chemotherapy groups. Overall survival (OS) and disease-free survival (DFS) were similar across both groups with HR=0.80 (p=0.62) and HR=0.72 (p=0.72) respectively. CONCLUSION The lesser toxic CP regimen may be used in older patients with locally advanced esophageal cancer, with tumor response and survival rates similar to P5F chemotherapy.
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Affiliation(s)
- Mohammed Al-Jumayli
- Department of Medicine, Division of Medical Oncology, Kansas University Cancer Center, Kansas City, KS, U.S.A.,Department of Medicine, Division of Hematology/Oncology, South Florida University/Moffit Cancer Center, Tampa, FL, U.S.A
| | - Khalil Choucair
- Department of Medicine, Kansas University School of Medicine, Wichita, KS, U.S.A
| | - Ammar Al-Obaidi
- Department of Medicine, Division of Hematology/Oncology, University of Missouri-Kansas City, Kansas City, MO, U.S.A
| | - Robin Park
- MetroWest Medical Center/Tufts University School of Medicine, Framingham, MA, U.S.A
| | - Ajay Bansal
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Kansas Medical Center and Kansas Cancer Institute, Kansas City, KS, U.S.A
| | - Joaquina Baranda
- Department of Medicine, Division of Medical Oncology, Kansas University Cancer Center, Kansas City, KS, U.S.A
| | - Weijing Sun
- Department of Medicine, Division of Medical Oncology, Kansas University Cancer Center, Kansas City, KS, U.S.A
| | - Anwaar Saeed
- Department of Medicine, Division of Medical Oncology, Kansas University Cancer Center, Kansas City, KS, U.S.A.
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9
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Abstract
Extramedullary hematopoiesis (EMH) is the development of hematopoietic tissue outside of the bone marrow. In adults, the bone marrow is the main site of hematopoiesis. When this process occurs outside of the bone marrow, it is a sign of disease or deficiency. Clinically, the findings of EMH may be diverse. One rare complication that can arise from EMH is obstructive jaundice. This occurs when there is a blockage of bile flow leading to retention of bilirubin in hepatocytes. Identifying the markers of EMH and obstructive jaundice is important for optimizing positive outcomes. While often asymptomatic, EMH can be deadly if left untreated. In this case, we present a patient with obstructive jaundice secondary to EMH.
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Affiliation(s)
- Syed Kamran
- Internal Medicine, Kansas University School of Medicine, Wichita, USA
| | - Ammar Al-Obaidi
- Internal Medicine, Kansas University School of Medicine, Wichita, USA
| | | | - Joel Alderson
- Pathology, Ascension Via Christi St. Francis Hospital, Wichita, USA
| | - Pavan S Reddy
- Internal Medicine, Kansas University School of Medicine, Wichita, USA
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10
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Al-Obaidi A, Tuck N, Al-Hadeethi D, Mohammed A, Truong Q. Spontaneous, Loculated, and Massive Hemothorax: An Uncommon Complication of Warfarin Therapy. Cureus 2021; 13:e14923. [PMID: 34123622 PMCID: PMC8189267 DOI: 10.7759/cureus.14923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Warfarin, a commonly used oral anticoagulant, is associated with several adverse drug reactions, principally bleeding. Of all hemorrhagic complications from warfarin therapy, thoracic hemorrhage accounts for only 3% and is usually related to trauma. Cases of spontaneous hemothorax secondary to anticoagulation therapy are rarely reported in the literature.
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Affiliation(s)
- Ammar Al-Obaidi
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Nicholas Tuck
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Daly Al-Hadeethi
- Internal Medicine/Hospital Medicine, Wesley Medical Center, Wichita, USA
| | - Alaeldin Mohammed
- Internal Medicine, Robert J. Dole Veterans Affairs Medical Center, Wichita, USA
| | - Quoc Truong
- Cancer Center of Kansas, University of Kansas School of Medicine, Wichita, USA
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Abstract
The SMARCB1/INI1 gene was first discovered in the mid-1990s, and since then it has been revealed that loss of function mutations in this gene result in aggressive rhabdoid tumors. Recently, the term "rhabdoid tumor" has become synonymous with decreased SMARCB1/INI1 expression. When genetic aberrations in the SMARCB1/INI1 gene occur, the result can cause complete loss of expression, decreased expression, and mosaic expression. Although SMARCB1/INI1-deficient tumors are predominantly sarcomas, this is a diverse group of tumors with mixed phenotypes, which can often make the diagnosis challenging. Prognosis for these aggressive tumors is often poor. Moreover, refractory and relapsing progressive disease is common. As a result, accurate and timely diagnosis is imperative. Despite the SMARCB1/INI1 gene itself and its implications in tumorigenesis being discovered over two decades ago, there is a paucity of rhabdoid tumor cases reported in the literature that detail SMARCB1/INI1 expression. Much work remains if we hope to provide additional therapeutic strategies for patients with aggressive SMARCB1/INI1-deficient tumors.
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Affiliation(s)
- Nathaniel A Parker
- University of Kansas School of Medicine, 1010 N Kansas St, Wichita, KS, 67214, USA
| | - Ammar Al-Obaidi
- University of Kansas School of Medicine, 1010 N Kansas St, Wichita, KS, 67214, USA
| | - Jeremy M Deutsch
- Cancer Center of Kansas, 818 N. Emporia #403, Wichita, KS, 67214, USA
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12
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Choucair K, Okut H, Al-Obaidi A, Morand S, Stanbery L, Kallail K, Nemunaitis J. 117P Tumour mutation burden and response to immune checkpoint inhibitors in solid tumors: A systematic review and meta-analysis. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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13
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Al-Obaidi A, Parker NA, Choucair K, Lalich D, Truong P. Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type: A Case Report. Cureus 2020; 12:e8651. [PMID: 32566435 PMCID: PMC7301429 DOI: 10.7759/cureus.8651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Primary cutaneous diffuse large B-cell lymphoma, leg type, is an exceedingly rare and aggressive variant of primary cutaneous lymphoma. An 84-year-old male presented to an oncologist for new skin lesions on his abdomen and right thigh. Excisional biopsy followed by histopathology and immunohistochemistry confirmed the diagnosis of primary cutaneous diffuse large B-cell lymphoma, leg type. His clinical course was complicated by multiple relapses and refractory disease. Ultimately, he achieved complete response with fourth-line ibrutinib therapy. Due to the contentious nature of this disease, poor prognosis, and higher rates of recurrence, prompt identification and aggressive treatment are recommended. Given the different cellular pathways and genomic alterations identified in its carcinogenesis, various chemotherapy regimens and targeted immunotherapies have emerged as potential therapeutic options to halt disease progression and prevent future relapses.
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Affiliation(s)
- Ammar Al-Obaidi
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Nathaniel A Parker
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Khalil Choucair
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | | | - Phu Truong
- Hematology/Oncology, Cancer Center of Kansas, Wichita, USA
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Abstract
Renal cell carcinoma (RCC) accounts for 3% of all adult malignancies and is known for metastatic initial presentation, unpredictable metastatic pathway, and late recurrence post-curative resection. We report a case of solitary late metastatic renal cell carcinoma to the pancreas more than 10 years after radical nephrectomy. A high index of suspicion must be maintained to detect RCC late recurrence and metastasis to rare and atypical locations. A lifelong follow-up is recommended.
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Affiliation(s)
- Khalil Choucair
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Nathaniel A Parker
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Ammar Al-Obaidi
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Joel Alderson
- Pathology, Ascension Via Christi St. Francis Hospital, Wichita, USA
| | - Phu Truong
- Hematology/Oncology, Cancer Center of Kansas, Wichita, USA
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15
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Al-Obaidi A, Parker NA, Hussein Agha Y, Alqam H, Page S. Pancreatic Myeloid Sarcoma. Cureus 2020; 12:e8462. [PMID: 32528784 PMCID: PMC7279692 DOI: 10.7759/cureus.8462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Myeloid sarcoma is an isolated extramedullary tumor mass consisting of immature myeloid cells. It is characterized by highly variable outcomes and usually disrupts the normal architecture of the normal tissue in which it originates. It may occur de novo or be associated with other hematological malignancies. Clinical presentation of myeloid sarcomas can be highly variable based on the tumor site, size, and extent of tissue involvement. The diagnosis of myeloid sarcoma is challenging and requires a high index of suspicion. Tissue sampling followed by the use of auxiliary studies is essential for diagnosis. Moreover, bone marrow sampling is necessary to exclude morrow involvement. Currently, the recommended therapeutic regimens for myeloid sarcoma are similar to those for acute myeloid leukemia. Much work remains to be accomplished as myeloid sarcomas, if initially missed or misdiagnosed, have poor overall survival rates. Furthermore, prognostic factors for this malignancy remain poorly understood.
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Affiliation(s)
- Ammar Al-Obaidi
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Nathaniel A Parker
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | | | - Hamzah Alqam
- Internal Medicine, Ascension Via Christi St. Francis, Wichita, USA
| | - Seth Page
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
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16
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Parker NA, Al-Obaidi A, Lalich D, Deutsch JM. SMARCB1/INI1-Deficient Extrarenal Rhabdoid Tumor: A Case Report of a Rare and Aggressive Soft Tissue Sarcoma. Cureus 2020; 12:e8273. [PMID: 32467817 PMCID: PMC7250519 DOI: 10.7759/cureus.8273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Malignant SMARCB1/INI1-deficient extrarenal rhabdoid tumors are aggressive tumors that are extremely rare in adults. A 56-year-old male presented with the chief complaints of unilateral lower abdominal and pelvic pain. He underwent urgent surgical intervention and mass resection with tissue sampling. After pathology confirmed the diagnosis, systemic chemotherapy with vincristine, doxorubicin plus ifosfamide, and mesna was administered. Following treatment, he experienced a durable and long-lasting response to therapy for this aggressive and rare soft tissue sarcoma. To date, the patient remains in complete remission following the cessation of chemotherapy. Malignant SMARCB1/INI1-deficient extrarenal rhabdoid tumors are aggressive neoplasms that are extremely rare in adults. We report a rare case of such a tumor and review the literature for its molecular, clinical, and imaging features.
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Affiliation(s)
- Nathaniel A Parker
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Ammar Al-Obaidi
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
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17
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Al-Obaidi A, Parker N, Truong QV. Nivolumab versus the standard of care for cancer therapy: A meta-analysis of 6 CHECKMATE trials comparing overall survival. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e15165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15165 Background: Nivolumab (N) is an antineoplastic agent approved for multiple different tumor origins as well as tumor agnostic based on MSI status. Thus, understanding the tumor characteristics most predictive of response is essential. Living meta-analysis provides a method to continuously assimilate emerging trials. In this study, we created a living meta-analysis to compare the effect of N on overall survival (OS). Methods: Meta-analysis was conducted according to the PRISMA guidelines. PubMed and Cochrane databases, and conference abstracts (e.g. ASCO, ESMO), were searched for phase III CHECKMATE RCT’s that reported OS among cancer patients receiving N. Results: Six phase III trials involving 3,342 patients (1,826 in N arms) treated for 4 different types of cancer were retrieved. Median follow up was 12.1 months [range: 5.1-25.2]. Improved efficacy and safety were observed in all N arms compared to control groups (22.8% ORR; 17.4% grade 3-5 AE vs 15.1% ORR; 51% grade 4-5 AE). Treatment was N alone, SOC chemo, and N + chemo in four (33%), six (50%), and two (16%) arms, respectively. Primary endpoints were OS in the first-line setting in 50% of all arms. Excluding one RCT due to insufficient survival data, the mean median OS was 11.1 [95% CI: 7.5-14.4] vs 8.7 [95% CI: 5.1-13.2] months in the total populations for all N and control arms, respectively. N improved OS when used in any cancer type, setting, or therapy for advanced refractory or chemo-naive cancer patients. Also, efficacy of N was improved with PD-L1% (Table). Conclusions: Among all trials, N was associated with improved OS. Additional meta-analysis is ongoing with R software (version 3.3.3; R Fdn.). Random-effects models will be used to compare OS. Heterogeneity will be assessed with Cochrane Q-statistic and quantified with I2test via subgroup analyses for cancer type, setting, therapy, and PD-L1%. [Table: see text]
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Abstract
Inhibitors of cytotoxic T-lymphocyte-associated antigen-4, programmed cell death protein-1, and programmed death-ligand 1 have been shown to produce significant antitumor activity in multiple malignancies, and have become essential oncology standard-of-care therapies. Despite their success, the checkpoint inhibitors’ ability to amplify the immune system response against tumor cells has been associated with a unique panel of side effects known as immune-related adverse events. The involvement of the myocardium has been reported previously, but it’s remarkably uncommon. Even more noteworthy is that secondary autoimmune myocarditis and heart failure due to these medications are typically fatal.
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Affiliation(s)
- Ammar Al-Obaidi
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Nathaniel A Parker
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Khalil Choucair
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Joel Alderson
- Pathology, Ascension Via Christi St. Francis Hospital, Wichita, USA
| | - Jeremy M Deutsch
- Hematology / Oncology, University of Kansas School of Medicine, Wichita, USA.,Internal Medicine, University of Kansas School of Medicine, Wichita, USA
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Abstract
Inflammatory myofibroblastic tumors (IMTs) of the lung were first reported in 1939. The most common site of predilection is the lungs of the pediatric population. They are extremely rare in adults, constituting less than 1% of adult lung tumors. They are mesenchymal neoplasms that may arise in the soft tissues of almost every organ. IMTs often arise from excessive inflammatory response, and as the name implies, they are composed of myofibroblastic spindle cells accompanied by an inflammatory infiltrate of plasma cells, lymphocytes, and eosinophils.
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Affiliation(s)
- Ammar Al-Obaidi
- Internal Medicine, Kansas University School of Medicine, Wichita, USA
| | - Charles Buess
- Internal Medicine, Kansas University School of Medicine, Wichita, USA
| | - Job Mogire
- Internal Medicine, Kansas University School of Medicine, Wichita, USA
| | - Pavan S Reddy
- Internal Medicine, Kansas University School of Medicine, Wichita, USA
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Parker N, Al-Obaidi A, Truong QV, Badgett R. Pembrolizumab versus the standard of care for cancer therapy: A meta-analysis of 12 KEYNOTE trials comparing overall survival. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e14159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14159 Background: Pembrolizumab (P) is an antineoplastic agent approved for multiple different tumor origins as well as tumor agnostic based on MSI status. Thus understanding the tumor characteristics most predictive of response is essential. Living meta-analysis provides a method to continuously assimilate emerging trials. In this study, we created a living meta-analysis to compare the effect of P on overall survival (OS). Methods: Meta-analysis was conducted according to the PRISMA guidelines. PubMed and Cochrane databases, and conference abstracts (e.g. ASCO, ESMO), were searched for phase III KEYNOTE RCT’s that reported OS among cancer patients receiving P. Results: 12 phase III trials involving 7,319 patients (3,861 in P arms) treated for 6 different types of cancer were retrieved. Median follow up was 12.9 months [range: 0.1-35.5]. Treatment was P alone, SOC chemo, and P + chemo in 11 (40%), 13 (46%), and 4 (14%) arms, respectively. P significantly improved OS (HR 0.71, 95% CI: 0.59-0.85, p <0.001, I2 = 0%) when used in any cancer type, setting, or therapy for advanced refractory or chemo-naïve cancer patients. The mean median OS was 12.5 vs 11.1 months in the total populations for all P and control arms, respectively (Table). Conclusions: Among all trials, P was associated with improved OS. Additional meta-analysis will be performed with R software (version 3.3.3; R Fdn.). Random-effects models will be used to compare OS. Heterogeneity will be assessed with Cochrane Q -statistic and quantified with I2test via subgroup analyses for cancer type, setting, therapy, and PD-L1%. This meta-analysis is continuously updated at http://openmetaanalysis.github.io/checkpoint-inhibitors. [Table: see text]
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21
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Khayyat S, Ebrahem R, Al-Hadeethi D, Al-Obaidi A, Shahouri S. Cerebellar Atrophy and Neurocognitive Disorder as Primary Presentation of Antiphospholipid Syndrome in a Young Male. Kans J Med 2019; 12:22-23. [PMID: 30854166 PMCID: PMC6396961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sinan Khayyat
- University of Kansas School of Medicine-Wichita, Department of Internal Medicine
| | - Rawaa Ebrahem
- University of Kansas School of Medicine-Wichita, Department of Internal Medicine
| | - Daly Al-Hadeethi
- University of Kansas School of Medicine-Wichita, Department of Internal Medicine
| | - Ammar Al-Obaidi
- University of Kansas School of Medicine-Wichita, Department of Internal Medicine
| | - Shadi Shahouri
- University of Kansas School of Medicine-Wichita, Department of Internal Medicine,Arthritis and Rheumatology Clinics of Kansas, Wichita, KS
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22
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Khayyat S, Ebrahem R, Al-Hadeethi D, Al-Obaidi A, Shahouri S. Cerebellar Atrophy and Neurocognitive Disorder as Primary Presentation of Antiphospholipid Syndrome in a Young Male. Kans J Med 2019. [DOI: 10.17161/kjm.v12i1.11706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Antiphospholipid syndrome (APS) is a multisystem autoimmunedisorder characterized by arterial or venous thrombosis and pregnancymorbidity in the presence of antiphospholipid antibodies(aPL).1 It can be primary or secondary. Primary antiphospholipid syndromeoccurs in the absence of any other related disease. Secondaryantiphospholipid syndrome occurs with other autoimmune diseases,such as systemic lupus erythematosus.The presence of aPL can be demonstrated in one of three ways:the presence of anticardiolipin antibodies (aCL), β 2-glycoprotein Iantibodies (GPI), or lupus anticoagulant antibodies (LA).1 To meetclassification criteria for antiphospholipid syndrome, patients shouldhave one clinical criterion, either vascular thrombosis (venous orarterial) or pregnancy morbidity (at least one fetal death or pretermdelivery or three or more unexplained, consecutive, spontaneouspregnancy losses) and one laboratory criterion, the presence of aPLantibodies need to be seen twice and at least 12 weeks apart for confirmation.Neurological manifestations are common in APS and areattributed mainly to vascular thrombosis and aPL-induced neuronaltissue injury. The most common neurological presentation is an ischemiccerebrovascular accident (CVA) or transient ischemic attack(TIA). However, clinical presentations including cognitive dysfunction,headaches, seizures, and psychosis may be atypical in some cases,which makes diagnosis more difficult.2In our case, a male patient initially presented with a neurocognitivedisorder, dementia, cerebral atrophy, and seizure of unknown etiology.A diagnosis of APS was made after a brain biopsy revealed microinfarctsand intimal fibrosis and an aPL antibody test was positive.
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