புற்றுநோய் அறிவியல் & சிகிச்சை

Lineage switch acute leukemia is a rare condition mostly reported in pediatrics. Despite new advances in the treatment of acute leukemia, switching between lymphoid and myeloid lineages at relapse could worsen outcome of the disease. Awareness of this phenomenon might be beneficial in terms of early detection and applying more aggressive or more specific therapy specially in the context of some genetic alterations.

Objective: Percutaneous isolated hepatic perfusion (PIHP) is becoming increasingly important for the treatment of hepatic metastasis of uveal melanoma. However, the best treatment strategy is not yet clear.

Method: We present a case series of seven patients suffering from hepatic metastases of uveal melanoma who received several treatments of PIHP with melphalan, with or without immunotherapy.

Results: Seven patients with hepatically metastasized uveal melanoma (three men, four woman) with an average age of 51 years (range 37–68 years) received two cycles of PIHP at intervals of 4–10 weeks and were then monitored clinically (three patients) or treated with a PD-1 antibody ± ipilimumab (six patients) until disease progression or intolerable toxicity was determined. Two cycles of PIHP controlled the disease for between 3.9 and 15.6 months, resulting in a median hepatic progression-free survival (hPFS) of 7.3 months. A further 1–2 PIHP cycles were then performed, followed by anti-PD1 therapy for two patients, resulting in short-term control of the disease only. Median hPFS until final disease progression (measured from first PIHP until progression despite PIHP) was 15.4 months (Range 3.9–24.9), and overall survival was 16.8 months (Range 4.8–36.0). The first two PIHP cycles in particular were very well tolerated.

Conclusion: Although conclusions from small case series should be drawn with caution, the clinical experiences described provide the first indications that two treatment cycles of PIHP might suffice to control hepatic metastasis of uveal melanoma for several months. Additional immunotherapy might benefit patients after a reduction of tumour load by PIHP. Side effects and treatment risks seem lower with this treatment scheme. Further studies on this topic are warranted.

Osimertinib (AZD9291, Tagrisso) is an irreversible third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) compound. Limited effective therapeutic regimens are recommended for patients who progress with osimertinib. We retrospectively reviewed two patients with EGFR mutations who were resistant to osimertinib and received anti-programmed cell death-1 (anti-PD-1) agents combined with Abraxane with stage IV cancer. The two patients (one male and one female) were diagnosed with EGFR mutation-positive advanced lung adenocarcinoma and received first- or second-generation EGFR-TKIs. When these patients became resistant, both received osimertinib. Both patients had disease progression after osimertinib and received combination therapy of immune checkpoint blockade (nivolumab or pembrolizumab) and albumin-bound paclitaxel (Abraxane). These patients achieved partial remission (PR), and their progression-free survival (PFS) were respectively 8.0 months and 10.0 months. The combination of immunotherapy and Abraxane could be an effective option for the treatment of patients resistant to osimertinib.

Objectives: We evaluated the practice in our outpatient setting to analyze and study the outcomes of patients with palliative lung cancer.
Methods: All consecutive patients with palliative non-small cell lung cancer (NSCLC) treated between June 1995 and December 2016 were analyzed retrospectively.
Results: 736 patients with a median age of 66 (37-88) could be evaluated. All patients had a primary lesion in the lung and 71% metastatic disease at the time of presentation. Adenocarcinoma (61%) was the most common histological subtype followed by squamous cell cancer (28%). The majority (93%) received at least one line of chemotherapy. A mean of 2.5 lines of treatment per patient (1-11) was delivered with platin doublet chemotherapy being the most common therapeutic choice (479/650; 74%). 93% of patients died, mostly due to tumor (76%) during the observation period.. The median overall survival (OS) was 13.5 months (0.4-194.6). Patients with disease limited to the lungs without metastases had an OS of 16.9 months (1.2–188.5+) compared with 11.6 months (0.4-194.6) for patients with metastases (p=0.003).
Conclusions: Good quality care can be delivered closer to home in an outpatient setting with the help of a competent multidisciplinary framework. Our results are comparable to that of clinical trial and cancer registry data.

Background: Thymic epithelial tumors are rare tumors with variable prognosis. They include thymomas and thymic carcinomas. The therapeutic strategy depends on the anatomo-clinical stage. However, significant differences are observed in therapeutic response and survival. The aim of this study is to describe the epidemiological, clinical, pathological characteristics, therapeutic results and the prognosis of thymomas and thymic carcinomas.
Materials and methods: This is a retrospective study of a series of thymomas and thymic carcinomas collected at the Medical Oncology Department of the Hassan II Hospital in Fez during a period of 7 years [October 2010 to May 2017]. Epidemiological, clinical, pathological and therapeutic results were analyzed by Excel. Disease-free survival, progression-free survival and overall survival were calculated using the Kaplan-Meier method.
Results: Thymomas represent a frequency of 0.1% of all cancers treated in the Oncology Department. The median age of the study population was 49.64 years [22-81 years] and the sex ratio was 2.4. Dyspnea and chest pain were the most common revealing symptoms. Myasthenia represents the essential paraneoplastic syndrome encountered in our series. Majority of cases were diagnosed at locally advanced and metastatic stages (82.3% of cases). 70.6% of cases were thymomas and 29.4% thymic carcinomas. Two cases in this study underwent surgery, it was complete and without microscopic residue in both cases. Two patients received radiotherapy adjuvant to surgery or after neoadjuvant chemotherapy. Chemotherapy was prescribed in 13 patients mostly in a palliative setting. Two patients were cured, 8 patients died from disease, 3 patients were lost of view, the remaining patients were in locoregional and distance control.
Conclusion: Thymic epithelial tumors, including thymomas and thymic carcinomas, are rare tumors and belong to the group of orphan tumors. They present specific problems, from pathological diagnosis to the treatment requiring multidisciplinary therapeutic strategy.

Osteosarcoma (OS) or Osteogenic sarcoma is a commonly occurring primary bone tumor that occurs in young age including adolescence age group and contributes approximately about 20% of all the other sarcomas. Giant cell rich osteosarcoma (GCRO) is considered as a rare sub-type in the category of primary osteogenic sarcoma. GCRO sarcoma possesses giant cells that look like osteoclasts in abundance and insufficient amount of osteoids are also present. GCRO excludes several features related to classical radiographic aspects in conventional osteosarcomas. This results in its pivotal importance in recognition as a subspace of osteosarcoma and its distinction from other meticulously related tumor in bone. GCRO can be either benign or malignant osteolytic tumor that can be observed on the plain radiographs. Furthermore, giant cell tumor (GCT) whether benign or malignant, in case of histological differentiation is challenging and is highly important because of its aggressively fatal consequences. The GCT contributes nearly 5% of primary bone and the tumor bone is commonly found in the end points of the long bone. In this review, we attempted to recognize and summarize the involvement of giant cells in the development of bone tumor and describe some important gene expressions to get an insight about the strategies to control this type of bone tumor.

Ewing's sarcoma (ES) is an uncommon malignancy of childhood and adults that constitutes 6%-8% of all primary malignant tumors and the third-most common tumor after osteosarcoma and chondrosarcoma. This article presents a case of localized ES iliac wing in a 12-year-old male patient, treated in accord to the ISG-EW1 protocol, showing extensive percentage of circulating tumor cells if compared with other non-metastatic patients, which is not a frequent presentation. Histopathological needle biopsy from the soft tissue extension of the tumor revealed small round-cell tumor with strong CD99 positivity, supporting the diagnosis of Ewing's sarcoma. The diagnosis was confirmed by reciprocal translocation of chromosomes 11 and 22. Analysis of tumor circulating cells revealed a massive percentage of tumor cell in peripheral blood, comparable to the levels that usually were found in metastatic patient.