NTRK gene fusions are found in <1% of all cancers but are uniformly present in mammary analog secretory carcinomas (MASC) of the salivary glands. Two selective histology-agnostic tropomyosin receptor kinase (TRK) inhibitors are currently approved for malignancies with these oncogenic fusions. Resistance to TRK inhibition has been recognized, and the mediating mechanisms are presently being studied. This report describes a patient diagnosed with an MASC of the parotid gland who after undergoing multiple lines of treatment was found to have an ETV6-NTRK3 fusion and initiated TRK-targeted therapy using entrectinib. Upon disease progression, we performed tumor genetic sequencing that showed a secondary resistance mutation. The patient subsequently responded to selitrectinib, a next-generation TRK inhibitor.
Background. Transfusion of blood products is a frequent and often necessary lifesaving intervention. While changes to blood bank practices over the past several decades have reduced the infectious complications associated with transfusions, risks still exist. Septic transfusion reactions caused by bacterial contamination of blood products, especially platelets, still occur relatively frequently. Unfortunately, clinical recognition of septic transfusion reactions is difficult due to significant symptom, exam, and laboratory abnormality overlap between different types of transfusion reactions, as well as other conditions. Novel methods have been developed to detect blood product contamination but have yet to be widely implemented in the United States. Case Report. A 67-year-old male with chronic thrombocytopenia was transfused with platelets prior to a planned procedure. Shortly afterwards, he developed fever and hypotension. He was transferred to the intensive care unit where he was treated with aggressive fluid resuscitation and broad-spectrum antibiotics. The patient went on to develop progressively worsening shock and profound disseminated intravascular coagulation. Blood cultures from the patient and the transfused platelets grew an Acinetobacter species. Despite aggressive resuscitative efforts and appropriate antibiotics, the patient died approximately 48 hours following the transfusion reaction. Conclusion. We report a fatal case of septic shock associated with Acinetobacter bacteremia caused by platelet transfusion. Our review of the literature revealed only one other documented platelet transfusion associated fatality caused by Acinetobacter species. Novel pathogen reduction and contamination detection methods have been developed but have yet to be widely adopted in the United States.
BackgroundOesophageal cancer (OC) survival rates have improved since the widespread adoption of neoadjuvant chemoradiation therapy (NACRT) followed by oesophagectomy (trimodality therapy). Unfortunately, the overall prognosis for patients with locally advanced disease remains poor. In this study, we sought to assess the effect of adjuvant chemotherapy (AC) in patients treated with trimodality therapy.MethodsUsing the National Cancer Database we retrospectively identified 6785 patients with locally advanced (cT1b-T4a, N0-N+, M0) OC who were treated with trimodality therapy from 2006 to 2014. Patients were separated based on receipt of AC (n=463), as well as clinical and pathological lymph node involvement. Overall survival (OS) between groups was compared using the Kaplan-Meier method and Cox proportional hazard modelling.ResultsBased on multivariate analysis, AC was associated with a statistically significantly reduced risk of death (HR 0.77, p<0.001). Subgroup analysis revealed that AC was associated with reduced risk of death compared with NACRT alone in the cN+/pN0 (median OS 64 vs 43 months; p=0.019) and the cN+/pN+ (median OS 27 vs 22 months; p=0.010) groups, but not in the cN0/pN0 (median OS 48 vs 49 months; p=0.253) or cN0/pN+ (median OS 31 vs 24 months; p=0.077) groups.ConclusionAC following trimodality therapy may improve survival in patients with locally advanced OC. Patients who undergo lymph node downstaging may be the most likely to benefit from AC. Prospective studies are needed to confirm this finding.
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