Background Cardiac metastasis due to colon cancer is extraordinarily uncommon. Given the rarity of diagnosis, there is paucity of evidence and hence, no established guidelines for evaluation or clinical management strategy. Clinical presentation We present the case of a 59 year old male with a previously treated colonic carcinoma who presented with new onset exertional dyspnea. He was noted to be having a right atrial mass on an echocardiogram performed at his cardiologist’s office. Further workup with CT angiogram of the chest confirmed a right atrial mass measuring 4.0 cm. Serum CEA was normal. Biopsies of the right atrial mass demonstrated metastatic moderately differentiated colonic adenocarcinoma. Mismatch repair protein expression analysis by immunohistochemistry showed no loss of MLH1, MSH2, MSH6 or PMS2 expression. Next generation sequencing for RAS and BRAF mutations was negative. Patient received treatment with FOLFIRINOX/ bevacizumab with noted reduction in size of mass. Conclusion To the best of our knowledge, this is the first report of next generation sequencing results available on a biopsy of metastatic colorectal cancer to the heart with the largest literature review of 31 reported cases of metastatic colorectal cancer to the heart. It will help direct clinical management and also adds evidence to the potential efficacy of treatment of this rare aggressive disease with chemotherapy in combination with VEGF inhibitors.
Introduction. Primary cutaneous anaplastic large-cell lymphoma (PC-ALCL) is a rare T-cell lymphoma. A prior analysis of the Surveillance, Epidemiology, and End Results (SEER) database reported only 157 cases of localized primary cutaneous CD30+ T-cell lymphoproliferative disorders (PC-ALCL and lymphomatoid papulosis) from 1973 to 2004. Our analysis of the SEER database since 2004 is the largest to date and our results improve our understanding of this disease and their potential prognostic factors. Methods. We used the SEER database to retrospectively identify patients. Survival was analysed using the Kaplan-Meier method, and log-rank tests were used to compare survival distributions. Results. There were 501 cases of PC-ALCL recorded from 2005 to 2016. Overall survival rates at 5 and 10 years were found to be 80.6% (95% CI 76.3%-84.3%) and 61.5% (95% CI 54.1%-68.1%) respectively. Age ≥ 60 years [hazard ratio (HR) = 1.09, P = 0.001 and use of chemotherapy (HR = 1.86, P = 0.01)] were associated with lower overall survival. In contrast to the 1973-2004 cohort, the head and neck site was not significantly associated with prognosis on multivariate analysis. Conclusion. PC-ALCL has been increasingly recognized over the past decade. Age > 60 years and use of chemotherapy are associated with a worse outcome. Contrary to prior studies, location was not associated with poor survival.
The treatment paradigm for colorectal cancer (CRC) has changed significantly over the past decade with targeted therapeutics. Human epidermal growth factor receptor 2 ( HER2) amplification is seen among 3%-4% of patients with metastatic CRC (mCRC). The biological discovery of HER2 amplification in cancer cells has led to practice-changing drug development for several solid tumors, including breast, gastric, and esophageal cancers. HER2 amplification is now highly actionable in CRC with distinct therapeutic combinations, including the combination of monoclonal antibodies and HER2 receptor–specific tyrosine kinase inhibitors, as well as antibody-drug conjugates, that delivers targeted cytotoxic agents. However, it is essential to define the therapeutic role and sequence of these different combinations, some of which are already part of standard clinical practice. In this review article, we discuss recent clinical studies demonstrating the clinical benefits of each distinct therapeutic approach and their impacts on the current management of HER2-amplified mCRC. We also review ongoing clinical trials targeting the HER2 pathway in mCRC and elaborate on novel therapeutic opportunities in this space that may further define the changing paradigm of HER2-targeted therapy for CRC.
28 Background: Amongst all cancers in men, prostate cancer (PCa) is the most common cancer, and the second leading cause of death. Racial disparities in PCa care in the United States (US) are known to exist. However, it is not clear if this disparity is also noted specifically in patients diagnosed with metastatic PCa (metaPCa). We analyzed the Surveillance Epidemiology and End results Program (SEER) 18 registry, to determine the racial disparity in survival of AA patients diagnosed with metaPCa compared to other races recorded in this registry. Methods: Cancer incidence data was obtained from the SEER 18 registry (2000-2018). The data was analyzed using StataMP 16 (StataCorp) software. Demographic and clinical outcomes were recorded from the registry. We performed univariate Cox regression using proportional hazard model and obtained Kaplan Meier curves to look at the difference in survival based on different age groups and race. Results: A total of 51,979 cases were identified with metaPCa, out of whom 75.8% were Whites. 40,579 deaths were recorded. Mean age group of patients with metaPCa were 70-74 years. Grade 3 poorly differentiated adenocarcinoma was noted in 54.6% patients. There was no statistically significant difference in survival of AA patients with metaPCa compared to Non-Hispanic Whites (NHW) (Hazard Ratio (HR): 0.99; 95%CI 0.96,1.03 p = 0.71) or Alaskan and American Natives (AIAN) with metaPCa (HR:1.048; 95%CI 0.91,1.21 p = 0.539). AA with metaPCa had a statistically better outcome compared to Asian and Pacific Islanders with metaPCa (HR:0.775; 95%CI 0.731,0.821 p = 0.00). Amongst patients with less than 65 years of age with metaPCa, AA patients had statistically better survival than NHW (HR: 0.94; 95% CI 0.89-0.98 p = 0.05). No statistically supported racial disparity in survival was observed in patients above 65 years with metaPCa (AA to NHW patients- HR: 0.99; 95% CI 0.96,1.03 p = 0.71). Conclusions: Although racial disparities exist in survival of all patients diagnosed with prostate cancer, when it comes to those with metaPCA, there is no statistically supported racial disparity amongst AA patients compared to NHW, except for those who are younger than 65 years where white patients have a worse outcome compared to AA diagnosed with metaPCa.
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