e18104 Background: Papillary serous uterine cancer (PSUC) is a rare, clinically aggressive histotype accounting for 40% of uterine cancer deaths. Clinicopathologic characteristics and outcomes between older and younger PSUC patients may differ. Methods: With IRB approval, we conducted a retrospective analysis of 554 consecutive patients with uterine cancer treated at our institution from 2009-19. Consistent with findings from the SEER database, 28 patients (5%) had PSUC. Most PSUC patients were Caucasian; Latinas comprised 14.2%. Thirteen patients were seventy years of age or younger (≤70) and fifteen were older than seventy ( > 70). Clinicopathologic features, therapy and survival were compared between two cohorts. Statistical analysis: Significance of associations was assessed with Fishers' exact test. Survival analysis was performed with Cox proportional model with censoring to calculate hazard ratios (HR). Results: The two cohorts were well-balanced for stage (TNM stages I+II vs. TNM stages III+IV). More than 90% of patients in each group had surgical excision/debulking, and nearly half of patients in each group received systemic chemotherapy. The most frequently used chemotherapy regimen was carboplatin-paclitaxel. Compared to patients ≤70, patients > 70 were less likely to undergo postoperative radiation therapy (6% vs 61.5%; p = 0.001). Cancer-specific survival (CSS) was worse in patients > 70 as opposed to patients ≤70 (21.8 vs. 27.4 months; HR 0.61, p = 0.03). Four PSUC patients > 70 had a personal history of metachronous breast cancer; none ≤70 had a history of breast cancer. We identified five cases of breast cancer, two cases of colon cancer, and one case each of ovarian and uterine cancer in first-degree relatives of PSUC patients > 70. Conclusions: Older PSUC patients displayed significantly shorter CSS than their younger counterparts. They were also less likely to receive radiation therapy. As personal and family history of older PCUS patients identified an excess of other cancers, comprehensive germline mutation testing may be warranted. Final statistical analysis, comparison to SEER data and significance will be presented.
Introduction Immune checkpoint inhibitors have improved clinical outcomes in a wide range of cancers. While skin toxicity is not uncommon with immune checkpoint inhibitors, generalized nail discoloration has not been reported with their use in oncology. Case report Herein, we report a unique case of bluish-gray fingernail discoloration due to nivolumab therapy for relapsed melanoma. Management and outcome: This condition reversed completely 10 weeks after nivolumab discontinuation. Naranjo nomogram assessment renders the causality relationship between nivolumab and nail discoloration probable. Discussion To our knowledge, this is the first case report of an unusual bluish-gray nail discoloration due to therapy with nivolumab. The mechanism by which nivolumab causes this side effect remains to be elucidated.
Malignant mixed Müllerian tumor remains an important contributor to morbidity and mortality in women with uterine cancer. Surgery is the primary treatment modality, followed by chemotherapy and/or radiation for advanced disease or high-risk patients. Clinico-epidemiologic characteristics and outcomes in older versus younger women with Malignant mixed Müllerian tumor may differ. We analyzed and now report on 15 consecutive patients with uterine Malignant mixed Müllerian tumor treated at our institution from 2000 to 2018. The mean age at diagnosis was 65 years; 60% (9/15) patients were overweight/obese. Forty-six percent (7/15) had hypercholesterolemia, an association not previously linked with Malignant mixed Müllerian tumor in the literature. All patients but one had surgical excision of the tumor. A third of patients received adjuvant radiation therapy. A majority of patients received chemotherapy; the preferred regimen was carboplatin-paclitaxel. The patients older than 70 had a tendency towards a more advanced disease stage at diagnosis and a significantly shorter cancer-specific survival than their younger counterparts (6 months vs. 102 months (hazard ratio 1.32, p = 0.02)). Our study's conclusions are restricted due to its relatively small size, retrospective design, and some variation in the chemotherapy doses administered in individual patients. Larger studies are needed to confirm the significance of our findings.
Introduction Clinical indications of immune checkpoint inhibitors have expanded to a variety of malignancies. Approximately one in six patients with hepatocellular carcinoma respond to programmed death 1 inhibitors nivolumab and pembrolizumab. Case report We report herein a patient with synchronous metastatic hepatocellular carcinoma and advanced papillary thyroid carcinoma treated with nivolumab in the second-line therapy. Management and outcome: The hepatocellular carcinoma showed a durable response to the second-line agent nivolumab. Remarkably, the patient’s papillary thyroid carcinoma also responded to this programmed death 1 inhibitor. Discussion To our knowledge, this is the first case report showing the efficacy of nivolumab in the treatment of metastatic papillary thyroid carcinoma. Further studies with immune checkpoint inhibitors in papillary thyroid carcinoma seem warranted.
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