Patients with an epidermal growth factor receptor (EGFR) mutation are usually administered EGFR‐tyrosine kinase inhibitors (TKIs) as standard‐of‐care treatment. However, acquired resistance occurs between 9 and 13 months. The T790M‐resistant mutations are the most common, and osimertinib has been found to be effective in treating EGFR‐T790M‐positive patients. A 73‐year‐old female lung cancer patient with an EGFR‐sensitizing mutation was receiving fourth‐line chemotherapy when she complained of anorexia, headache, and irritability. A lumbar puncture showed adenocarcinoma in the cerebrospinal fluid (CSF), which led to the diagnosis of leptomeningeal metastasis. Her performance status (PS) deteriorated quickly and she also developed dysphagia. The EGFR mutation testing of the CSF demonstrated L858R+T790M double mutations, and an osimertinib suspension was subsequently administered through a nasogastric tube. The PS improved to 1, oral intake became possible after 20 days, and further improvements were observed by gadolinium‐enhanced magnetic resonance imaging. The patient remains progression‐free for 10 months after osimertinib administration.
Lung cancer has aggressive behaviour which often progresses rapidly with disseminated disease and leads to poor performance status (PS) in patients. Because cytotoxic chemotherapy is not recommended under these conditions, there are currently no alternative therapeutic options other than providing supportive care. Immune checkpoint inhibitors have been developed, but their efficacy and tolerability have not been fully investigated in patients with poor PS. A 72-year-old male patient with lung adenocarcinoma harbouring no EGFR-sensitizing mutation or ALK translocation was receiving second-line chemotherapy with S-1 monotherapy when he complained of worsening dyspnea. Chest computed tomography (CT) demonstrated disease progression at the primary site that was accompanied by bilateral pulmonary lymphangitic carcinomatosis, which was the cause for respiratory failure. Oxygen administration at 10 L/min was required due to the rapid progression of the tumour that resulted in poor PS. A retrospective study was conducted to assess the upregulation of programmed death ligand 1 (PD-L1) using anti-PD-L1 22C3 mouse monoclonal primary antibody and found that the PD-L1 expression was 50-60% (i.e. tumour proportion score ≥50%). Since cytotoxic chemotherapy could not be considered due to a poor PS of 4, nivolumab was cautiously administered. After the introduction of nivolumab, ground glass opacities, and consolidations on chest CT temporarily deteriorated on day 4 without any other clinical signs and symptoms. The reevaluation on day 10 demonstrated significant improvements on chest X-ray. Then the patient was subsequently diagnosed with pseudoprogression. Thereafter, both the respiratory status and the PS improved gradually. The PS recovered to baseline conditions with oxygen administration at 1 L/min after four cycles of treatment. The patient currently remains at a PS of 1 and is progression-free for eight months after the introduction of nivolumab.
We report a case of autoimmune gastritis (AIG) in which gastric mucosal atrophy improved with <i>Helicobacter pylori</i> eradication. Based on endoscopic findings (advanced gastric atrophy with vascular visibility and diffuse redness in remnant oxyntic mucosa), a woman in her 40s was suspected of having AIG coexisting with an active <i>H. pylori</i> infection. This was confirmed by a positive anti-parietal cell antibody (PCA, 1:160), an elevated serum gastrin level (638 pg/mL), and positive anti-<i>H. pylori</i> antibody (<i>Hp</i> Ab, 15.5 U/mL) and <i>H. pylori</i> stool antigen tests. Seven months after eradication, reduced vascular visibility and disappearance of diffuse redness on endoscopy and reduced PCA (1:40) and <i>Hp</i> Ab (5.1 U/mL) titers were observed, although histopathological findings (basal-predominant lymphocytic infiltration, destruction of parietal and chief cells, pseudopyloric metaplasia, and enterochromaffin-like cell hyperplasia) were consistent with AIG. Endoscopy 26 months after eradication showed further improvement in atrophic findings in the gastric corpus and histopathological recovery of parietal and chief cells in fundic glands. Serum gastrin levels returned to normal (64 pg/mL), and the PCA titer fell further (1:20).
The current standard-of-care treatment for patients with limited-stage small-cell lung cancer (SCLC) is concurrent chemoradiotherapy for local and systemic control. However, standard-of-care treatment strategies have not been established for those with limited-stage SCLC who have a history of thoracic radiotherapy due to concerns with complications associated with radiation overdose. A 37-year-old male developed an aspergilloma in the postoperative left thoracic space after he was treated with concurrent chemoradiotherapy for mediastinal type lung adenocarcionoma and subsequent left upper lobectomy for heterochronous dual adenocarcinoma. Fiberoptic bronchoscopy was performed to examine the status of the suspected bronchopleural fistula when a polypoid mass was observed in the right mainstem bronchus. A histological examination showed that the mass was SCLC at a clinical stage of cTisN0M0, stageIA, without local invasion. Since thoracic radiotherapy was not an option due to a previous history of thoracic irradiation, a combination treatment of carboplatin and etoposide was administered for 4 cycles and resulted in good partial response. In addition, argon plasma coagulation (APC) was performed as an alternative to curative radiotherapy on day 22 of the 4th cycle. The 5th cycle was administered 7 days after APC at which the anticancer therapy was completed. The patient remains disease-free 60 months after the completion of treatment, which suggests that this combination therapy may resolve very early-stage SCLC.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.