Dramatic Response of a Metastatic Primary Small-Cell Carcinoma of the Pancreas to a Trial of Immunotherapy with Nivolumab: A Case Report

Ugwu, Justin Kenneth; Nwanyanwu, Chiemeziem; Shelke, Abhay R.

doi:10.1159/000479315

Cited by 17 publications

(10 citation statements)

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“…Immune checkpoint blockade has shown promising activity in multiple types of NEC, including small cell lung cancer [36], Merkel cell carcinoma [37, 38], as well as in NEC of the pancreas [39] and cervix [40]. Here we report an extremely good response of NEPC to combined immune checkpoint blockade with ipilimumab and nivolumab.…”

Section: Discussionmentioning

confidence: 87%

Clinical characteristics, treatment outcomes and potential novel therapeutic options for patients with neuroendocrine carcinoma of the prostate

et al. 2019

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BackgroundNeuroendocrine carcinomas of the prostate (NEPCs) are rare tumors with poor prognosis. While platinum and etoposide-based chemotherapy regimens (PE) are commonly applied in first-line for advanced disease, evidence for second-line therapy and beyond is very limited.MethodsRetrospective analysis of all patients with NEPCs including mixed differentiation with adenocarcinoma component and well differentiated neuroendocrine tumors (NETs, carcinoids) at two high-volume oncological centers between 12/2000 and 11/2017.ResultsOf 46 identified patients 39.1 % had a prior diagnosis of prostatic adenocarcinoma only, 43.5 % had a mixed differentiation at NEPC diagnosis, 67.4 % developed visceral metastases, 10.9 % showed paraneoplastic syndromes. Overall survival (OS) from NEPC diagnosis was 15.5 months, and significantly shorter in patients with a prior prostatic adenocarcinoma (5.4 vs. 32.7 months, p=0.005). 34 patients received palliative first-line systemic therapy with a median progression-free survival (PFS) of 6.6 months, mostly PE. Overall response rate (ORR) for PE was 48.1 %. 19 patients received second-line therapy, mostly with poor responses. Active regimens were topotecan (1 PR, 3 PD), enzalutamide (1 SD), abiraterone (1 SD), FOLFIRI (1 SD), and ipilimumab+nivolumab (1 PR). One patient with prostatic carcinoid was sequentially treated with octreotide, peptide receptor radionuclide therapy and everolimus, and survived for over 9 years.ConclusionsEP in first-line shows notable ORR, however limited PFS. For second-line therapy, topotecan, FOLFIRI, enzalutamide, abiraterone and immune checkpoint blockade are treatment options. Prostatic carcinoids can be treated in analogy to well differentiated gastrointestinal NETs.

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Section: Discussionmentioning

confidence: 87%

Clinical characteristics, treatment outcomes and potential novel therapeutic options for patients with neuroendocrine carcinoma of the prostate

et al. 2019

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“…In case reports, tumor responses to nivolumab have been observed in a patient with pancreas NEC following standard chemotherapy [51], and to pembrolizumab, in a heavily pretreated patient with a rare metastasized atypical thymic carcinoid [52]. Intensive multimodal treatment which included combined vaccination and PD-1/CTLA-4 blockade led to extremely long survival of more than 8 years with high quality of life and minimal residual disease in a patient with a histamine-secreting metastasized type 3 gastric NET, despite dedifferentiation of the tumor into a non-functional NEC [53].…”

Section: Clinical Experience With Checkpoint Inhibitors In Nensmentioning

confidence: 99%

Immune Checkpoint Inhibitors in the Treatment of Patients with Neuroendocrine Neoplasia

Weber

Fottner²

2018

Oncol Res Treat

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Background: Well-differentiated neuroendocrine neoplasms (NENs) are usually controlled by antiproliferative, local ablative and/or radionuclide therapies, whereas poorly differentiated NENs generally require cytotoxic chemotherapy. However, treatment options for patients with advanced/metastatic high-grade NENs remain limited. Method: Review of the literature and international congress abstracts on the efficacy and safety of immunotherapy by checkpoint inhibition in advanced/metastatic NENs. Results: Evidence points to an important role of immune phenomena in the pathogenesis and treatment of neuroendocrine tumors (NETs). Programmed cell death 1 (PD-1) protein and its ligand are mainly expressed in poorly differentiated NENs. Microsatellite instability and high mutational load are more pronounced in high-grade NENs and may predict response to immunotherapy. Clinical experience of immune checkpoint blockade mainly exists for Merkel cell carcinoma, a high-grade cutaneous neuroendocrine carcinoma (NEC), which has led to approval of the anti-PD-1 antibody avelumab. In addition, there is anecdotal evidence for the efficacy of checkpoint inhibitors in large-cell lung NECs, ovarian NECs and others, including gastroenteropancreatic NENs. Currently, phase II studies investigate PDR001, pembrolizumab, combined durvalumab and tremelimumab, and avelumab treatment in patients with advanced/metastatic NENs. Conclusion: Immune checkpoint inhibitors are a promising therapeutic option, especially in progressive NECs or high-grade NETs with high tumor burden, microsatellite instability, and/or mutational load.

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“…Thus, combined surgery with adjuvant chemoradiation therapy might improve the prognosis of SCCP [6]. cisplatin-based chemotherapy has been the mainstay of treatment for most histologically similar extrapulmonary small-cell cancers [11], the combination of cisplatin/carboplatin and etoposide is most frequently prescribed in SCCP, therefore a potency to induce malignant transformation is persisting.…”

Section: Discussionmentioning

confidence: 99%

Non-Hodgkin Lymphoma Secondary to Cancer Chemotherapy in a Patient with Small Cell Carcinoma of the Pancreas

Wasita¹,

Rinonce²,

Dwianingsih³

et al. 2019

KLS

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Dramatic Response of a Metastatic Primary Small-Cell Carcinoma of the Pancreas to a Trial of Immunotherapy with Nivolumab: A Case Report

Cited by 17 publications

References 10 publications

Clinical characteristics, treatment outcomes and potential novel therapeutic options for patients with neuroendocrine carcinoma of the prostate

Clinical characteristics, treatment outcomes and potential novel therapeutic options for patients with neuroendocrine carcinoma of the prostate

Immune Checkpoint Inhibitors in the Treatment of Patients with Neuroendocrine Neoplasia

Non-Hodgkin Lymphoma Secondary to Cancer Chemotherapy in a Patient with Small Cell Carcinoma of the Pancreas

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