Pembrolizumab for Refractory Metastatic Myxofibrosarcoma: A Case Report / Journal of the Korean Cancer Association, 대한암학회지

Myxofibrosarcoma is a rare tumor, refractory to cytotoxic chemotherapy and radiotherapy. Pembrolizumab is an innovative immunotherapy drug consisting of programmed death receptor ligand 1 antibody proven to be useful for numerous types of cancer cells. A patient had been diagnosed with metastatic myxofibrosarcoma, refractory to radiotherapy and conventional cytotoxic chemotherapy. The patient achieved a partial response during palliative chemotherapy with pembrolizumab for 14 cycles. To the best of our knowledge, this is the first case report demonstrating the efficacy of pembrolizumab for refractory myxofibrosarcoma.

Bile Flow Phantom Model and Animal Bile Duct Dilation Model for Evaluating Biliary Plastic Stents with Advanced Hydrophilic Coating

BACKGROUND/AIMS: The efforts to improve biliary plastic stents (PSs) for decreasing biofilm formation and overcome short patency time have been continued. The aim of this study is to evaluate the effect of advanced hydrophilic coating for patency and biodurability of PS. METHODS: Using an in vitro bile flow phantom model, we compared patency between prototype PS with hydrophilic coating (PS+HC) and prototype PS without hydrophilic coating (PS-HC). We performed an analysis of the degree of luminal narrowing by microscopic examination. Using an in vivo swine bile duct dilation model made by endoscopic papillary closure and stent insertion, we evaluated biodurability of hydrophilic coating. RESULTS: In the phantom model, PS+HC showed less biofilm formation and luminal narrowing than PS-HC at 8 weeks (p<0.05). A total of 31 stents were inserted into the dilated bile duct of seven swine models, and 24 stents were successfully retrieved 8 weeks later. There was no statistical difference of stent patency between the polyethylene PS+HC and the polyurethane PS+HC. The biodurability of hydrophilic coating was sustained up to 8 weeks, when assessing the coating layer by scanning electron microscopy examination. CONCLUSIONS: Advanced hydrophilic coating technology may extend the patency of PS compared to uncoated PS.

A Case of Complete Stent Facture at Proximal and Distal Site in One Drug Eluting Stent / 대한내과학회지

A patient came to the hospital with chest pain and was diagnosed with acute myocardial infarction. Coronary angioplasty was performed at the right coronary artery (RCA) and left anterior descending artery (LAD). A bare metal stent (BMS) was inserted in the RCA and a drug eluting stent (DES) was inserted in mid-LAD. The patient was discharged and was followed up as an outpatient without any symptoms. After 6 years, the patient complained of intermittent chest pain. A treadmill test was performed, and the results were positive. Follow-up coronary angiography was performed, and it showed that the DES inserted in mid-LAD had a complete stent fracture at the distal and proximal sites of the stent. Thus, we report a case of complete stent fracture at the proximal and distal sites in one drug eluting stent.

A Case of Variant Angina Developing Transient Collateral Circulation During Vasospasm

Variant angina is characterized by spontaneous episodes of angina, usually occurring in the morning and having ST segment elevation on the electrocardiogram. However, in the case presented here, vasospasm and angina was shown by ergonovine without ST elevation. The patient was a 60-year-old man who presented with a 2-year history of frequent chest pain. There were no abnormalities in coronary angiography. When ergonovine (100 microg) was injected, total occlusion of the proximal right coronary artery was seen, without ST elevation at the electrocardiogram. The cause was collateral from left anterior descending artery to distal right coronary artery at the left coronary angiography. Therefore, in a patient with variant angina without ST elevation, a transient collateral circulation during vasospasm should be considered.

A Case of Malignant Pericardial Mesothelioma With Constrictive Pericarditis Physiology Misdiagnosed as Pericardial Metastatic Cancer

Malignant pericardial mesothelioma is a rare and progressive cardiac tumor. There is no established standard treatment and the prognosis is poor. Most patients were retrospectively diagnosed from surgery or autopsy due to absence of specific clinical manifestation. Most patients with pericardial mesothelioma have demonstrated constrictive physiology on echocardiography or cardiac catheterization. Therefore, pericardial mesothelioma was often misdiagnosed as other causes of constrictive pericarditis. We report a case of primary pericardial mesothelioma misdiagnosed as pericardial metastasis of unknown origin.

Complete Atrioventricular Block Secondary to Bortezomib Use in Multiple Myeloma

Bortezomib is an inhibitor of 26S proteasome, which is an effective treatment for multiple myeloma. The common adverse effects of bortezomib are asthenic conditions, gastrointestinal disturbances, and peripheral neuropathy. Here we describe a patient with dyspnea and general weakness because of complete atrioventricular block while receiving bortezomib. We immediately stopped bortezomib, and after inserting a permanent VDD pacemaker, the patients' symptoms disappeared.

Complete Atrioventricular Block Secondary to Bortezomib Use in Multiple Myeloma

Bortezomib is an inhibitor of 26S proteasome, which is an effective treatment for multiple myeloma. The common adverse effects of bortezomib are asthenic conditions, gastrointestinal disturbances, and peripheral neuropathy. Here we describe a patient with dyspnea and general weakness because of complete atrioventricular block while receiving bortezomib. We immediately stopped bortezomib, and after inserting a permanent VDD pacemaker, the patients' symptoms disappeared.

Induction Chemotherapy Followed by Radiotherapy for Stage IV Hypopharyngeal Cancer / 대한방사선종양학회지

PURPOSE: Hypopharyngeal cancer is diagnosed at the advanced stage in most cases, which the prognosis known to be poor. Thus, the efficacy of induction chemotherapy followed by radiotherapy, with regards to the response and survival rate for stage IV hypopharyngeal cancer patients, was examined. MATERIALS AND METHODS: From July 1998 to February 2000, 18 cases were diagnosedas AJCC stage IV hypopharyngeal cancer without distant metastasis. These patients were treated with induction chemotherapy followed by radiotherapy, and the results retrospectively analyzed. The regimen of the induction chemotherapy was the 5-FU and cisplatincombination, at 3-week intervals for, 2 cycles. The total radiation dose for the primary lesion and metastatic lymph nodes was 68.4~72.0 Gy (median: 70.2 Gy). RESULTS: The median follow up period was 28 months, ranging from 7 to 99 months. The 3-year overall survival and disease-free survival rate were 41.7 and 31.1%, respectively. In 6 cases (33.3%), conservation of the larynx for over 3 years was possible. After the induction chemotherapy there were 16 partial responses (88.8%), 1 complete response and 1 with no response (5.6% each), therefore, 17 of the 18 cases (94.6%) showed responses. After the completion of the induction chemotherapy and radiotherapy, a complete response was noted in 13 cases (72.2%), a partial response in 5 (27.8%), with an overall response rate of 100%. In the analysis of the prognostic factors influencing the survival rate, the 3-year and disease-free survival rates for the complete and partial response groups were 43.1, and 20.0%, and 39.6, and 20.0%, respectively (p=0.0003, p=0.002). Only the final response after treatment completion was statistically significant. CONCLUSION: For stage IV hypopharyngeal cancer, induction chemotherapy followed by radiotherapy was an effective treatment, with no severe side effects.

Paclitaxel and Cisplatin with Concurrent Radiotherapy for Stage III Non-Small Cell Lung Cancer

PURPOSE: The prognosis of stage III non-small cell lung cancer (NSCLC) treated with radiotherapy alone has been disappointing. Combined therapy including chemotherapy and radiotherapy has potential of improving both local and distant metastatic control. Paclitaxel and cisplatin have demonstrated activity as radiation sensitizers. The aim of this study was to evaluate the efficacy of paclitaxel and cisplatin with concurrent radiotherapy for stage III NSCLC. MATERIALS AND METHODS: Between April 2000 and July 2002, twenty-four previously untreated patients with unresectable stage III NSCLC received paclitaxel (60 mg/m2) and cisplatin (20 mg/m2) with concurrent radiotherapy. Chemotherapy was given on the first day of each week during radiotherapy. Concurrent radiotherapy was performed in 1.8 Gy daily fractions to a total dose of 54~59.4 Gy in 6~7 weeks (median: 59.4 Gy). RESULTS: Among 24 evaluable patients, the overall response was 83.3%, with four complete responses and 16 partial responses. Median survival was 16 months, with survival rates of 62.5% at 1 year and 28.7% at 2 years. Serious side effect was generally limited to grade 3 pulmonary toxicity in 37.5% of patients. CONCLUSION: Paclitaxel and cisplatin with concurrent radiotherapy has acceptable response with manageable toxicity in patients with stage III NSCLC. More randomized studies with a larger group of patients are required to improve the true efficacy

A Phase II Study of Genexol(R) (paclitaxel) in Metastatic Breast Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Paclitaxel is a very effective agent in the treatment of breast cancer. Samyang Corporation has developed its own process to produce paclitaxel in a large volume using plant cell culture technology. To evaluate the efficacy and safety of Genexol(R) in patients with metastatic breast cancer who have failed to respond to standard therapy, we performed a prospective, multi- center phase II clinical trial. MATERIALS AND METHODS: Patients with metastatic breast cancer were included in this study. Enrollees were required to have histologically confirmed breast cancer with bidimensionally measurable metastatic disease. Genexol(R) was administered at 175 mg/m2 as a 3-hour intravenous infusion every 3 weeks. All patients were premedicated with hydrocortisone, pheniramine maleate, and H2 blocker 30 minutes prior to paclitaxel. We planned to administer at least 4 courses of paclitaxel unless there was disease progression or unacceptable toxicity and to continue treatment up to a total of 6 courses in cases of objective response following 4 courses. RESULTS: The median duration of follow-up was 8.9 (2.07~13.7) months. Forty-five patients were registered and 43 were eligible. The performance status of patients was ECOG 0~1 in 39 patients (90.7%) and 2 in 4 (9.3%). The location of metastases at the start of the study were the lung (15 patients), liver (8 patients), lymph nodes (22 patients), and other (7 patients). Among the 40 evaluable patients, 15 patients obtained partial responses (PRs) (37.5%, 95% CI: 22.5~52.5%). The median duration of response was 11.67 (4.1~11.7) months and the median time to progression was 7.73 (2.8~11.7) months. The median survival time was not reached at 13.7 months, and the overall survival rate at 13.7 months was 70.1%. The hematologic toxicity was primarily neutropenia with grade 3 or 4 in 10 patients (23.3%). The grade 3 or 4 non-hematologic toxicities included alopecia (17, 39.5%), myalgia (2, 4.7%), neuropathy (2, 4.7%), and pruritus (1, 2.3%). Mild hypersensitivity reaction was observed in 2 patients, although it did not cause withdrawal of the test drug. CONCLUSION: The results suggest that the Genexol injection is an effective anticancer formulation for the treatment of metastatic breast cancer and toxicity is acceptable.