Real-world analysis of teclistamab in 123 RRMM patients from Germany.

Teclistamab, a B-cell maturation antigen (BCMA) × CD3 directed bispecific antibody, has shown high response rates and durable remissions in the MAJESTEC-1 trial in patients with relapsed and refractory multiple myeloma (RRMM). We retrospectively assessed efficacy and tolerability in 123 patients treated at 18 different German centers to determine whether outcome is comparable in the real-world setting. Most patients had triple-class (93%) or penta-drug (60%) refractory disease, 37% of patients had received BCMA-directed pretreatment including idecabtagene vicleucel (ide-cel) CAR-T cell therapy (21/123, 17.1%). With a follow-up of 5.5 months, we observed an overall response rate (ORR) of 59.3% and a median progression-free survival (PFS) of 8.7 months. In subgroup analyses, we found significantly lower ORR and median PFS in patients with extramedullary disease (37%/2.1 months), and/or an ISS of 3 (37%/1.3 months), and ide-cel pretreated patients (33%/1.8 months). Nonetheless, the duration of response in ide-cel pretreated patients was comparable to that of anti-BCMA naive patients. Infections and grade ≥3 cytopenias were the most frequent adverse events. In summary, we found that teclistamab exhibited a comparable efficacy and safety profile in the real-world setting as in the pivotal trial.

[Endocrine abnormalities in a young patient with metastatic cancer - case 3/2013]. / Endokrine Veränderungen bei einem jungen Patienten mit metastasiertem Tumorleiden - Fall 3/2013.

HISTORY AND ADMISSION FINDINGS: We report on a 24-year-old male patient who presented with worsening of the general condition and abdominal pain. INVESTIGATIONS: On physical examination, gynecomastia was noted. Laboratory tests showed manifest hyperthyroidism. The beta-hCG levels were markedly increased. By ultrasound, the thyroid gland was hyperperfused without thyroid nodules. Several large echo mixed lesions were found in the liver. The testes appeared normal. DIAGNOSIS: In light of the typical laboratory findings, a non-seminomatous extragonadal germ cell tumor was diagnosed. Hyperthyroidism was most probably HCG induced. TREATMENT AND COURSE: Initially the patient was treated with thyreostatic drugs. After initiation of chemotherapy and a marked decrease in beta-hCG, thyreostatic therapy could be terminated. CONCLUSIONS: Germ cell tumors may cause an increase in beta-hCG concentration. By cross-reacting with the TSH-receptor this could induce hyperthyroidism. Germ cell tumors are therefore a rare differential diagnosis of hyperthyreoidism.

Insulinoma in pregnancy.

Insulinomas are rare, mostly benign neuroendocrine tumours with an incidence of approximately four cases per million person per year. Only isolated case reports of insulinomas occurring in pregnancy have been documented. Clinical signs and symptoms of insulinoma appear to be attenuated and, in some cases, even masked by pregnancy. Therefore, in the present overview of insulinomas occurring during pregnancy, special attention is paid to potential factors contributing to the altered insulin response during pregnancy.

[31-year-old male patient with testicular mass and hyperthyroidism]. / 31-jähriger Patient mit Hodentumor und Hyperthyreose.

An excess of human chorionic gonadotropin (hCG) is a rare differential diagnosis of hyperthyroidism, due to the TSH-like effect of hCG. hCG levels physiologically increase during pregnancy. In patients with germ cell tumors of the testicles and the ovary, a pathological increase of hCG serum concentrations may also be found, depending on the histological subtype. We report on a 31-year-old male patient with overt clinical hyperthyroidism resulting of a hCG-producing metastasized germ cell tumor of the right testicle. After initiation of chemotherapy, thyroid function normalized in parallel to the tumor's remission with marked decrease of hCG levels.