Case Report: Re-Treatment With Lu-DOTATATE in Neuroendocrine Tumors.

Peptide receptor radionuclide therapy (PRRT) is an established treatment in advanced neuroendocrine tumors (NETs), which overexpressed somatostatin receptors. However, after progression there are a limited number of available treatments. We want to share a case report about a patient with a NET re-treated with 177Lu-DOTATATE and a literature review about salvage treatment with PRRT. We present a 26-year-old man who started with pelvic pain and after a biopsy of a retro-rectal mass observed in a magnetic resonance was diagnosed with an advanced neuroendocrine tumour. After progression to lanreotide, everolimus and sunitinib, treatment with 177Lu-DOTATATE was initiated, achieving an excellent response with a progression free survival (PFS) of 38 months. At the time of progression, re-treatment with 177Lu-DOTATATE was decided, showing a new partial response, which is currently stable after 15 months. The patient had not presented significant treatment-related toxicity. Although there are no randomized phase III trials or a consensus about the number or dose of cycles, there is evidence about the efficacy and low toxicity of salvage treatment with 177Lu-DOTATATE in NETs. Median progression-free survival ranges from 6 to 22 months. Toxicity is mostly hematologic (anemia and neutropenia), 4-7% grade 3/4.

Spanish Society of Medical Oncology consensus on the use of erythropoietic stimulating agents in anaemic cancer patients.

Treatment of anaemia is a very important aspect in the management of cancer patients. In order to carry out a consensus process about the use of erythropoietic stimulating agents (ESAs) in cancer patients, the Spanish Society of Medical Oncology (SEOM) elaborated a working group which coordinated a panel of medical oncology specialists. This working group has reviewed the main issues about the use of ESAs. In addition a consensus meeting was held in Madrid on 25 April 2007. The following conclusions were made: Since ESA treatment increases the haemoglobin (Hb) level and decreases the red blood cell (RBC) transfusion requirements, ESAs should be used within the approved indications in patients undergoing chemotherapy treatment, beginning at a Hb level below 11 g/dl and maintaining it around 12 g/dl, with iron supplements if necessary. Neither increasing the ESA dose in nonresponders nor the use of ESAs in the treatment of chronic cancer-related anaemia is recommended.

Malignant uveitis masking a lymphocytic lymphoma.

A multitude of diseases can present as posterior bilateral uveitis. In most cases, the cause of pericardial effusion can be determined, but in some instances, the cause is not apparent even after making a systematic and complete diagnostic evaluation. We report here an unusual case of a patient who had a B-cell lymphochytic lymphoma, which presented as bilateral posterior uveitis. The diagnosis by biopsy is described, as is the role of multiple test in the diagnosis of bilateral uveitis.

A patient with breast cancer with hepatic metastases and a complete response to herceptin as monotherapy.

The majority of deaths due to breast cancer occur in the context of complications secondary to metastatic disease. Trastuzumab, as a second line treatment, has shown a 15% objective response rate in patients with metastatic breast cancer. We present the case of a patient with two breast tumours, the second of more aggressive characteristics, with negative hormone receptors and c-erb-B2 +++, and with few therapeutic options due to her hepatic insufficiency secondary to metastatic disease; she was administered herceptin as monotherapy, and she had a complete clinical response. Trastuzumab has revolutionised the management of patients with metastatic breast cancer and Her-2- neu overexpression. Its combination with chemotherapy agents achieves a synergic activity.

Recurrent pericardial effusion as initial manifestation of primary diffuse pericardial malignant mesothelioma.

The case of a 61-year-old woman who presented a recurrent symptomatic pericardial effusion and a malignant cardiac tamponade six months prior to the detection of a mediastinal anterior mass is described. Diffuse malignant pericardial mesothelioma was diagnosed after mediastinal mass biopsy. The patient underwent further oncological evaluation followed by chemotherapy.

Skin metastases as first manifestation of lung cancer.

Skin metastases as manifestation of internal neoplasias constitute a 0.8% of their initial presentation and generally imply an advanced stage of the disease and a short survival. The lung cancer metastasises to the skin in 2.8-24% of the cases, generally in advanced stages of the disease, although in 7-19%, skin metastases appear as first manifestation thereof. Sometimes, the study of the extent in the patients reveals that there are no metastases at other levels. We hereby present the case of a male diagnosed with a lung cancer whose first manifestation was the appearance of skin metastases.

Cushing's paraneoplastic syndrome as first manifestation of an adenocarcinoma of unknown origin.

Small cell lung cancer is the most common cause of paraneoplastic Cushing's syndrome. The definitive treatment consists in surgical removal of the tumour, which is not possible in most of these cases (they are often diagnosed at advanced stages), and therefore it is frequently necessary adding the drug ketoconazol. We hereby present the case of a patient diagnosed with a metastatic carcinoma of unknown origin associated with two paraneoplastic syndromes: a Cushing's syndrome and a sensitive-motor axonal neuropathy, a very uncommon association.

Skin metastases as first manifestation of lung cancer

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Skin metastases as manifestation of internal neoplasiasconstitute a 0.8% of their initial presentation1and generally imply an advanced stage of thedisease and a short survival2.The lung cancer metastasises to the skin in 2.8-24%of the cases, generally in advanced stages of the disease,although in 7-19%, skin metastases appear asfirst manifestation thereof1,3. Sometimes, the studyof the extent in the patients reveals that there areno metastases at other levels. We hereby present thecase of a male diagnosed with a lung cancer whosefirst manifestation was the appearance of skin metastases

Cushing’s paraneoplastic syndrome as first manifestation of an adenocarcinoma of unknown origin

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Small cell lung cancer is the most common cause ofparaneoplastic Cushing’s syndrome. The definitivetreatment consists in surgical removal of the tumour,which is not possible in most of these cases(they are often diagnosed at advanced stages), andtherefore it is frequently necessary adding the drugketoconazol.We hereby present the case of a patient diagnosedwith a metastatic carcinoma of unknown origin associatedwith two paraneoplastic syndromes: aCushing’s syndrome and a sensitive-motor axonalneuropathy, a very uncommon association

Dysphagia and dysphonia in a woman with a previous breast cancer

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Metastasis to the thyroid occur infrequently. Theoverall incidence in autopsy series vary from 0-5%in unselected cases to 24% in patients with a knownmalignancy. They usually occur when there are anothermetastases, sometimes many years after diagnosisof the original primary tumour. We presentthe case of a woman with dysphagia and dysphoniadue to a thyroid mass as first manifestation of ametastatic breast cancer

Paciente con reactivación de hepatitis B tras quimioterapia. Papel del tratamiento con lamivudina / Patient with reactivation of hepatitis B after chemotherapy. Role of lamivudine therapy

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Paciente con reactivación de hepatitis B tras quimioterapia. Papel del tratamiento con lamivudina / Patient with reactivation of hepatitis B after chemotherapy. Role of lamivudine therapy

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Cutaneous metastases of lung cancer

It is uncommon for a cancer to be diagnosed becauseof skin metastases. Cutaneous metastases as initialmanifestation of internal neoplasias, represent only0.8% of total cases and implies, in general, a very advancedgrade of the disease and short survival.When skin metastases of an unknown primary siteappear, lung cancer is the first option to be discardedin case of men, and breast cancer in case of women.Lung cancer spreads to the skin in 2.8-8.7% of thecases, in advanced phases of the disease, althoughjust in 7-23.8% of the cases, cutaneous metastasesappear as first manifestation of the primary tumor.Sometimes, a complete examination to discover thetumor reveals no metastases elsewhere

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A phase II trial of gemcitabine and weekly high-dose 5-fluorouracil in a 48-hour continuous-infusion schedule in patients with advanced pancreatic carcinoma. A study of the Spanish Cooperative Group for Gastrointestinal Tumour Therapy (TTD)

Aim. A multi-centred, open-labelled, phase II study containing 46 patients was conducted to evaluate the clinical benefit of gemcitabine (1,400 mg/m2) combined with 5-FU (3 g/m2) in a 48h continuous infusion (CI). Methods. Both drugs were administered on days 1, 8 and 15 of every 4 week cycle in chemotherapy-naïve patients with locally advanced un-resectable metastatic pancreatic carcinoma. The minimum follow-up was 6 months. Results. Clinical benefit response was the primary endpoint and this was achieved by 24.4% of the patients. Quality of life (QoL) improved in 16.6% of patients. Objective response was observed in 7% of the patients. The median progression-free survival (PFS) was 14.4 weeks and the median overall survival (OS) time was 22.7 weeks. One-year survival was 25%. The most frequent grade 3-4 toxicities were neutropenia (45%), mucositis (7.5%) and hyperbilirubinaemia (10.5%). Conclusions. This schedule was not superior in terms of clinical benefit, response rate, PFS and OS than standard gemcitabine treatment

[Ophthalmoplegia in a patient with prostate cancer and bone metastases]. / Oftalmoplejía completa izquierda por metástasis ósea de cáncer de próstata.

Prognosis in prostate cancer is determined, in greater part, by the presence of metastases. Bone metastases can occur in any part of the skeleton even, for example, at the base of the skull. We present a case of a 78 year old male who, in December 2001, presented with paralysis of the third cranial nerve. The NMR and CAT scans were normal and circulating levels of PSA were elevated. He was referred to the Urology Service where the treatment guidelines included complete androgen block. Subsequently, he developed retro-orbital pain, divergent strabismus and palpebral ptosis. CAT and NMR indicated a soft tissue mass at the sphenoid level. Treatment was Gamma Knife Radio-surgery. Since August 2004, in conjunction with the latest rise in PSA, the patients general status deteriorated considerably and he was referred to the Oncology Service. There was an increase in the paralysis of the third, fourth and sixth cranial nerve (complete left ophthalmoplegia) and left-central facial paralysis. Metastases from prostate cancer can be disseminated via the lymphatic or the blood system. Currently, there are more metastases from large-size tumours. Metastases are critical in prostate cancer because of their adverse effect on the patients survival. Measurements of circulating levels of prostate specific antigen and prostate acid phosphatase are very useful in the clinical diagnosis of the primary tumour, or its metastases.

Oftalmoplejía completa izquierda por metástasis ósea de cáncer de próstata / Cranial nerve paralysis in a patient with prostate cancer and bone metastases

El pronóstico del cáncer de próstata viene definido en gran medida por la afectación metastásica . Las metástasis óseas pueden afectar a cualquier parte del esqueleto, como por ejemplo a la base del cráneo. Se trata del caso de un varón de 78 años que en diciembre de 2001 presentó parálisis del III par crane-al, con TAC y RMN normales. Se acompañaba de niveles de PSA sérico elevados. Fue remitido al Servicio de Urología donde se pautó tratamiento con bloqueo androgénico completo. Posteriormente comenzó con dolor retroorbitario, estrabismo divergente y ptosis palpebral. En TAC y RM se objetivó una masa de partes blandas a nivel del esfenoides. Recibió tratamiento con radiocirugía mediante Gamma Knife. Desde agosto de 2004, coincidiendo con la última elevación del PSA, el paciente presenta importante deterioro de su estado general, por lo que se remite al servicio de Oncología para valoración. Aparece un aumento de la parálisis de los pares craneales III, IV y VI izquierdos (oftalmoplejía completa izquierda) y parálisis central facial izquierda. Las metástasis del cáncer de próstata se realizan por vía linfática o hematógena. Pero normalmente existen más metástasis en tumores de mayor tamaño. Las metástasis son de gran importancia en el cáncer de la próstata, ya que, con pocas excepciones, de ellas depende la mortalidad. Las determinaciones serológicas de antígeno prostático y fosfatasa ácida prostática son de gran utilidad para el diagnóstico clínico del tumor primario o de sus metástasis

Prognosis in prostate cancer is determined, in greater part, by the presence of metastases. Bone metastases can occur in any part of the skeleton even, for example, at the base of the skull. We present a case of a 78 year old male who, in December 2001, presented with paralysis of the third cranial nerve. The NMR and CAT scans were normal and circulating levels of PSA were elevated. He was referred to the Urology Service where the treatment guidelines included complete androgen block. Subsequently, he developed retro-orbital pain, divergent strabismus and palpebral ptosis. CAT and NMR indicated a soft tissue mass at the sphenoid level. Treatment was Gamma Knife Radio-surgery. Since August 2004, in conjunction with the latest rise in PSA, the patient’s general status deteriorated considerably and he was referred to the Oncology Service. There was an increase in the paralysis of the third, fourth and sixth cranial nerve (complete left ophthalmoplegia) and left-central facial paralysis. Metastases from prostate cancer can be disseminated via the lymphatic or the blood system. Currently, there are more metastases from large-size tumours. Metastases are critical in prostate cancer because of their adverse effect on the patient’s survival. Measurements of circulating levels of prostate specific antigen and prostate acid phosphatase are very useful in the clinical diagnosis of the primary tumour, or its metastases

Patient with angina secondary to capecitabine

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