Bladder metastasis from epidermal growth factor receptor mutant lung cancer: A case report.

BACKGROUND: Bladder metastasis from lung cancer with epidermal growth factor receptor (EGFR) mutation is extremely rare. Here, we report a case of bladder metastasis from lung adenocarcinoma with EGFR mutation. CASE SUMMARY: A 53-year-old female patient was diagnosed with advanced lung adenocarcinoma with EGFR exon 19 deletion. Multiple nodules on the bladder wall were found by regular examination of the pelvic cavity through computed tomography during targeted therapy. Further cystoscopy and histological examination of bladder biopsy tissues confirmed the bladder metastasis from lung adenocarcinoma. In addition, genetic analysis of the bladder metastasis revealed EGFR T790M mutation. The patient achieved a good response to a third-generation EGFR tyrosine kinase inhibitor. CONCLUSION: During routine follow-up of lung cancer patients, imaging examination of the pelvic cavity should be performed to avoid missing bladder metastasis. The ultimate diagnosis of bladder metastasis sill depends on the pathological result of biopsy tissues.

Immunotherapy-Related Cardiotoxicity Re-Emergence in Non-Small Cell Lung Cancer - A Case Report.

PD-1/PD-L1 inhibitors activate immunological response and have become one of the main modalities of cancer treatment. However, they may result in the immune-related adverse events (irAEs). Immune-related cardiotoxicity is relatively rare but may become fatal. We will present a case of a male patient who experienced immunotherapy-related cardiotoxicity one year after received pembrolizumab treatment. The patient had atypical symptom presentation initially, but his condition deteriorated worsened rapidly and he developed severe cardiac disease. The patient experienced significant relief after corticosteroid treatment. Unfortunately, he experienced a reoccurence of the severe adverse event when discontinuing the use of corticosteroids. Ultimately, larger doses and longer courses of corticosteroid treatment cured the heart damage. Fortunately, we observed that lesions were stable and maintained for a long time after cessation of using pembrolizumab for eight months.

Histological transformation of non-small cell lung cancer: Clinical analysis of nine cases.

BACKGROUND: Histological transformation is one of the numerous mechanisms of acquired resistance to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). Given its rarity, the underlying transformational mechanisms, clinical features, and therapeutic prognoses are only studied through limited case reports. AIM: To analyze the clinical characteristics and underlying mechanisms in non-small cell lung cancer (SCLC) patients with histological transformation after treatment with EGFR-TKIs. METHODS: We retrospectively investigated nine patients diagnosed with non-SCLC transforming to SCLC, large-cell neuroendocrine carcinoma (LCNEC), or squamous cell carcinoma on re-biopsy after first- or third-generation EGFR-TKIs. RESULTS: The median age of nine patients was 60 years. Among them, six patients had the EGFR 19del mutation, one had the L858R mutation, and one had wild-type EGFR. The level of plasma NSE was measured in six patients with SCLC or LCNEC transformation when transformation occurred, and five patients had elevated plasma NSE levels. All patients received standard chemotherapy after transformation with the exception of one patient who received chemotherapy and anlotinib. CONCLUSION: Tumor re-biopsy should be performed routinely when EGFR-TKI therapy fails in lung cancer patients to avoid ignoring histological transformation and to select a subsequent therapeutic strategy. The transformed tumor retained the original EGFR mutation, indicating that histological transformation represents an evolution from the initial tumor.

A Case of Delayed Diagnostic Pulmonary Tuberculosis during Targeted Therapy in an EGFR Mutant Non-Small Cell Lung Cancer Patient.

The coexistence of lung cancer and pulmonary tuberculosis (TB) is rare, and the clinical and radiological features are always similar between lung cancer and pulmonary TB. In the present case, a non-small cell lung cancer patient with an epidermal growth factor receptor (EGFR)-sensitive mutation was diagnosed with pulmonary TB during the treatment of tyrosine kinase inhibitor (TKI) because of the discrepant and confusing responses among different lesions. Therefore, we should combine clinical and radiological characteristics with pathological and microbiological tests to confirm the diagnosis of TB or lung cancer. It is a safe and selectable therapeutic strategy to treat EGFR mutant lung cancer patients with active TB using anti-TB medications and TKIs simultaneously.

Effect of cetuximab combined with chemotherapy in treating metastatic colorectal cancer and its prognostic analysis.

PURPOSE: To explore the efficacy and safety of cetuximab plus chemotherapy in the treatment of metastatic colorectal cancer (mCRC), and to analyze the possible factors affecting the prognosis. METHODS: Clinical data were collected from 136 patients who were definitely diagnosed with mCRC in our hospital from January 2015 to December 2016, and whose genetic test showed wild-type (WT) Kirsten Ras (KRAS), and they were randomly divided into two groups and underwent cetuximab plus chemotherapy (n=68, Cetuximab group) or only chemotherapy (n=68, Chemotherapy group). The clinical short-term efficacy, incidence of adverse reactions and quality-of-life score of patients were compared between the two groups, and the survival and disease progression were recorded during follow-up. RESULTS: After treatment, there were statistically significant differences between Cetuximab group and Chemotherapy group regarding objective response rate (ORR) and disease control rate (DCR) [69.1% (47/68) vs. 60.3% (41/68), 85.3% (58/68) vs. 79.4% (54/68)] (p=0.282, p=0.368). After treatment, Cetuximab group exhibited notably higher physical and emotional functioning scores on the function subscale [(92.53±12.11) points vs. (88.39±11.78) points, p=0.045, (94.63±12.72) points vs. (89.06±12.40) points, p=0.011] and rash score on the symptom subscale [(39.35±9.73) vs. (35.51±9.09) points, p=0.019)] than Chemotherapy group. According to the follow-up results, the median overall survival (mOS) and median progression-free survival (mPFS) were 25.1 months and 9.5 months, respectively, in Cetuximab group, and 19.8 months and 7.4 months, respectively, in Chemotherapy group. It was found through log-rank test that the OS and PFS in Cetuximab group were dramatically longer than those in Chemotherapy group (p=0.038, p=0.013). Based on the results of multivariate analysis, poor tumor differentiation was an independent risk factor for the mPFS and mOS of patients [hazard ratio (HR) =0.894, 95% confidence interval (CI) (0.581-0.987), p=0.034, HR=0.907, 95%CI (0.603-0.960), p=0.041]. CONCLUSION: Cetuximab plus chemotherapy has exact efficacy in treating mCRC, and it results in a higher long-term survival rate and a lower disease progression rate than chemotherapy alone, improves the quality of life of patients and produces tolerable adverse reactions. Besides, poor tumor differentiation is an independent risk factor for the mPFS and mOS of patients.

Effect of molecular targeted therapy combined with radiotherapy on the expression and prognostic value of COX-2 and VEGF in bone metastasis of lung cancer.

PURPOSE: This study aimed to explore the effect of molecular targeted therapy combined with radiotherapy on the expression and prognostic value of cyclooxygenase-2 (COX-2) and vascular endothelial growth factor (VEGF) in bone metastasis of lung cancer. METHODS: 82 patients with bone metastases of lung cancer who underwent targeted therapy combined with radiotherapy in Hubei Cancer Hospital were regarded as the experimental group, and another 64 patients with bone metastases of lung cancer who underwent conventional radiotherapy were regarded as the control group. Serum VEGF and COX-2 levels were measured by enzyme-linked immunosorbent assay (ELISA) before and after the treatment. The efficacy and adverse reactions of both groups were compared. RESULTS: The levels of COX-2 and VEGF in serum of both groups were significantly lower than those before treatment (p<0.05). The effective rate and local tumor efficiency of the experimental group were significantly higher than those of the control group (p<0.05). The diarrhea and asthenia and vomiting events in the experimental group were significantly lower than those in the control group (p<0.05). No significant differences were found between the two groups in other adverse reactions (p>0.05). A significant positive correlation was found between COX-2 and VEGF in serum in the two groups before and after treatment; the survival rate of COX-2 and VEGF high expression group was significantly lower than in the low expression group (p<0.05); ECOG score, pathological type, COX-2 and VEGF level were independent risk factors of death in the experimental group. CONCLUSION: Targeted therapy combined with radiotherapy has a strong inhibitory effect on the expression of COX-2 and VEGF in bone metastasis of lung cancer. There was a significant positive correlation between the expression of COX-2 and VEGF, and the use of targeted therapy combined with radiotherapy can significantly improve the efficacy and quality of life and to prolong survival.

Dramatic Response of Pulmonary Sarcomatoid Carcinoma to Nivolumab Combined with Anlotinib: A Case Report.

Pulmonary sarcomatoid carcinoma (PSC) is a rare subtype of non-small-cell lung cancer, which is resistant to the conventional chemotherapy and radiotherapy with a poor prognosis. Limited case reports have showed good response to the immunotherapy in PSC patients with high PD-L1 expression generally. Herein, we report a case of rapid recurrence of PSC during postoperative adjuvant chemotherapy in a 62-year-old male ex-smoker. The patient had high PD-L1 expression (tumor proportion score: 90%) and KRAS exon 2 mutation. Nivolumab combined with anlotinib was administered synchronously. Clinical symptoms gradually relieved and response evaluation on imaging revealed a partial response after 8 weeks. This case suggests immunotherapy combined with antiangiogenic agent anlotinib may be a potential promising strategy to treat PSC patients.

Bilateral endobronchial metastases from prostate cancer: A case report with literature review.

Endobronchial metastases from prostate cancers are a rare phenomenon with only limited cases reported to date. Bronchoscopic biopsy and immunohistochemical test are essential for determining the diagnosis. And serum PSA level is a significant biomarker to assist the diagnosis. Our case describes a 68-year-old man presenting with bilateral endobronchial metastases after 5 years disease-free survival of prostate cancer.

LncRNA DLX6-AS1 increases the expression of HIF-1α and promotes the malignant phenotypes of nasopharyngeal carcinoma cells via targeting MiR-199a-5p.

OBJECTIVE: To investigate the expression of long-chain noncoding growth stasis specific protein 6 antisense RNA1 (lncRNA DLX6-AS1) in nasopharyngeal carcinoma (NPC) tissues and cells, and its regulatory effect on malignant phenotypes of NPC cells. METHODS: The expressions of DLX6-AS1, miR-199a-5p, and HIF-1α mRNA in NPC issues and cells were detected by qRT-PCR. The proliferation, metastasis, and invasion of cells were monitored via MTT and transwell assay. The interactions between DLX6-AS1 and miR-199a-5p, miR-199a-5p and HIF-1α were verified by luciferase activity assay. Western blot was performed to determine the regulatory effect of DLX6-AS1 and miR-199a-5p on HIF-1α protein. RESULTS: The expression of lncRNA DLX6-AS1 was up-regulated in NPC tissues and cells. The proliferation, migration, and invasion of NPC were enhanced by overexpressed DLX6-AS1 but inhibited by DLX6-AS1 knockdown. In addition, DLX6-AS1 can be used as a kind of ceRNA to regulate miR-199a-5p and, thereby modulating the expression of HIF-1α. CONCLUSION: We found that DLX6-AS1 was a cancer-promoting lncRNA to facilitate the progression of NPC, and its underlying mechanism was suppressing miR-199a-5p expression. This study can provide novel clues for the treatment of NPC.

Effect of gefitinib on serum EGFR and CYFRA21-1 in patients with advanced non-small cell lung cancer.

Changes of epidermal growth factor receptor (EGFR) and cytokeratin fragment antigen 21-1 (CYFRA21-1) in patients with advanced non-small cell lung cancer (NSCLC) before and after gefitinib treatment were observed to explore the significance of such changes. A total of 175 patients with advanced NSCLC who were admitted to Hubei Cancer Hospital from July 2012 to October 2015 were collected and divided into two groups: the control group (85 patients who received conventional chemotherapy) and the experimental group (90 patients treated with gefitinib combined with chemotherapy). The serum expression levels of EGFR and CYFRA21-1 were detected by enzyme-linked immunosorbent assay (ELISA). The therapeutic efficacy and 3-year survival of the two groups were compared, and the factors affecting the survival of the patients were analyzed. The total effective rate and local effective rate of the experimental group were significantly higher than those of the control group (P<0.05). Before treatment, no significant difference was detected in the levels of EGFR and CYFRA21-1 between the two groups (P>0.05). After treatment, the expression levels of EGFR and CYFRA21-1 in the two groups were significantly lower than those before treatment (P<0.05). According to the 3-year survival rate, the experimental group was divided into the survival group and the non-survival group. Single factor analysis was performed on the general data, showing that the influencing factors of the survival include the KPS score, smoking history, number of lesions, pathological stage, EGFR, and CYFRA21-1. Gefitinib can bring significantly improved therapeutic efficacy, lower expression levels of EGFR and CYFRA21-1, and longer survival time for patients with advanced NSCLC. Indicators including confirmed smoking history, a KPS score less than or equal to 60 points, multiple lesions, pathological stage IV, high expression of EGFR and CYFRA21-1, are important factors affecting the survival of patient with advanced NSCLC.

A clinical observation of Chinese chronic myelogenous leukemia patients after discontinuation of tyrosine kinase inhibitors.

Whether tyrosine kinase inhibitors (TKIs) can be safely discontinued is a key focus of chronic myelogenous leukemia (CML) at present. We report a clinical observation of TKIs cessation in Chinese CML patients and a probable connection between CML leukemia stem cells (LSCs) and relapse. In all, 22 of 1057 patients consented to participate in this observation. The average time of complete molecular response was 12.73 months after TKI withdrawal. LSCs could be flow cytometrically detected in most of the patients. However, the number of LSCs did not differ between the relapsers and non-relapsers. We evaluated the leukemogenetic ability of the LSCs by transplanting bone marrow into irradiated NOD/SCID mice. The results indicated that part of the bone marrow from the relapsers lead to leukemogensis in the mice. Besides, we found that LSCs-derived microvesicles might serve as a novel factor for the stratification of undetectable minimal residual disease and an early warning sign of relapse. In summary, post-TKI cessation relapse seems to show none association with the number of LSCs. A mouse xenograft model would provide a novel and useful method of analyzing LSCs function and predicting relapse. Microvesicles may provide important information about optimal molecular monitoring schedules in TKI discontinuation strategies.