RESUMO
Synchronous tumors of the pancreas and gallbladder are rare and often attributed to an abnormal pancreato-biliary junction, which results in a persistent reflux of pancreatic secretions leading to chronic biliary inflammation. We present the case of a 73-year-old woman with synchronous lesions of the pancreas and gallbladder initially considered as two primary localized cancers and treated with curative intent. At relapse, targeted next generation sequencing (NGS), performed in search of potential therapeutic targets, uncovered the fact that the two lesions appeared to be clonally related. This case illustrates the problem of synchronous lesions of the pancreas and gallbladder. New pathologic assessments with comparative molecular analysis of mutational profiles may be helpful in this context.
RESUMO
Immunotherapy, especially checkpoint inhibitors such as anti-PD1 and anti-PDL1 antibodies, has changed the standard of care and the prognosis of melanoma, but also more recently of lung cancer, renal cancer and Hodgkin lymphoma. Results of preliminary studies in head and neck squamous cell carcinoma (HNSCC) as well as in less frequent tumors of the region, such as nasopharyngeal carcinoma and high grade salivary gland carcinoma, are also promising. Indeed, in a recent phase 3 study, the PD1 inhibitor nivolumab has recently demonstrated a significant improvement in overall survival for platin-resistant recurrent and/or metastatic HNSCC.
L'immunothérapie, en particulier les inhibiteurs de points de contrôles immunitaires (checkpoints) tels que les anticorps anti-PD1 et anti-PDL1, a déjà modifié la prise en charge standard et le pronostic du mélanome, mais également du cancer pulmonaire, rénal et du lymphome de Hodgkin. Les résultats des études préliminaires sont aussi prometteurs dans le traitement des carcinomes épidermoïdes ORL, ainsi que pour des cancers plus rares de la sphère tête et cou, comme les carcinomes nasopharyngés et les carcinomes de haut grade des glandes salivaires. Le traitement anti-PD1 par nivolumab a récemment démontré un bénéfice de survie globale chez les patients présentant un carcinome épidermoïde ORL récidivant et/ou métastatique résistant aux platines dans une étude de phase 3.
