Increasing Jaundice Secondary to an Acute Toxic Hepatitis Induced by Levofloxacin in a 20-year-old Man with a Fibrolamellar Hepatocarcinoma

Introduction: Levofloxacin-induced liver injury is rare and usually mild and transient. Presentations in the form of acute fulminant hepatitis are extremely uncommon.Presentation of the case: We report the case of a 20-year old man with a fibrolamellar hepatocellular carcinoma (fHCC), with affected retroperitoneal lymph nodes but no hepatic disease involvement. After receiving levofloxacin for the treatment of a community-acquired pneumonia, he developed hyperbilirrubinemia and abnormal liver function tests in the context of an acute cholestasic toxic hepatitis. In spite of optimal supportive treatment, that included admission in the Intensive Unit Care and extracorporeal albumin dialysis detoxification, the patient developed a rapidly progressive liver failure and died a month after the beginning of the process. The necropsy findings confirmed extensive drug-induced hepatic necrosis. No liver involvement by the fHCC was found in the autopsy.Conclusion: Rarer intercurrent conditions, such as drug-induced hepatotoxicity, should be taken into account in cancer patients with deranged liver function tests, even in those patients with advanced disease.

Bilateral pulmonary nodules after the successful treatment of a mediastinal seminoma

Germ cell tumors are unusual, but they represent the most common neoplasm in young men. Since the introduction of cisplatin-based chemotherapy, most cases are expected to be cured today. Intensive monitoring of these patients during follow-up is required to rule out relapses or late complications of therapy. We present the case of a 21-year-old male who developed extensive lung dissemination by Langerhans cell histiocytosis eight months after the successful treatment of a bulky mediastinal seminoma.

Heart Failure as First Sign of Development of Cardiac Metastases in a Patient with Diagnosis of Papillary Thyroid Carcinoma on Treatment with Tyrosine-Kinase Inhibitors: Differential Diagnoses and Clinical Management

Background: Cardiac metastases from papillary thyroid carcinoma are very uncommon. Their incidence is rising due to improvements in survival and diagnosis; nevertheless, our patient is the fourth case reported up to date. There are no clinical trials available in this scenario. Therefore, treatment choice is made based on clinical experience and case reports; notably, the largest case report series was prior to the approval for using tyrosine-kinase inhibitors in thyroid cancer. Patient: A 73-year-old lady had dedifferentiated papillary thyroid cancer with ongoing sorafenib. After 9 months on this treatment, she presented with dyspnea and heart failure. Differential diagnosis included infection, progression of disease and cardiotoxicity. After a comprehensive assessment (echocardiography, computed tomography, PET, magnetic resonance), we found progression of lung disease, and the appearance of heart metastases. Results: After recovering from the basal status, she started on second-line treatment with sunitinib, which was well-tolerated. She achieved stable disease with a decrease in tumor marker levels. Conclusions: We should include cardiac metastases in the differential diagnosis of heart failure in cancer patients. Magnetic resonance imaging is the gold standard for assessment. Sorafenib is the mainstay of the first-line therapy in metastatic thyroid cancer, achieving long-term disease control with good tolerance. Sunitinib could be a safe second-line treatment option (not cardiotoxicity related) with promising results. Therefore, our report presents a sequence of treatment with tyrosine-kinase inhibitors in metastatic thyroid carcinoma with an encouraging outcome, which deserves further investigation

Bilateral pulmonary nodules after the successful treatment of a mediastinal seminoma

Germ cell tumors are unusual, but they represent the most common neoplasm in young men. Since the introduction of cisplatin-based chemotherapy, most cases are expected to be cured today. Intensive monitoring of these patients during follow-up is required to rule out relapses or late complications of therapy. We present the case of a 21-year-old male who developed extensive lung dissemination by Langerhans cell histiocytosis eight months after the successful treatment of a bulky mediastinal seminoma.  </p

Pleuropulmonary and Lymph Node Progression after Docetaxel - Benefits from Treatment with Cabazitaxel in Metastatic Prostate Cancer

Introduction: To date, there are no guidelines for a rational and more favourable sequence of treatment after docetaxel. Two drugs (cabazitaxel and abiraterone) have recently been approved as second-line treatment after docetaxel failure in metastatic castration-resistant prostate cancer (mCRPC), but there are no studies comparing abiraterone versus cabazitaxel. The most suitable drug is chosen based on the physician's opinion and the patient's characteristics. In patients with a good performance status who are able to receive either treatment, it would be convenient to begin with cabazitaxel and to reserve abiraterone in case there is a worsening of the general status, in consideration of abiraterone's more favourable toxicity profile. Case Report: We describe the case of a 74-year-old male with mCRPC who presented with an interesting and uncommon tumour dissemination (pleuropulmonary) occurring after the first standard treatment with docetaxel. Intravenous treatment with cabazitaxel 25 mg/m2 and oral prednisone 10 mg continuously was initiated. The patient received a total of 8 cycles of chemotherapy. A reduction of mediastinal adenopathies and infrarenal para-aortic stable bone involvement and an absence of pleural effusion were observed. No relevant toxicity was noted. Since February 2012, a progressive PSA increase without clinical deterioration has been noted. Conclusions: The selection criteria for second- and third-line systemic treatment and the excellent response obtained with cabazitaxel in an unusual disease setting are described. The results confirm the long duration and quality of response of cabazitaxel treatment. Further therapeutic options in this group of patients are suggested

Molecular profiling of advanced solid tumours. The impact of experimental molecular-matched therapies on cancer patient outcomes in early-phase trials: the MAST study

Molecular-matched therapies have revolutionized cancer treatment. We evaluated the improvement in clinical outcomes of applying an in-house customized Next Generation Sequencing panel in a single institution