Impressive clinical response following combined BRAF and MEK inhibition in a low-grade serous ovarian carcinoma patient with a BRAF V600E mutation

Introduction: Low-grade serous ovarian cancer (LGSOC) accounting for less than 10% of all serous ovary cancers. The chemoresistance inherent to this type of ovarian cancer narrows the therapeutic options, especially in the recurrent setting. It is thought that the mitogen-activated protein kinase (MAPK) pathway plays a significant role in the pathogenesis of these tumours, and about 2 to 20% of LGSOC harbour a BRAF mutation.  Case report: We present a case report of a 58-year-old woman with LGSOC FIGO stage IIIC who presented recurrence of the tumor process after total abdominal hysterectomy and systemic treatment. Thereafter, she underwent molecular profiling, which revealed a BRAF V600E mutation; accordingly, the patient was administered dabrafenib and trametinib combination therapy. The patient noted significant clinical improvement with normalization of CA 125 and radiological partial response. To date, the patient still maintains partial response, with good treatment tolerance and performance status ECOG 0/1 and good quality of life.  Conclusions:  LGSOC represents the challenge that is managing a rare cancer with scarce therapeutic options. Given the prevalence of BRAF mutations in this type of tumour, it might be relevant to consider genetic testing. It may provide new treatment opportunities for patients with a known chemoresistant tumour, by identifying potential actionable targets and avoid potential toxicities associated with chemotherapy. Here we demonstrate that impressive clinical responses can be achieved in BRAF mutated LGSOC treated with combined BRAF and MEK inhibitor treatment.&nbsp

Impact of COVID-19 pandemic on therapy in cancer patients

Introduction and purpose: The Covid-19 pandemic has spread rapidly across the globe, resulting in more than 6 million deaths worldwide. Oncological patients are considered to be at increased risk of SARS-CoV-2 coronavirus infection and the severe course of the disease. The current understanding of the correlation between COVID-19 and cancer is limited. In this study, we attempted to analyze the course of SARS-CoV-2 infection in cancer patients who were treated at the Department of Clinical Oncology and Chemotherapy SPSK4 in Lublin in the period from November 2020 to March 2022.  Material and methods: This retrospective study included patients in the age rage from 36–79 years old. All necessary information were obtained from electronic medical records. Subsequently collected data were submitted to statistical calculations.  Results: A varied course of COVID-19 infection in oncology patients has been observed. Preliminary observations showed that, in many cases COVID-19 infection caused a delay in the administration of the next dose of a therapeutic agent during the course of systemic anticancer treatment, but this delay was not observed to have a significant impact on reducing the effectiveness of oncology treatment  Conclusions:  In the light of our own presented observations, global statistics and reports of other authors, the role of certain individual characteristics of patients is visible, which increase the risk of more severe course of SARS-CoV-2 infection and / or increased mortality . It is necessary to continue the search for an optimal diagnostic regimen that would identify cancer patients with a particular risk of the most severe complications of SARS-CoV-2 infection.&nbsp

Squamous cell carcinoma as a primary pleural tumor – case report

The differential diagnosis of primary pleural tumors is a very difficult challenge. The clinical symptoms are insufficient to make a clear and definitive diagnosis. This report presents the case of a 63-year-old male patient who was admitted to Department of Pulmonology due to evidence of increasing respiratory failure due to COVID-19 infection. The X-ray showed massive infiltrate on the left pleural cavity. A bronchofiberoscopy was performed with material removal for histopathological examination. No tumor cells were found in the first pathomorphology report. A videothoracoscopy was performed, in which excerpts from the wall and pleura of the lungs were taken. Pathomorphologic findings excluded mesotheliomas and adenocarcinomas, and after additional reactions a low-differentiated squamous cell carcinoma with adenomatoid differentiation features. The final diagnosis was squamous cell carcinoma. This case highlights that the diagnosis of tumors of the pleura requires cooperation between pathomorphologists and clinicians. Further studies are needed to associate COVID-19 infection with the occurrence of rare pleural tumours

Chemoembolization as a minimally invasive treatment of primary malignant liver cancer

Background: Hepatocellular carcinoma (HCC) is the most common type of liver cancer and one of the most malignant neoplasms with high incidence and mortality in humans worldwide. The complex nature of the disease and its high resistance to systemic therapies result in poor prognosis for patients with advanced HCC.  Case Report: In March 2017, the patient was admitted to the Department of Oncological Surgery, where a non-anatomical tumor resection was performed. Three years later, the patient developed a single change in segment 8 of the liver that was a relapse of the neoplastic process. Based on the Bracelon Criteria, the patient was qualified for the 1st stage of chemoembolization using the Seldinger method. In the presented patient as a result of the applied treatment, the neoplastic process was stabilized.  Conclusion: The chemoembolization treatment that was applied to the presented patient turned out to be the correct treatment option. After only the first stage of chemoembolization, the patient regressed the neoplastic lesion.

Impressive clinical response following combined BRAF and MEK inhibition in a low-grade serous ovarian carcinoma patient with a BRAF V600E mutation

Introduction: Low-grade serous ovarian cancer (LGSOC) accounting for less than 10% of all serous ovary cancers. The chemoresistance inherent to this type of ovarian cancer narrows the therapeutic options, especially in the recurrent setting. It is thought that the mitogen-activated protein kinase (MAPK) pathway plays a significant role in the pathogenesis of these tumours, and about 2 to 20% of LGSOC harbour a BRAF mutation.  Case report: We present a case report of a 58-year-old woman with LGSOC FIGO stage IIIC who presented recurrence of the tumor process after total abdominal hysterectomy and systemic treatment. Thereafter, she underwent molecular profiling, which revealed a BRAF V600E mutation; accordingly, the patient was administered dabrafenib and trametinib combination therapy. The patient noted significant clinical improvement with normalization of CA 125 and radiological partial response. To date, the patient still maintains partial response, with good treatment tolerance and performance status ECOG 0/1 and good quality of life.  Conclusions:  LGSOC represents the challenge that is managing a rare cancer with scarce therapeutic options. Given the prevalence of BRAF mutations in this type of tumour, it might be relevant to consider genetic testing. It may provide new treatment opportunities for patients with a known chemoresistant tumour, by identifying potential actionable targets and avoid potential toxicities associated with chemotherapy. Here we demonstrate that impressive clinical responses can be achieved in BRAF mutated LGSOC treated with combined BRAF and MEK inhibitor treatment.

Unexpectedly long progression-free time in a patient with squamous cell carcinoma of the lung treated with Nivolumab – a case study

Background: In the reported case, our patient with lung cancer diagnosed as squamous cell carcinoma (SqCC) achieved eight times longer progression-free time (PFT; 25.3 months) than that obtained in the median of randomized clinical trials (3.5 months). Case Report: A 61-year-old man presented for treatment due to a long-lasting cough and a type of pain in the chest, in good general condition. The patient had a smoking history when he was young. Computed tomography  (CT) showed a lesion larger than 70 x 60 mm. The diagnosis was made on the basis of the bronchoscopic material. The prognosis was unfavorable and the tumor was inoperable. In the first line of treatment, chemotherapy with cisplatin was started. Due to the progression, second-line immunotherapy with Nivolumab was administered, and was continued for a longer period of time. Treatment was well tolerated and there were no side effects reported. Therapy was however interrupted due to the patient's deteriorating condition and progression in the follow up CT examination. Finally the patient was qualified for palliative treatment with chemotherapy and zoledronic acid. Opioid medications were used to treat pain. Conclusion: The patient lived for over 4 years, including over 2 years without progression. It therefore seems that there is a group of patients who respond exceptionally well to immunotherapy, but the identification of predictors requires further research

Atypical age of onset of the small bowel adenocarcinoma – case report

Background: Small bowel adenocarcinoma is a rare malignant tumor, with the typical age of diagnosis being 60 years old. In the field of risk factors, we can distinguish, between genetic disorders, inflammatory bowel diseases, smoking, and alcohol abuse. Guidelines for the screening methods are very wide, hence it may be difficult to make the right diagnosis at the early stages of cancer. Additional difficulties can be caused by similarities to inflammatory processes in the gastrointestinal tract. Case report: We present a case of a 22-year-old male patient, with the symptoms of weight loss, stool retention, abdominal pain, and vomiting. The patient was initially misdiagnosed with inflammatory bowel disease and received the first dose of anti-inflammatory treatment. At that point, the diagnostic process and the workflow of medical care were delayed due to the COVID-19 pandemic. After receiving the x-ray and computed tomography, the obstruction of the ileum was found, and an urgent operation was performed. Tissue samples obtained during surgery revealed the proper diagnosis, a low-differentiated adenocarcinoma (G3) of the small intestine, stage T4Nx. Conclusion: Taking into consideration the patient’s condition, age, and symptoms, we should always think about the probable malignant process. Inflammatory diseases are known for increasing cancer risk and should always be the indication of this disease. The age of onset of the disease is very unusual, however, we must be aware of such cases in our clinical practice

Ibrutinib in the Treatment of Solid Tumors: Current State of Knowledge and Future Directions

Bruton’s Tyrosine Kinase (BTK) is considered crucial in the activation and survival of both physiological and malignant B-cells. In recent years, ibrutinib, an oral BTK inhibitor, became a breakthrough therapy for hematological malignancies, such as chronic lymphocytic. However, ibrutinib’s feasibility might not end there. Several other kinases with established involvement with solid malignancies (i.e., EGFR, HER2) have been found to be inhibited by this agent. Recent discoveries indicate that BTK is a potential anti-solid tumor therapy target. Consequently, ibrutinib, a BTK-inhibitor, has been studied as a therapeutic option in solid malignancies. While most preclinical studies indicate ibrutinib to be an effective therapeutic option in some specific indications, such as NSCLC and breast cancer, clinical trials contradict these observations. Nevertheless, while ibrutinib failed as a monotherapy, it might become an interesting part of a multidrug regime: not only has a synergism between ibrutinib and other compounds, such as trametinib or dactolisib, been observed in vitro, but this BTK inhibitor has also been established as a radio- and chemosensitizer. This review aims to describe the milestones in translating BTK inhibitors to solid tumors in order to understand the future potential of this agent better