Category: Other - Endocrinology-Oncology
With immunotherapy as a newer modality for oncological treatment, advances have been made in patients with metastatic cancer. Emerging trials show efficacy of immune-activating and antiangiogenic drugs, especially in renal cell cancer and non-small cell lung cancer. Further research observes synergistic effects with immunotherapy.
Methods : Two case studies were followed at MD Anderson Cancer Center.
In the first case, a 59 year old Bahranian male with excellent performance status was diagnosed with anaplastic thyroid carcinoma after fine needle aspiration, followed by total thyroidectomy in Bahrain on 11/2/15. He received 4 doses of doxorubicin followed by neck radiation of 66 Gy. The disease progressed with left lung metastases. Patient arrived to MD Anderson 4/28/16. Staging showed bilateral pulmonary metastases with left pleural effusion. A biopsy revealed poorly differentiated carcinoma compatible with sarcomatoid variant of anaplastic thyroid carcinoma with TP53 mutation. Patient then received 2 cycles of weekly nab-paclitaxel therapy with disease progression. On 6/24/16, patient was trialed on lenvatinib at 24mg QD. Interval imaging at six weeks displayed disease progression in bilateral pulmonary nodules with no other new metastases. On 8/30/16, patient started pembrolizumab 200mg IV every 3 weeks added to lenvatinib 20mg QD. Interval imaging at 4 months revealed partial response in the lung parenchyma and pleura.
Discussion : (Imaging)
Conclusion : In both cases, individual trials of PD-1 inhibitor or anti-angiogenic therapy displayed progression. However, with combination therapy, there was a significant difference yielding partial remission. With only case studies, it is difficult to assess the nature of the remission, how long partial remission may be sustained, or if complete remission may be possible. Further research is required to explore the nature of synergistic immunotherapy.
University of Texas
Fellow in Endocrinology