Category: Other - Endocrinology-Oncology

Monitor: 12

12 - Oddities of Endocrinology and Synergistic Immunotherapy

Friday, Apr 26
12:30 PM – 1:00 PM

Objective :

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.


Results :

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. 



In the second case, a 42 year old caucasian male was diagnosed in 2013 with right adrenal cortical carcinoma with metastases to the right liver lobe. He initially received sorafenib before presenting to MD Anderson, where he was then switched to mitotane with etoposide, doxorubicin, and cisplatin therapy.  He underwent surgical resection of 3 hepatic lesions and right adrenelectomy. One month later, he resumed mitotane therapy, but progressed in the lung. He then received multiple lines of chemotherapy with subsequent progression after each line, including anti-PD1 with local radiation, Wee-1 inhibitor therapy, cabozantinib, anti-PD1 with a LAG-3 inhibitor, and gemcitabine with capecitabine.  Patient was switched to lenvatinib.  Interval imaging 4 weeks later showed a partial response.


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.

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Muhammad OMAR. Salim

Fellow
University of Texas
Webster, Texas

Fellow in Endocrinology

Nabiha Aziz

Fellow
University of Texas

Fellow in Oncology

Mouhammad Habra