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Primary Mediastinal Malignant Mixed (Non-seminomatous) Germ Cell Tumor Presenting as Superior Vena Cava Syndrome
abstracts the median OS between liposarcoma (24.4 months, 95% CI: 6.14-42.59) and leiomyosarcoma (21.90 months, 95% CI: 0.76-43.03) significantly (p ¼ 0.568). Conclusion: Eribulin showed longer prognoses in L-sarcoma, especially in liposarcoma in terms of the PFS.
Isoliquiritigenin induces cell death programs and reduces ECM accumulation in uterine leiomyoma
Shih-Min Hsia1, Po-Han Lin1, Hsiang-Lin Kung1, Hsin-Yuan Chen1, Ko-Chieh Huang1, Tzong-Ming Shieh2 1 School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taiwan, 2Department of Dental Hygiene, College of Health Care, China Medical University Background: Uterine leiomyomas, also known as fibroids, are the comment and high prevalence in women of reproductive age. Isoliquiritigenin (ISL), a licorice flavonoid, exerts variant biological properties. In this study, the effect of ISL on anti-proliferation of uterine leiomyoma was investigated. Methods: Cell viability was determined using the MTT assay. The protein expression was assayed using Western blot analysis. Cell apoptosis was assayed using Annexin VFITC/PI and Hoechst 33342 staining. Results: The results showed that treatment of uterine leiomyoma ELT3 cells and primary uterine smooth muscle UtSMC cells with ISL alone or ISL plus estradiol (E2) reduced cell proliferation. Cotreatment with E2 and ISL inhibit G2/M and S phase arrest in ELT3 and UtSMC cells, respectively. The higher sub-G1 phase arrest and fluorescence intensity of Hoechst 33342 nucleus stain were observed in cotreatmenet of ELT3 cells with E2 and ISL compared with UtSMC cells. Furthermore, cotreated ELT3 cells with E2 and ISL induced apoptosis and autophagy cell death programs. The E2enhanced mice uterine myometrium growth was reduced by ISL presence, resulting in reduced the myometrium layer. Moreover, ISL reduced extracellular matrix proteins and matrix metalloproteinase (MMPs) expression, whereas increased tissue inhibitor of MMPs (TIMPs) expression. Conclusion: Our findings indicated the inhibitory effects of ISL on the animal model and indicated that ISL reduced ECM-related protein expression and cell proliferation in the leiomyoma cell line. Taken together, our results suggested that ISL could be considered as a new option for the treatment of uterine leiomyoma.
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Investigation of Radioactive Iodine-Refractory Differentiated Thyroid Carcinoma at Hochiminh City Oncology Hospital
Nguyen Huynh Khanh An, Vo Thi Phuong Thao, Vo Khac Nam, Dang Huy Quoc Thinh Department Nuclear Medicine, HCM Oncology Hospital, Viet Nam Introduction: Differentiated thyroid carcinoma (DTC) is the most common endocrine malignancy. These areforms of follicular cell-derived tumors, and they have the capacity to catch iodine. The overall survival rates of metastatic or progressive differentiated thyroid carcinomaat 10 and 15years were 56% and 45% in cases of the radioiodine-avid tumor. The rates were only 10% and 6%at 10and 15 years respectively if the tumor becamenon-iodine avid.Identification ofthe iodine-refractorycriteria helps us treat properly. Patients and Methods: a retrospective, cross-sectional descriptive analysis of radioactive iodine-refractory DTC conducted from January 2017 to December 2017. Data Processing and Analysis with SPSS 22.0 Results: Forty-three in 1428 patients enrolled in the study from January 2017 to December 2017. About 50% of patients were T3-and T4 tumor,48.8% got N1b lymph nodes metastasis. Distal accounted for 50%, in which pulmonary, bone metastasis, and both were 66.7%, 23.8%, and 9.5%, respectively. The refractory rate was 3.0%, in which most of them belonged to group III (44.2%). Treatment followed by operation (11.6%), external radiotherapy ( 20.9%) and the others were followed up actively or treated Levothyroxinsuppression therapy and further radioactive iodine, aiming to palliative care and reduction of tumor burden.No patient administrated TKIstherapy. Conclusions: The most of the refractory patients were elder and under the high-risk group of recurrence, in which mainly T4 tumor or locoregional invasion or distant metastasis. Identification of radioactive iodine-refractory criteria helps us treat properly. TKIs therapy in case of progression administrated recently.
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Scheduled cessation in treatment using lenvatinib for differentiated thyroid carcinoma
Yasuhiro Ito1,2, Toshihiko Kasahara3, Akihiro Miya1, Naomi Kiyota4,5, Hiroo Masuoka1, Tomohiko Nakamura3, Waka Yoshioka3, Ito Mitsuru3, Akira Miyauchi1 1 Department of Surgery, Kuma Hospital, 2Department of Clinical Trial, Kuma Hospital, 3 Department of Internal Medicine, Kuma Hospital, 4Kobe University Hospital, Cancer Center, 5Kobe University Hospital, Department of Medical Oncology and Hematology Backgrounds: Recently, multi-targeted tyrosine kinase inhibitors(m-TKIs) have become a treatment strategy for radioactive iodine-refractory differentiated thyroid
vi124 | Poster Session
carcinoma (RR-DTC).m-TKIs often require dose reduction or cessation due to various adverse events (AEs). Moreover, these AEs often lose the motivation of patients for the continuation of treatment. We therefore tried scheduled cessation of lenvatinib (LEN) to avoid or reduce AEs during the course of long-term administration. Methods: We tried scheduled cessation for five of 20 DTC patients who started LEN administration between Jul. 2015 and Oct. 2017. These five patients experienced intolerable toxicities resulting in frequent interruptions and dose reductions of LEN before introduction of scheduled cessation. Results: All were females and aged 66-83 years. Two patients underwent LEN administration of 8 mg/day for two weeks and cessation for one week. Others underwent LEN administration of 10 mg/day for three weeks and cessation for one week, of 10-14 mg/ day for two weeks and cessation for one week, and of 10 mg/day for two weeks and cessation for one week. Direct reasons for introduction of scheduled cessation were fatigue and anorexia for three patients, hand-foot-syndrome for one patient, and proteinuria for one patient, respectively. With a median follow-up period of 26.7 months, no patients showed further deterioration of AEs, enabling all patients to continue LEN in these schedules. One patient showed progression of metastatic lesions, but the remaining four patients achieved stable disease during these periods. Conclusions: Scheduled cessation can relieve AEs of patients, and may be considered as an effective strategy to continue treatment of LEN with maintaining the motivation of patients.
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Primary Mediastinal Malignant Mixed (Non-seminomatous) Germ Cell Tumor Presenting as Superior Vena Cava Syndrome
Emilio JoseS. Gravador1,2, Mayen T. Grageda1,4, Marie BelleD. Francia1,2,3 St. Luke’s Medical Center - Global City, Philippines, 2Department of Medicine, 3Cancer Institute, 4Institute of Pathology
1
Introduction: Mediastinal germ cell tumors are commonly seen in children and young adults with male preponderance. They are clinically classified as teratomas, seminomas and nonseminomatous germ cell tumors. Primary mediastinal mixed germ cell tumor falls under the nonseminomatous classification and are very rare. These patients have poor prognoses despite multidimensional strategic approach (chemotherapy, radiotherapy, surgical intervention). Case Discussion: A previously well 27-year old male initially presenting with non-productive cough and a right anterior neck mass unresponsive to antibiotic therapy is subsequently diagnosed to be an extra-gonadal germ cell tumor of the anterior mediastinum. Two months through the course of disease, patient’s symptoms have progressed presenting with facial edema, engorged neck veins and cardio-respiratory distress. He is later found to be admitted in the intensive care unit where further workups led to the diagnosis of primary mediastinal mixed (non-seminomatous) germ cell tumor. Chemotherapy (cisplatin, bleomycin, etoposide - 1 cycle) and chest radiotherapy (4 sessions) were initiated causing resolution of symptoms. One week after discharge, patient presented with seizures and sudden onset of dyspnea. Patient was brought to the emergency room where he subsequently expired. Discussion: This case report presents an account of this rare disease entity from its initial presentation to post-mortem analysis. Primary mediastinal germ cell tumors are rare with a poor prognosis and should be strongly considered in the diagnosis of young men with a mediastinal mass and superior vena cava syndrome.
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Various immuno-related adverse events after IPI1NIVO therapy; a case report of metastatic choroidal melanoma
Yumi Yoshii1,2, Shunsuke Okazaki1, Yuki Nakatani1, Yuko Tsuboguchi1, Kohei Akiyoshi1, Shinya Ueda1, Shinya Tokunaga1, Masataka Shimozono3, Hitoshi Goto4, Kazuyoshi Fukai5, Haruko Daga1 1 Department of Medical Oncology, Osaka City General Hospital, 2Oncology Center, Nara Medical University, 3Department of ophthalmology, Osaka City General Hospital, 4 Department of General Medicine, Osaka City General Hospital, 5Department of dermatology, Osaka City General Hospital Background Choroidal melanoma with metastasis is known to have a poor prognosis with no established standard therapy. Recently there are some case reports that combination therapy of IPI and NIVO is effective, but with high incidence of immune-related adverse events (irAE). Case presentation A 53-year-old man presented with choroidal melanoma of the right eye and underwent stereotactic radio surgery but eighteen months later developed diffuse hepatic metastases. He was treated with combination therapy of IPI and NIVO, but he developed hyposalivation from the next day of first administration, and grade 3 hepatic disorder after 2 cycles. After 3 days administration of mPSL 125mg followed by PSL 0.5mg/kg, his hepatic enzymes normalized, then we started steroid tapering. At the dose of 30mg, he developed grade 4 Stevens-Johnson syndrome, for which 3 days pulse therapy of mPSL 1mg was effective. We re-escalated PSL to 1mg/kg and tapered carefully. At the dose of 15mg, MRI showed progression of liver metastasis. We decided to resume nivolumab monotherapy three months after termination of IPIþNIVO therapy, but it resulted in grade 3 diarrhea. Lower gastrointestinal endoscopy found seemingly normal mucosa,
Volume 30 | Supplement 6 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_6/mdz343.031/5582746 by University of Newcastle user on 20 October 2019
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Annals of Oncology
Isoliquiritigenin induces cell death programs and reduces ECM accumulation in uterine leiomyoma
Shih-Min Hsia1, Po-Han Lin1, Hsiang-Lin Kung1, Hsin-Yuan Chen1, Ko-Chieh Huang1, Tzong-Ming Shieh2 1 School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taiwan, 2Department of Dental Hygiene, College of Health Care, China Medical University Background: Uterine leiomyomas, also known as fibroids, are the comment and high prevalence in women of reproductive age. Isoliquiritigenin (ISL), a licorice flavonoid, exerts variant biological properties. In this study, the effect of ISL on anti-proliferation of uterine leiomyoma was investigated. Methods: Cell viability was determined using the MTT assay. The protein expression was assayed using Western blot analysis. Cell apoptosis was assayed using Annexin VFITC/PI and Hoechst 33342 staining. Results: The results showed that treatment of uterine leiomyoma ELT3 cells and primary uterine smooth muscle UtSMC cells with ISL alone or ISL plus estradiol (E2) reduced cell proliferation. Cotreatment with E2 and ISL inhibit G2/M and S phase arrest in ELT3 and UtSMC cells, respectively. The higher sub-G1 phase arrest and fluorescence intensity of Hoechst 33342 nucleus stain were observed in cotreatmenet of ELT3 cells with E2 and ISL compared with UtSMC cells. Furthermore, cotreated ELT3 cells with E2 and ISL induced apoptosis and autophagy cell death programs. The E2enhanced mice uterine myometrium growth was reduced by ISL presence, resulting in reduced the myometrium layer. Moreover, ISL reduced extracellular matrix proteins and matrix metalloproteinase (MMPs) expression, whereas increased tissue inhibitor of MMPs (TIMPs) expression. Conclusion: Our findings indicated the inhibitory effects of ISL on the animal model and indicated that ISL reduced ECM-related protein expression and cell proliferation in the leiomyoma cell line. Taken together, our results suggested that ISL could be considered as a new option for the treatment of uterine leiomyoma.
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Investigation of Radioactive Iodine-Refractory Differentiated Thyroid Carcinoma at Hochiminh City Oncology Hospital
Nguyen Huynh Khanh An, Vo Thi Phuong Thao, Vo Khac Nam, Dang Huy Quoc Thinh Department Nuclear Medicine, HCM Oncology Hospital, Viet Nam Introduction: Differentiated thyroid carcinoma (DTC) is the most common endocrine malignancy. These areforms of follicular cell-derived tumors, and they have the capacity to catch iodine. The overall survival rates of metastatic or progressive differentiated thyroid carcinomaat 10 and 15years were 56% and 45% in cases of the radioiodine-avid tumor. The rates were only 10% and 6%at 10and 15 years respectively if the tumor becamenon-iodine avid.Identification ofthe iodine-refractorycriteria helps us treat properly. Patients and Methods: a retrospective, cross-sectional descriptive analysis of radioactive iodine-refractory DTC conducted from January 2017 to December 2017. Data Processing and Analysis with SPSS 22.0 Results: Forty-three in 1428 patients enrolled in the study from January 2017 to December 2017. About 50% of patients were T3-and T4 tumor,48.8% got N1b lymph nodes metastasis. Distal accounted for 50%, in which pulmonary, bone metastasis, and both were 66.7%, 23.8%, and 9.5%, respectively. The refractory rate was 3.0%, in which most of them belonged to group III (44.2%). Treatment followed by operation (11.6%), external radiotherapy ( 20.9%) and the others were followed up actively or treated Levothyroxinsuppression therapy and further radioactive iodine, aiming to palliative care and reduction of tumor burden.No patient administrated TKIstherapy. Conclusions: The most of the refractory patients were elder and under the high-risk group of recurrence, in which mainly T4 tumor or locoregional invasion or distant metastasis. Identification of radioactive iodine-refractory criteria helps us treat properly. TKIs therapy in case of progression administrated recently.
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Scheduled cessation in treatment using lenvatinib for differentiated thyroid carcinoma
Yasuhiro Ito1,2, Toshihiko Kasahara3, Akihiro Miya1, Naomi Kiyota4,5, Hiroo Masuoka1, Tomohiko Nakamura3, Waka Yoshioka3, Ito Mitsuru3, Akira Miyauchi1 1 Department of Surgery, Kuma Hospital, 2Department of Clinical Trial, Kuma Hospital, 3 Department of Internal Medicine, Kuma Hospital, 4Kobe University Hospital, Cancer Center, 5Kobe University Hospital, Department of Medical Oncology and Hematology Backgrounds: Recently, multi-targeted tyrosine kinase inhibitors(m-TKIs) have become a treatment strategy for radioactive iodine-refractory differentiated thyroid
vi124 | Poster Session
carcinoma (RR-DTC).m-TKIs often require dose reduction or cessation due to various adverse events (AEs). Moreover, these AEs often lose the motivation of patients for the continuation of treatment. We therefore tried scheduled cessation of lenvatinib (LEN) to avoid or reduce AEs during the course of long-term administration. Methods: We tried scheduled cessation for five of 20 DTC patients who started LEN administration between Jul. 2015 and Oct. 2017. These five patients experienced intolerable toxicities resulting in frequent interruptions and dose reductions of LEN before introduction of scheduled cessation. Results: All were females and aged 66-83 years. Two patients underwent LEN administration of 8 mg/day for two weeks and cessation for one week. Others underwent LEN administration of 10 mg/day for three weeks and cessation for one week, of 10-14 mg/ day for two weeks and cessation for one week, and of 10 mg/day for two weeks and cessation for one week. Direct reasons for introduction of scheduled cessation were fatigue and anorexia for three patients, hand-foot-syndrome for one patient, and proteinuria for one patient, respectively. With a median follow-up period of 26.7 months, no patients showed further deterioration of AEs, enabling all patients to continue LEN in these schedules. One patient showed progression of metastatic lesions, but the remaining four patients achieved stable disease during these periods. Conclusions: Scheduled cessation can relieve AEs of patients, and may be considered as an effective strategy to continue treatment of LEN with maintaining the motivation of patients.
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Primary Mediastinal Malignant Mixed (Non-seminomatous) Germ Cell Tumor Presenting as Superior Vena Cava Syndrome
Emilio JoseS. Gravador1,2, Mayen T. Grageda1,4, Marie BelleD. Francia1,2,3 St. Luke’s Medical Center - Global City, Philippines, 2Department of Medicine, 3Cancer Institute, 4Institute of Pathology
1
Introduction: Mediastinal germ cell tumors are commonly seen in children and young adults with male preponderance. They are clinically classified as teratomas, seminomas and nonseminomatous germ cell tumors. Primary mediastinal mixed germ cell tumor falls under the nonseminomatous classification and are very rare. These patients have poor prognoses despite multidimensional strategic approach (chemotherapy, radiotherapy, surgical intervention). Case Discussion: A previously well 27-year old male initially presenting with non-productive cough and a right anterior neck mass unresponsive to antibiotic therapy is subsequently diagnosed to be an extra-gonadal germ cell tumor of the anterior mediastinum. Two months through the course of disease, patient’s symptoms have progressed presenting with facial edema, engorged neck veins and cardio-respiratory distress. He is later found to be admitted in the intensive care unit where further workups led to the diagnosis of primary mediastinal mixed (non-seminomatous) germ cell tumor. Chemotherapy (cisplatin, bleomycin, etoposide - 1 cycle) and chest radiotherapy (4 sessions) were initiated causing resolution of symptoms. One week after discharge, patient presented with seizures and sudden onset of dyspnea. Patient was brought to the emergency room where he subsequently expired. Discussion: This case report presents an account of this rare disease entity from its initial presentation to post-mortem analysis. Primary mediastinal germ cell tumors are rare with a poor prognosis and should be strongly considered in the diagnosis of young men with a mediastinal mass and superior vena cava syndrome.
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Various immuno-related adverse events after IPI1NIVO therapy; a case report of metastatic choroidal melanoma
Yumi Yoshii1,2, Shunsuke Okazaki1, Yuki Nakatani1, Yuko Tsuboguchi1, Kohei Akiyoshi1, Shinya Ueda1, Shinya Tokunaga1, Masataka Shimozono3, Hitoshi Goto4, Kazuyoshi Fukai5, Haruko Daga1 1 Department of Medical Oncology, Osaka City General Hospital, 2Oncology Center, Nara Medical University, 3Department of ophthalmology, Osaka City General Hospital, 4 Department of General Medicine, Osaka City General Hospital, 5Department of dermatology, Osaka City General Hospital Background Choroidal melanoma with metastasis is known to have a poor prognosis with no established standard therapy. Recently there are some case reports that combination therapy of IPI and NIVO is effective, but with high incidence of immune-related adverse events (irAE). Case presentation A 53-year-old man presented with choroidal melanoma of the right eye and underwent stereotactic radio surgery but eighteen months later developed diffuse hepatic metastases. He was treated with combination therapy of IPI and NIVO, but he developed hyposalivation from the next day of first administration, and grade 3 hepatic disorder after 2 cycles. After 3 days administration of mPSL 125mg followed by PSL 0.5mg/kg, his hepatic enzymes normalized, then we started steroid tapering. At the dose of 30mg, he developed grade 4 Stevens-Johnson syndrome, for which 3 days pulse therapy of mPSL 1mg was effective. We re-escalated PSL to 1mg/kg and tapered carefully. At the dose of 15mg, MRI showed progression of liver metastasis. We decided to resume nivolumab monotherapy three months after termination of IPIþNIVO therapy, but it resulted in grade 3 diarrhea. Lower gastrointestinal endoscopy found seemingly normal mucosa,
Volume 30 | Supplement 6 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_6/mdz343.031/5582746 by University of Newcastle user on 20 October 2019
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Annals of Oncology