RESUMEN
Endoscopic ultrasound using convex endobronchial ultrasound probe (EUS-B) is an evolving diagnostic technique. We present a case of successful EUS-B biopsy of pleural metastasis in a patient with lung adenocarcinoma. This was an accurate, uncomplicated procedure and demonstrates the feasibility of EUS-B for pleural lesions.
Asunto(s)
Adenocarcinoma del Pulmón/secundario , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Pleura/patología , Neoplasias Pleurales/secundario , Adenocarcinoma del Pulmón/patología , Broncoscopía , Ecocardiografía Transesofágica , Humanos , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Pleura/diagnóstico por imagen , Neoplasias Pleurales/patología , Tomografía Computarizada por Rayos XRESUMEN
The BCL2 inhibitor venetoclax achieves responses in â¼79% of patients with relapsed or refractory chronic lymphocytic leukemia/small lymphocytic lymphoma (RR-CLL/SLL), irrespective of risk factors associated with poor response to chemoimmunotherapy. A limitation of this targeted therapy is progressive disease (PD) in some patients. To define the risk factors for progression, the clinicopathological features of PD, and the outcomes for patients after venetoclax failure, we analyzed 67 heavily pretreated patients on 3 early phase clinical trials. Investigations at progression included positron emission tomography scan and biopsy. Twenty-five (37%) patients manifested PD on therapy: 17 with Richter transformation (RT) and 8 with progressive CLL/SLL. RT occurred significantly earlier (median 7.9 months) than progressive CLL (median 23.4 months) (P = .003). Among patients who received the recommended phase 2 dose of venetoclax or higher (≥400 mg/d), fludarabine refractoriness and complex karyotype were associated with progression (hazard ratio 7.01 [95% confidence interval 1.7-28.5]; P = .002 and 6.6 [1.5-29.8]; P = .005, respectively), whereas del(17p) and/or TP53 mutation were not (P = .75). Median postprogression survival was 13 (<1-49.9) months. Bruton tyrosine kinase inhibitors were active in progressive CLL, but outcomes were mixed. Patients with disease that is fludarabine refractory or who have complex cytogenetics should have occult RT excluded before initiating venetoclax therapy.
Asunto(s)
Antineoplásicos/uso terapéutico , Compuestos Bicíclicos Heterocíclicos con Puentes/uso terapéutico , Leucemia Linfocítica Crónica de Células B/tratamiento farmacológico , Proteínas Proto-Oncogénicas c-bcl-2/antagonistas & inhibidores , Sulfonamidas/uso terapéutico , Adulto , Agammaglobulinemia Tirosina Quinasa , Anciano , Anciano de 80 o más Años , Progresión de la Enfermedad , Femenino , Humanos , Cariotipo , Leucemia Linfocítica Crónica de Células B/genética , Leucemia Linfocítica Crónica de Células B/patología , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/tratamiento farmacológico , Recurrencia Local de Neoplasia/genética , Recurrencia Local de Neoplasia/patología , Inhibidores de Proteínas Quinasas/uso terapéutico , Proteínas Tirosina Quinasas/antagonistas & inhibidores , Estudios Retrospectivos , Resultado del Tratamiento , Vidarabina/análogos & derivados , Vidarabina/uso terapéutico , Adulto JovenRESUMEN
EUS-B-FNA is a feasible and accurate technique for diagnosis of extrathoracic lesions https://bit.ly/34TFMR8.