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Introduction: Lenvatinib and Pembrolizumab together are used as a chemotherapy regimen for patients with metastatic endometrial carcinoma. Lenvatinib is a vascular endothelial growth factor (VEGF) receptor inhibitor, fibroblast growth factor inhibitor and an inhibitor that acts on platelet derived growth factor receptor alpha, ret oncogene and c-KIT oncogene. Pembrolizumab is an immune checkpoint inhibitor that acts against programmed-death one (PD-1) receptors and programmed-death ligand one (PD-L1) receptors. In combination, this regimen has proven to be efficacious in the setting of advanced endometrial carcinoma, but this must be weighed against its' side effect profile, most specifically their individual side effects. Pembrolizumab has been associated with pancreatitis. Lenvatinib has been associated with hypertriglyceridemia. However, little has been published with hypertriglyceridemia-induced pancreatitis in the setting of the combination of Lenvatinib and Pembrolizumab and its' management. Case Presentation: This case presentation discusses a 57-year-old female with history of stage IV uterine cancer with metastasis to the liver status post total abdominal hysterectomy/bilateral salpingo-oophrectomy (on Lenvatinib 8 mg PO daily/Pembrolizumab 200 mg IV every three weeks) presenting with epigastric pain, nausea, vomiting and decreased appetite; her symptoms were due to hypertriglyceridemia-induced pancreatitis with CT findings consistent with pancreatitis as well as a serum lipase of 1,508, and serum triglyceride level of 2,052; she was treated with IV insulin, resulting in resolution of her hypertriglyceridemia-induced pancreatitis. Conclusion: This case demonstrates a unique presentation of the hypertriglyceridemia induced pancreatitis in the setting of Lenvatinib and Pembrolizumab use and the need for future research to better understand the pathophysiology of the pancreatitis induced by this chemotherapy regimen.
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Epithelial ovarian cancer (EOC) is the most common histology of ovarian cancer defined as epithelial cancer derived from the ovaries, fallopian tubes, or primary peritoneum. It is the fifth most common cause of cancer-related death in women in the United States. Because of a lack of effective screening and non-specific symptoms, EOC is typically diagnosed at an advanced stage (FIGO stage III or IV) and approximately one third of patients have malignant ascites at initial presentation. The treatment of ovarian cancer consists of a combination of cytoreductive surgery and systemic chemotherapy. Despite the advances with new cytotoxic and targeted therapies, the five-year survival rate for all-stage EOC in the United States is 48.6%. Delivery of up-to-date guideline care and multidisciplinary team efforts are important drivers of overall survival. In this paper, we review our frontline management of EOC that relies on a multi-disciplinary approach drawing on clinical expertise and collaboration combined with community practice and cutting edge clinical and translational research. By optimizing partnerships through team medicine and clinical research, we combine our cancer center clinical expertise, community practice partnership, and clinical and translational research to understand the biology of this deadly disease, advance therapy and connect our patients with the optimal treatment that offers the best possible outcomes.
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Recent public policy, governmental regulatory and economic trends have motivated the establishment and deepening of community health and academic medical center alliances. Accordingly, community oncology practices now deliver a significant portion of their oncology care in association with academic cancer centers. In the age of precision medicine, this alliance has acquired critical importance; novel advances in nucleic acid sequencing, the generation and analysis of immense data sets, the changing clinical landscape of hereditary cancer predisposition and ongoing discovery of novel, targeted therapies challenge community-based oncologists to deliver molecularly-informed health care. The active engagement of community oncology practices with academic partners helps with meeting these challenges; community/academic alliances result in improved cancer patient care and provider efficacy. Here, we review the community oncology and academic medical center alliance. We examine how practitioners may leverage academic center precision medicine-based cancer genetics and genomics programs to advance their patients' needs. We highlight a number of project initiatives at the City of Hope Comprehensive Cancer Center that seek to optimize community oncology and academic cancer center precision medicine interactions.
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Lemur tyrosine kinase-3 (LMTK3) was recently identified as an estrogen receptor (ER)-α modulator related to endocrine therapy resistance, and its polymorphisms rs9989661 (T>C) T/T genotype and rs8108419 (G>A) G/G or A/G genotype predicted improved outcomes in breast cancer. Because different predominant ER distributions link to breast and gastric cancer and little is known of the prognostic role of LMTK3 in gastric cancer, this study was carried out to clarify the prognostic role of these polymorphisms in gastric cancer. One-hundred and sixty-nine Japanese and 137 U.S. patients with localized gastric adenocarcinoma were enrolled. Genomic DNA was extracted from blood or tissue, and all samples were analyzed by PCR-based direct DNA sequencing. Overall, these polymorphisms were not associated with survival in both cohorts. When gender was considered, in multivariate analysis, harboring rs9989661 T/T genotype was associated with disease-free survival [HR, 4.37; 95% confidence interval (CI), 2.08-9.18; P < 0.0001] and overall survival (OS; HR, 3.69; 95% CI, 1.65-8.24; P = 0.0014) in the Japanese males and time to recurrence (HR, 7.29; 95% CI, 1.07-49.80; P = 0.043) in the U.S. females. Meanwhile, harboring rs8108419 G/G genotype was associated with OS in the Japanese females (HR, 3.04; 95% CI, 1.08-8.56; P = 0.035) and the U.S. males (HR, 3.39; 95% CI, 1.31-8.80; P = 0.012). The prognostic role of these polymorphisms may be negative in gastric cancer. These findings suggest that the estrogen pathway may play a prognostic role in patients with gastric cancer but this may be dependent on the regional differences both in physiology and genetic alterations of gastric cancer.