• PDF / 171,219 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 98 Downloads / 158 Views

DOWNLOAD

REPORT

---

1

S

Diarrhoea and mild oedema and development resistance to dabrafenib and trametinib: case report A 57-year-old man developed diarrhoea and mild oedema during treatment with imatinib for gastrointestinal stromal tumour. Additionally, he developed resistance to dabrafenib and trametinib during treatment of non-small cell lung cancer [not all routes and outcomes stated]. The man, who had was diagnosed with low-grade malignant gastrointestinal stromal tumour, started receiving oral imatinib 400mg daily in May 2013. During that period, he developed diarrhoea and mild oedema, which resolved spontaneously following 2 months [duration of treatment to reactions onsets not stated]. Therefore, the dose of imatinib was not decreased. In November 2015, he was referred to the Qilu Hospital of Shandong University because of pain on the left side of the back. On 11 January 2016, a surgery was performed to remove the lumbar soft tissue tumours. Postoperative pathology showed malignant ossifying myxofibrosarcoma (MFS) with infiltrating growth and satellite nodules besides the main body of the tumour. After re-examination (CT scan and MRI), no significant changes were observed. In March 2018, he was diagnosed with pulmonary adenocarcinoma (non small cell lung cancer) located on the inferior lobe of the right lung and liver metastases. Next-generation sequencing technology (NGS) was positive for the B-Raf proto-oncogene serine/ threonine kinase (BRAF) V600E mutation. In April 2018, he started receiving targeted therapy with dabrafenib 300 mg/day and trametinib 2 mg/day. On 8 June 2018, and 3 August 2018, a CT scan of the chest showed a significant reduction in the size and number of the nodule in the inferior lobe of the right lung, the multiple pulmonary nodules and the lymph nodes in the mediastinum. The evaluation results were indicative of stable disease. On 24 October 2018, a CT scan of the upper abdomen demonstrated larger hypoechoic nodules in the right liver compared with those noted on the previous CT scan. These findings were suggestive of disease progression. On 29 October 2018, a CT-guided percutaneous liver biopsy was performed and invasion of malignant tumour cells in liver tissue was observed. The findings were consistent with resistance to dabrafenib and trametinib. The findings of immunohistochemistry were positive positivity for pancytokeratin, cytokeratin 7, p40, Napsin A part and transcription termination factor 1, which were indicative of intrahepatic lesions metastases from lung cancer. Later, he received two cycles of pemetrexed and bevacizumab, following which his disease was found to be stable. Author comment: "Following the use of imatinib, the patient in the present case had mild edema and diarrhea, which continued for ~6 months. However, these adverse reactions gradually resolved without any intervention." "[T]herefore combined dabrafenib and trametinib treatment was administered. At 6 months after the treatment, the lesions in the liver had progressed, which suggested drug resistance." Zhang L, et al.