Multiple drugs
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Various toxicities: case report A 76-year-old woman developed diarrhoea and thrombocytopenia during treatment with folinic-acid, fluorouracil, irinotecan and oxaliplatin, bone marrow toxicity during treatment with gemcitabine and paclitaxel for stage IV pancreatic ductal adenocarcinoma (PDAC). Additionally, she also developed resistance to erlotinib and off label osimertinib given for PDAC [not all dosages stated; routes, durations of treatments to reactions onsets and outcomes not stated]. The woman was diagnosed with stage IV PDAC with the pelvic metastatic lesion in the year 2014. The neoplastic cells were positive for CK7 and CDX2. Additionally, the tumour was found to harbour genomic alterations that have therapeutic implications with epidermal growth factor receptor (EGFR) E746_T751>VP mutation, a deletion in exon 19. She was also found to have other genomic alterations as well showing wild-type KRAS gene. Subsequently, she started receiving systemic palliative chemotherapy FOLFIRINOX consisting of folinic-acid [leucovorin], fluorouracil, irinotecan and oxaliplatin. However, she tolerated the treatment poorly. She developed thrombocytopenia and diarrhoea. After 6 months of starting FOLFIRINOX, her PDAC progressed. The woman was switched to erlotinib 75 mg/day from FOLFIRINOX and it showed stable disease in the pancreas but partial/ almost complete and durable response in the pelvic metastatic lesion that lasted for 12 months. However, her again disease progressed and she was switched to gemcitabine and paclitaxel [Nab paclitaxel]. However, she developed bone marrow toxicity. At that time, her peripheral blood was sent for molecular analysis, which showed the presence of EGFR A647T mutation in circulating cfDNA in the blood. She was then started on off label treatment with osimertinib 80 mg/day. Despite treatment, disease progression was noted after 3 months and osimertinib was stopped. During investigations, A647T‑mediated acquired resistance to erlotinib and osimertinib was confirmed. Subsequently, her general condition and performance status rapidly declined. She was not considered a suitable candidate for further therapy and was referred to hospice. After 2 months of stopping osimertinib, she died [cause of death not stated]. Patel GK, et al. Epidermal growth factor receptor-activating mutation(E746_T751>VP) in pancreatic ductal adenocarcinoma responds to erlotinib, followed by epidermal growth factor receptor resistance-mediating mutation (A647T): A case report and literature review. Journal of Cancer Research and Therapeutics 16: 950-954, No. 4, 30 Jan 803506595 2020. Available from: URL: http://doi.org/10.4103/jcrt.JCRT_729_18
0114-9954/20/1826-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 17 Oct 2020 No. 1826
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