Clinical Cancer Bulletin

Clinical Diagnosis and Treatment Recommendations for Immune Checkpoint Inhibitor-Associated Myocarditis

Yan WANG, Huiyong CHEN, Jinyi LIN, Jiahui CHEN, Yuhong ZHOU, Yingmei ZHANG, Hongwei ZHANG, Wei ZHU, Jie HU, Gang ZHAO, Xiangdong YANG, Shisuo DU, Xiaoyu LI, Guoming SHI, Jie CUI, Wei WU, Jing LI, Chi ZHANG, Cong WANG, Rongle LIU, Zheng LI, Chunhui WANG, Leilei CHENG, Junbo GE

2022, 1(3): 123-143. doi: 10.11910/j.issn.2791-3937.2022.20220018

[Abstract](506) [FullText HTML] (244) [PDF 1442KB](72)

Abstract:
Immune checkpoint inhibitors (ICIs) are often beneficial in the treatment of multiple types of malignant tumors. However, ICI-associated myocarditis has introduced new clinical challenges. This report highlights the key clinical issues of ICI-associated myocarditis, such as risk factors, diagnosis and differential diagnosis, clinical classification and treatment, monitoring of outcomes, and restart of treatment. Additionally, practical guidance and suggestions for the diagnosis and treatment of ICI-associated myocarditis are proposed with reference to the relevant consensuses or guidelines and newly published evidence-based studies in China and other countries in combination with clinical experience of physicians from Shanghai, China.

Comparison of Capillary and Venous Glucose Concentrations: A Real-world Study in Patients Undergoing Fluorodeoxyglucose–positron Emission Tomography

Ha WU, Guobing LIU, Yibo HE, Zhe ZHENG, Hongcheng SHI

2022, 1(3): 144-148. doi: 10.11910/j.issn.2791-3937.2022.20220019

[Abstract](255) [FullText HTML] (124) [PDF 1416KB](19)

Abstract:
Objective Fasting capillary blood glucose (CBG) must be measured before fluorodeoxyglucose–positron emission tomography (FDG–PET) imaging. In this study, we aimed to investigate whether a recently measured fasting venous blood glucose (VBG) concentration could be substituted for CBG. Methods This retrospective study included 520 of 1,378 patients who had undergone FDG–PET at our institution in June 2022. None of the study patients had a history of diabetes mellitus. Each study patient’s CBG was measured immediately before FDG administration, whereas the VBG (VBG < 7.8 mmol/L) was measured within one week before and after PET imaging. We used Bland−Altman plots to compare the two blood glucose concentrations. Results The 520 participants (315 male, 205 female; ages 13–87 years) accounted for 37.7% (520/1378) of all patients. The median CBG and VBG were 5.7 mmol/L (interquartile range, 5.2–6.2 mmol/L) and 5.1 mmol/L (interquartile range, 4.8–5.8 mmol/L), respectively. There was a moderate positive correlation between CBG and VBG (r=0.4370, 95% CI: 0.3625–0.5059, P<0.0001). Bland–Altman plots revealed that only 5.8% (30/520) of the dots exceeded the 95% limits of agreement and these were all within acceptable limits, indicating that the bias was not clinically significant. Conclusion When performing FDG–PET on patients without diabetes, a VBG of < 7.8 mmol/L within the previous week may be an acceptable alternative to CBG.

The Role of Anaplastic Lymphoma Kinase Receptor in Neuroblastoma

Tianfeng LI, Jianmin SUN, Hui ZHAO, Zhenjian ZHUO

2022, 1(3): 149-156. doi: 10.11910/j.issn.2791-3937.2022.20230001

[Abstract](133) [FullText HTML] (13) [PDF 1727KB](18)

Abstract:
Neuroblastoma (NB), a frequently occurring pediatric disease, is derived from the neural crest cells in the sympathetic ganglia and adrenal medulla. Notably, it is a heterogeneous tumor consisting of many affection factors, such as the diagnosis time within the first year and the diversity of the histology and genetic features. Despite improved outcomes in NB patients, it remains a difficult clinical problem and requires new therapeutic targets and methods. The somatic acquired activation point mutations in the receptor tyrosine kinase anaplastic lymphoma kinase (ALK) represent potential targets for treating NB. Herein, we review the underlying mechanisms of ALK in NB development, the latest available strategies to block ALK constitutive activity to treat NB, and discuss the current clinical challenges of resistance to these therapies and the strategies to overcome them.

Extracellular viscosity: a potential therapeutic target to combat cancer metastasis

Lihua HE, Yue GONG, Yi-Zhou Jiang

2022, 1(3): 157-159. doi: 10.11910/j.issn.2791-3937.2022.20220024

[Abstract](161) [FullText HTML] (75) [PDF 1413KB](14)

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DESTINY-Breast04: Calm Thinking on the HER2-low

Qingliang JIANG, Jie TANG, Xianglin LIU, Yingjie JIANG, Yanfang LIU, Hengyu LI

2022, 1(3): 160-163. doi: 10.11910/j.issn.2791-3937.2022.20220027

[Abstract](161) [FullText HTML] (73) [PDF 1196KB](12)

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Comprehensive Prevention of COVID-19 Infection in Immunocompromised Individuals with Cancer or Solid Organ Transplant

Yongbing QIAN

2022, 1(3): 164-166. doi: 10.11910/j.issn.2791-3937.2022.20220022

[Abstract](84) [FullText HTML] (11) [PDF 1139KB](11)

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Combined Transcranial and Endoscopic Endonasal Approach for Resecting a Giant Intracranial and Extracranial Communicating Meningioma: A Case Report

Ye GU, Kai XUE, Quan LIU, Huankang ZHANG, Hongmeng YU

2022, 1(3): 167-171. doi: 10.11910/j.issn.2791-3937.2022.20220026

[Abstract](335) [FullText HTML] (157) [PDF 5054KB](7)

Abstract:
Objective Although intracranial and extracranial communicating meningiomas are uncommon in clinical settings, they pose a considerable challenge for surgeons. Thus, one-stage surgery should be more comprehensively explained as it is not frequently reported as a first-line treatment. Case report A 27-year-old man with a massive intracranial and extracranial communicating meningioma was admitted with nasal congestion and mild numbness on the left side of his face. A combined transcranial and endoscopic endonasal approach was performed in a single day aided by preoperative tumor embolization. The tumor was nearly completely removed without any serious complications. Follow-up revealed the disappearance of diplopia, with the patient having a normal life. Furthermore, no tumor progression was noted. Conclusion The combined transcranial and endoscopic endonasal approach is feasible for removing certain massive intracranial and extracranial communicating tumors. Hybrid techniques, such as embolization, microscopic, and endoscopic manipulation, are indispensable tools for treating such cases.

A Case Report: Severe Bullous Skin Reaction Induced by Anti-PD-1 Antibody (Toripalimab) Therapy in a Patient with Thymic Carcinoma

Chong TENG, Xiaowei SONG, Chengjuan FAN, Yashuang ZHAO, Lina DU, Siqi MAN, Yuanyuan HU, Zhengjun JIANG, Tao XIN

2022, 1(3): 172-175. doi: 10.11910/j.issn.2791-3937.2022.20220025

[Abstract](275) [FullText HTML] (41) [PDF 4980KB](8)

Abstract:
The development of immune checkpoint inhibitors, such as those targeting programmed cell death protein 1 (PD-1), represents a major breakthrough in cancer therapy. Although immune checkpoint blockade therapy has a favorable risk/benefit ratio, it causes significant immune-related adverse events (irAEs), such as cutaneous reactions, in particular, severe bullous skin reactions and toxic epidermal necrolysis. Here, we report a case of a 51-year-old woman with malignant thymoma who developed a severe bullous skin reaction (characterized by a systemic rash, bullae, epidermal desquamation, and Stevens-Johnson syndrome) as a result of treatment with the PD-1 inhibitor toripalimab. The patient was treated with high doses of glucocorticoid, intravenous immunoglobulin, and intensive care, and eventually recovered from the severe irAEs. The intravenous injection of anti-PD-1 antibodies induces cutaneous reactions, which are associated with higher mortality rates. High doses of glucocorticoid combined with intravenous immunoglobulin are effective in alleviating such irAEs. Thus, improving the level of care and preventing skin infections can effectively reduce the risk of death.

Immune Checkpoint Inhibitor-induced Immune-mediated Hepatitis in A Lung Cancer Patient Undergoing Long-term Immunotherapy: A Case Report

Tengteng ZHANG, Yan ZHANG, Yiyin ZHANG

2022, 1(3): 176-181. doi: 10.11910/j.issn.2791-3937.2022.20220023

[Abstract](217) [FullText HTML] (106) [PDF 2039KB](10)

Abstract:
Immune-mediated hepatitis (IMH) induced by immune checkpoint inhibitors (ICIs) is an immune-related adverse event (irAE). IMH usually occurs 8–12 weeks after the first dose of ICI therapy. We report an unusual case of a lung cancer patient who developed IMH 2 years after initial ICI treatment and relapsed during corticosteroid therapy. A 55-year-old male with stage Ⅳ B lung cancer received ICIs (for over 2 years) and chemotherapy as a second-line therapy. Grade 4 IMH occurred 2 years after initial immunotherapy and was diagnosed as hepatitis via laboratory and imaging tests with the simultaneous exclusion of other causes. The patient responded well to the corticosteroids; however, he decided to discontinue treatment prematurely, meaning that the total treatment period was less than 4 weeks. This led to IMH reoccurrence and the need to readminister corticosteroids at a higher dose than before. Ultimately, the patient's IMH was controlled and did not reoccur. This case illustrates that immune-related toxicity needs to be monitored in patients undergoing long-term ICI therapy. Improving patient education is also essential for the management and treatment of irAEs.

Immune Checkpoint Inhibitor–associated Myocarditis with Myasthenia Gravis: A Case Report

Qing LIU, Jinyi LIN, Tianshu LIU, Yiyi YU

2022, 1(3): 182-184. doi: 10.11910/j.issn.2791-3937.2022.20230002

[Abstract](62) [FullText HTML] (28) [PDF 1433KB](13)

Abstract:
Immune checkpoint inhibitors (ICIs) have revolutionized the management of various cancers. However, myocarditis is a rare but severe complication associated with ICI use. We describe the case of a 62-year-old woman who presented with ICI-associated myocarditis alongside myasthenia gravis. Consequently, the patient was treated with initial high doses of corticosteroids combined with immunosuppressive therapy, and improved outcomes and clinical remission were observed. The overlap of myocarditis with myasthenia gravis is associated with high morbidity and mortality. The early administration of high dose of corticosteroids combined with immunosuppressive therapy was associated with improved outcomes in our patient.

Current Issue
December 25, 2022

VOL. 1, NO. 3

Contacts

Current Issue December 25, 2022 VOL. 1, NO. 3

Contacts

Current Issue
December 25, 2022

VOL. 1, NO. 3