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ESMO SUMMIT LATIN AMERICA 2019
Clinical cases presentation
Maria Ignez Braghiroli
CONFLICT OF INTEREST DISCLOSURE
Sub-title
Institutional clinical research:
Roche, Astra-Zeneca, MSD, BMS
Paid honoraria
ESMO SUMMIT LATIN AMERICA 2019 Clinical cases presentation Maria - - PowerPoint PPT Presentation
ESMO SUMMIT LATIN AMERICA 2019 Clinical cases presentation Maria - - PowerPoint PPT Presentation
ESMO SUMMIT LATIN AMERICA 2019 Clinical cases presentation Maria Ignez Braghiroli CONFLICT OF INTEREST DISCLOSURE Sub-title Institutional clinical research: Roche, Astra-Zeneca, MSD, BMS Paid honoraria Roche, MSD, Bayer CASE 1
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CASE 1
RAMT, 39 yo Male
No significant previous medical history or family history 2014 – Change in bowel habits and blood in the stools Colonoscopy: nearly obstructive sigmoid lesion, no further alterations
Path: Invasive moderately differentiated adenocarcinoma (grade 2) in the
sigmoid colon.
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CASE 1
RAMT, 39 yo Male
PET-CT: FDG uptake in the thickened sigmoid segment (2h SUV = 10,7) and in multiple focal liver areas, the majority corresponding to hypoattenuating lesions measuring up to 2.8 cm (highest 2h SUV = 9,7).
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CASE 1
RAMT, 39 yo Male
No significant previous medical history or family history 2014 – Change in bowel habits and blood in the stools Colonoscopy: nearly obstructive sigmoid lesion, no further alterations
Path: Invasive moderately differentiated adenocarcinoma (grade 2) in the
sigmoid colon. 39yo male with sigmoid adenocarcinoma, metastatic to the liver
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CASE 1
RAMT, 39 yo Male
No previous medical history 2014 – Change in bowel habits and blood in the stools Colonoscopy: nearly obstructive sigmoid lesion, no further alterations
Path: Invasive moderately differentiated adenocarcinoma (grade 2) in the
sigmoid colon. Jan/2014 – Laparoscopic sigmoidectomy - pT3 pN2a
Path: Moderately differentiated adenocarcinoma invading the adipose tissue Metastasis in 6/24 lymph nodes MSS; RAS wt, BRAF wt
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CASE 1
RAMT, 39 yo Male
No previous medical history 2014 – Change in bowel habits and blood in the stools Colonoscopy: nearly obstructive sigmoid lesion, no further alterations
Path: Invasive moderately differentiated adenocarcinoma (grade 2) in the
sigmoid colon. Jan/2014 – Laparoscopic sigmoidectomy - pT3 pN2a
Path: Moderately differentiated adenocarcinoma invading the adipose tissue Metastasis in 6/24 lymph nodes MSS; RAS wt, BRAF wt
FOLFIRINOX x 4 cycles
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CASE 1
RAMT, 39 yo Male
PET-CT: Comparing to previous exam, there has been marked reduction in the size and FDG uptake in the liver lesions. It is not observed the previous uptake in the sigmoid (status post surgical resection)
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CASE 1
RAMT, 39 yo Male
May/2014 – Segment 2, 3 e 4A resection and resection of segments 6,7 e 4B lesions
Path: Moderately differentiated tubular adenocarcinoma, free margins
39yo male with sigmoid adenocarcinoma, metastatic to the liver. s/p resection of primary tumor s/p FOLFIRINOX x 4 s/p resection of liver lesions
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CASE 1
RAMT, 39 yo Male
May/2014 – Segment 2, 3 e 4A resection and resection of segments 6,7 e 4B lesions
Path: Moderately differentiated tubular adenocarcinoma, free margins
FOLFOX to complete a total of 12 cycles
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CASE 1
RAMT, 39 yo Male
Feb/2017 – Possible Segment IV recurrence.
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CASE 1
RAMT, 39 yo Male
Feb/2017 – Possible Segment IV recurrence -> RFA Dec/2018 – Last F/U images performed: NED
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CASE 2
M.I.A.S, 54 yo female
PMH: Depression Hep A in childhood. Negative HVC and HBV SH: Smokes for the past 10 years, 10-15 cigarrets/d Social alcohol use FH: Brother had metastatic melanoma Father died at 77 with gastric cancer Maternal cousin and paternal cousin had breast cancer at age 38
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CASE 2
M.I.A.S, 54 yo female
History of altered bowel habits (daily diarrhea) for the previous 4 months. No weight loss Underwent EGD and colonoscopy that showed no alterations MRI showed a pancreatic lesion
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CASE 2
M.I.A.S, 54 yo female
Dec/2016 EchoEGD: Hypoechoic heterogeneous lesion in the body of the pancreas measuring 3.0x3.0 cm, with irregular and poorly precise limits. The lesion abuts the celiac axis and splenomesenteric junction. No enlarged nodes Normal hepatocholedocus Pancreas tail atrophy. Normal Wirsung.
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CASE 2
M.I.A.S, 54 yo female
Dec/2016 EchoEGD: Hypoechoic heterogeneous lesion in the body of the pancreas measuring 3.0x3.0 cm, with irregular and poorly precise limits. The lesion abuts the celiac axis and splenomesenteric junction. No enlarged nodes Normal hepatocholedocus Pancreas tail atrophy. Normal Wirsung.
FNA: Suspicious for malignancy
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CASE 2
M.I.A.S, 54 yo female
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CASE 2
M.I.A.S, 54 yo female
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CASE 2
M.I.A.S, 54 yo female
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CASE 2
M.I.A.S, 54 yo female
Dec/2016 EchoEGD: Hypoechoic heterogeneous lesion in the body of the pancreas measuring 3.0x3.0 cm, with irregular and poorly precise limits. The lesion abuts the celiac axis and splenomesenteric junction. No enlarged nodes Normal hepatocholedocus Pancreas tail atrophy. Normal Wirsung.
FNA: Suspicious for malignancy
54yo female with LA-PDAC
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CASE 2
M.I.A.S, 54 yo female
From Dec/2016 to May/2017 - FOLFIRINOX x 12 cycles May/2017 CT scan: Infiltrative solid lesion in the neck and body of pancreas measuring 3.0 cm, stable in comparison to the previous scan, determining diffuse tail atrophy. There is wide contact and signs of celiac axis infiltration and well as common hepati, splenic and left gastric arteries, diffusely irregular. It also determines a portal vein deformity
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CASE 2
M.I.A.S, 54 yo female
From Dec/2016 to May/2017 - FOLFIRINOX x 12 cycles -> Stable disease Jun/2017 to Jul/2017: CRT 25 x 2.3Gy in the tumor + 25 x 1.8Gy regional lymphatics – (planed weekly Gemcitabine 100mg/m2)
Thrombocytopenia post week 1
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CASE 2
M.I.A.S, 54 yo female
From Dec/2016 to May/2017 - FOLFIRINOX x 12 cycles -> Stable disease Jun/2017 to Jul/2017: CRT 25 x 2.3Gy in the tumor + 25 x 1.8Gy regional lymphatics – (planed weekly Gemcitabine 100mg/m2)
Thrombocytopenia post week 1
Sep/2017 CT scan: Solid and infiltrative lesion in the body of pancreas measuring 3.0 cm, stable in comparison to the previous scan, determining pancreatic duct dilatation and diffuse tail atrophy.
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CASE 3
TMMS 34yo female
No significant previous medical history No smoking No alcohol use Maternal grandfather has colon cancer at age 89 Maternal grandmother had breast cancer at age 86
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CASE 3
TMMS 34yo female
2013 was diagnosed with perforated sigmoid adenocarcinoma metastatic to the liver, lung and ovaries Apr/2013 – underwent resection of sigmoid tumour, partial cystectomy and
- ophorectomy
Path: Invasive moderately differentiated adenocarcinoma MSS, KRAS mutated codon 13
Apr/13 to Aug/13 – FOLFIRI + Bev x 10 cycles -> excelent response
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CASE 3
TMMS 34yo female
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CASE 3
TMMS 34yo female
Sep/13 – Partial right hepatectomy + resection of left liver nodules + ileostomy reversal
Path: confirmed Invasive moderately differentiated adenocarcinoma
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CASE 3
TMMS 34yo female
Sep/13 – Partial right hepatectomy + resection of left liver nodules + ileostomy reversal
Path: confirmed Invasive moderately differentiated adenocarcinoma
Oct/13 – Resection of lung nodules (6 lesions in the R, 4 lesions in the L) No measurable disease after surgical procedures
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CASE 3
TMMS 34yo female
Nov/13 to Dec/13 – FOLFOX x 4 cycles POD in the peritoneum and liver Re-started on FOLFIRI + Bev x 10 cycles until Jun/14 Feb/14 – Foundation one: HER2 amplification Sep/14 – Re-started on FOLFIRI + Bev due to POD in the peritoneum. Completed 5 cycles and had a good clinical response 6 months later, got symptomatic again
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CASE 3
TMMS 34yo female
Jul/15 to - May/18 – Trastuzumab + Pertuzumab + Capecitabine – 38 cycles
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CASE 3
TMMS 34yo female
Jul/15 to - May/18 – Trastuzumab + Pertuzumab + Capecitabine – 38 cycles
- May/18 – POD in the lungs
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CASE 3
TMMS 34yo female
Jul/15 to - May/18 – Trastuzumab + Pertuzumab + Capecitabine – 38 cycles
- May/18 – POD in the lungs
- XELOX+ Trastuzumab with stable disease
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CASE 4
64yo female
No significant previous medical history Jun/2017 – Diagnosis of right colon cancer Jun/2017 – Right hemicolectomy
Tubular well differentiated adenocarcinoma infiltrating the serosa No compromised lymph nodes of a total 22 dMMR (absent MLH1 e PMS2); BRAF inconclusive.
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CASE 4
64yo female
No significant previous medical history Jun/2017 – Right hemicolectomy – pT3N0
Tubular well differentiated adenocarcinoma infiltrating the serosa No compromised lymph nodes of a total 22 dMMR (absent MLH1 e PMS2); BRAF inconclusive.
Aug/2017 – Diagnosis of metastatic peritoneal disease in the right hypochondria invading the 1st and 3rd duodenal portions and ileum, besides large contact with gallbladder, measuring 11 cm.
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CASE 4
64yo female
No significant previous medical history Jun/2017 – Right hemicolectomy – pT3N0
Tubular well differentiated adenocarcinoma infiltrating the serosa No compromised lymph nodes of a total 22 dMMR (absent MLH1 e PMS2); BRAF inconclusive.
Aug/2017 – Diagnosis of metastatic peritoneal disease in the right hypochondria invading the 1st and 3rd duodenal portions and ileum, besides large contact with gallbladder, measuring 11 cm.
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CASE 2
M.I.A.S, 54 yo female
Nov/2017
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CASE 4
64yo female
Nov/2017 – Started on Pembrolizumab 200mg/dose 64yo female with dMMR right colon cancer with a large peritoneal implant
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CASE 2
M.I.A.S, 54 yo female
Feb/2019
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CASE 4
64yo female
No significant previous medical history Jun/2017 – Right hemicolectomy – pT3N0
Tubular well differentiated adenocarcinoma infiltrating the serosa No compromised lymph nodes of a total 22 dMMR (absent MLH1 e PMS2); BRAF inconclusive.