memo - Magazine of European Medical Oncology

Zach, Otto

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0460-7

For decades, polymerase chain reaction (PCR) has been playing a fundamental role in hematology. Not only in diagnostics, but also in follow-up and therapeutic decision-making, PCR impacts the treatment of patients with neoplastic diseases. In this educational, commonly used PCR methods are explained. In addition, the strengths and weaknesses of PCR in the clinical setting are illustrated.

Fuchs, David

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0457-2

Since the introduction of anti-CD20 antibodies and polychemotherapy, diffuse large B‑cell lymphoma (DLBCL) has become a treatable, and, for a high proportion of patients, curable disease. However, a sizeable proportion of patients, especially in poor-prognosis subgroups, will relapse.

Spanberger, Thomas

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0466-1

Immunochemotherapy has long been the backbone of all treatment for B‑cell non-Hodgkin lymphoma. These therapies led to long-term disease control or even cure for some patients. However, these treatments also caused—sometimes severe—toxicities and deterioration of the quality of life. Novel agents targeting the B‑cell-receptor pathway and bcl2 have made great inroads in the treatment of mature lymphoid neoplasms. These new agents present themselves with a wide variety of new toxicities, which have to be taken into account when being administered to our patients. Hematological toxicities are very common. All new agents lead to various levels of immune suppression or immune modulation, which is often not easily quantifiable. Opportunistic infections such as progressive multifocal leukoencephalopathy, pneumocystis pneumonia, other mycotic infections, cytomegalovirus infections and pneumocystis pneumonia have been described, sometimes with fatal outcome. Ibrutinib shows increased risk of atrial fibrillation. It also increases the risk of bleeding, making the proper anticoagulatory management of patients developing atrial fibrillation under treatment a challenge. Idelalisib causes severe, sometimes fatal immune-mediated end-organ toxicities, especially colitis, pneumonitis, and transaminitis. Copanlisib leads to metabolic changes, namely episodes of hyperglycemia and arterial hypertension. Venetoclax has caused clinically significant tumor lysis syndrome. The introduction of a prolonged ramp-up phase of step wise dose escalation has decreased the rate of clinically significant tumor lysis syndrome. The drug also causes high rates of hematological toxicities, especially neutropenia.

Fritz, Teresa; Schöfl, Rainer; Wewalka, Friedrich; Ziachehabi, Alexander

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0461-6

Endoscopic therapy is the gold standard for curative treatment of early esophageal adenocarcinoma (EAC) including dysplastic Barrett´s epithelium (BE) and very early squamous cell carcinoma (SCC) because it is superior to surgery in regard to morbidity, mortality and cost effectiveness while yielding excellent results and low complication rates.

Mayer, Elke; Arnold, Christoph; Ganswindt, Ute; Jäger, Robert

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0462-5

Esophageal cancer is one of the ten most frequent tumors worldwide. There are two major histologies: squamous cell carcinomas, which appear more frequently in the upper part of the esophagus, and adenocarcinomas, which are predominantly found in the distal part and at the gastroesophageal junction. Most patients suffer from locally advanced tumors, for which the prognosis is still poor with a 5-year survival rate of 15–25%. Treatment is based on histology, tumor stage, location of the tumor, performance status, age, and comorbidities and it consists of surgery, chemotherapy, or radiotherapy or a combination of these. Over the past decades, neoadjuvant radiochemotherapy followed by surgery became standard of care in patients with locally advanced squamous cell carcinomas suitable for surgery. The treatment of locally advanced adenocarcinomas and junctional tumors is still under debate and consists of either perioperative chemotherapy or neoadjuvant chemoradiotherapy followed by surgery. In patients not suitable for surgery, definitive radiochemotherapy is considered the treatment of choice. Modern radiotherapy in esophageal cancer is increasingly conformal and the dose at organs-at-risk could be reduced over the years to lower the rate of treatment-related side effects. Individualization of treatment and new combinations of systemic agents are under investigation to improve treatment outcome.

Taghizadeh, Hossein; Lampichler, Katharina; Beer, Andrea; Preusser, Matthias; Ilhan-Mutlu, Aysegul

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0463-4

In this report, we present the medical history of a 30-year-old male patient with HER2- and PD-L1-negative metastasized adenocarcinoma of the gastric cardia, who received three cycles of pembrolizumab (200  mg every 2 weeks) after the failure of the first-line (1L) treatment with docetaxel, cisplatin, 5‑fluorouracil (DCF). A restaging computed tomography (CT) scan for the chest and abdomen revealed an apparent progressive disease; therefore, the treatment was terminated. Five months after the termination of the treatment, a new CT scan demonstrated a spontaneous treatment response although no treatment was given during this time period, indicating pseudo-progression of the tumor in the first restaging after three cycles of pembrolizumab. This finding is apparently due to the long-term sustainable immunological effects of pembrolizumab. The current report will present this rare case in more detail and summarize the closed and ongoing clinical trials of immunotherapy drugs in gastroesophageal cancer.

Vargas, Andrés

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0465-2

Chakrabarti, Amrita; Banerjee, Anirban; Mohapatra, Ishani; Sachdev, Ritesh; Jain, Bosky; Sood, Nitin

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0439-4

Erdheim–Chester disease (ECD) is a rare multi-system, non-Langerhans cell histiocytic disorder (NLCHD) with only a few hundred cases reported in the literature. Its diverse clinical manifestations require a high level of diagnostic suspicion. BRAFV600E mutation analysis is of critical significance, as it has implications for targeted therapy with BRAF inhibitors such as vemurafenib and dabrafenib. We report a case of symptomatic, central nervous system (CNS)-predominant ECD initially presenting with CNS mass lesions mimicking meningiomas on imaging and prominent periorbital xanthogranulomas. CNS presentation of ECD, although not infrequent, bears particular significance here from a therapeutic point of view, since only partial debulking was possible owing to anatomical complexities. Radiological evaluation following surgery showed no significant change in the size of the lesions. Targeted therapy was commenced following histopathology, immunohistochemistry (IHC), and molecular testing, resulting in marked improvement of clinical symptoms and tumor regression. Thus, diagnostic accuracy was imperative for symptomatic relief in this rare but aggressive neoplasm with a complex clinical presentation and misleading initial radiological impressions, bearing an otherwise grim prognosis.

Iltar, Utku; Aslan, Vedat; Gocer, Mesut; Aykac, Fatma; Nizam, İlknur; Çelik, Mehmet; Gulec, Faruk; Ulaş, Turgay; Kurtoğlu, Erdal

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0445-6