Next generation sequencing driven successful combined treatment with laparoscopic surgery and immunotherapy for relapsed stage IVB cervical and synchronous stage IV lung cancer
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Clelia Madeddu1, Paraskevas Kotsonis2, Fabrizio Lavra2, Giacomo Chiappe2, Luca Melis3, Ester Mura4, Mario Scartozzi1 and Antonio Macciò2
1 Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
2 Department of Gynecologic Oncology, Azienda Ospedaliera Brotzu, Cagliari, Italy
3 Department of Nuclear Medicine, Azienda Ospedaliera Brotzu, Cagliari, Italy
4 Department of Pathology, Azienda Ospedaliera Brotzu, Cagliari, Italy
Keywords: laparoscopic total pelvic exenteratio; immunotherapy; synchronous cancer; cervical cancer; next-generation sequencing
Received: January 21, 2019 Accepted: February 22, 2019 Published: March 12, 2019
Background: The treatment of patients with multiple synchronous tumors is challenging and complex. The use of next generation sequencing (NGS) may help in identification of germline mutations in genes involved in a common etiology for both tumors thus allowing a common effective therapeutic strategy. Patients and Methods: We describe the unexpected positive results obtained in a young woman with relapsed chemo-resistant stage IVB cervical and synchronous stage IV lung cancer, who underwent an interdisciplinary approach including palliative surgery with laparoscopic total pelvic exenteratio followed by a chemo-immunotherapy protocol with the anti- Programmed Death (PD)-1 antibody nivolumab plus metronomic cyclophosphamide. The treatment choice was based on tumor PD-Ligand 1 assessment and NGS analysis for the identification of potential treatment targets. Outcomes included tumor objective response and patient-centered outcomes (pain, performance status and overall quality of life). Results: Laparoscopic surgery obtained an immediate symptom control and allowed the early start of medical treatment. One month after combined therapy start the patient achieved a significant improvement in performance status, pain, overall Quality of life and after 3 months she resumed working. After 3 and 6 months of treatment we observed an objective dimensional and metabolic response. Currently, after 24 months (and 48 cycles of nivolumab) the patient is continuing to benefit from treatment: she is in complete remission, with good performance status and she is working and leading a self-dependent life. Conclusion: Our study strongly affirms the efficacy of an interdisciplinary approach including surgical and innovative medical strategies based on immunotherapy in patients with advanced chemo-resistant synchronous cervical and lung cancer. The present findings support the use of NGS to drive a targeted rational treatment especially in heavily pre-treated patients.
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