Ashley Sumrall

Lenalidomide stops progression of multifocal epithelioid hemangioendothelioma including intracranial disease

Epithelioid Hemangioendothelioma (EH) is a rare soft-tissue tumor which may present as an isolated tumor or can spread to affect internal organs. The course of EH varies, based on the tissue of origin. This case report describes a young woman who developed cutaneous EH with concurrent intracranial disease during pregnancy. After resection, the lesions returned. Even after several courses of chemotherapy and radiotherapy, the patient developed multifocal disease including pulmonary, skeletal, and liver disease. She now exhibits stable disease after approximately 6 years of therapy with lenalidomide.

BCNU wafer placement with temozolomide (TMZ) in the immediate postoperative period after tumor resection followed by radiation therapy with TMZ in patients with newly diagnosed high grade glioma: final results of a prospective, multi-institutional, phase II trial

Temozolomide (TMZ) and BCNU have demonstrated anti-glioma synergism in preclinical models. We report final data from a prospective, multi-institutional study of BCNU wafers and early TMZ followed by radiation therapy with TMZ in patients with newly diagnosed malignant glioma. 65 patients were consented in 4 institutions, and 46 patients (43 GBM, 3 AA) were eligible for analysis. After resection and BCNU wafer placement, TMZ began on day four postoperatively. Radiation and TMZ (RT/TMZ) were then administered, followed by monthly TMZ at 200xa0mg/m2 for the first 26 patients, which was reduced to 150xa0mg/m2 for the remaining 20 patients. Non-hematologic toxicities were minimal. Nine of 27 patients (33xa0%) who received 200xa0mg/m2 TMZ, but only 1 of 20 (5xa0%) who received 150xa0mg/m2, experienced grade 3/4 thrombocytopenia. Median progression free survival (PFS) and overall survival (OS) period was 8.5 and 18xa0months, respectively. The 1-year OS rate was 76xa0%, which is a significant improvement compared with the historical control 1-year OS rate of 59xa0% (pxa0=xa00.023). However, there was no difference in 1-year OS compared with standard RT/TMZ (pxa0=xa00.12) or BCNU wafer followed by RT/TMZ (pxa0=xa00.87) in post hoc analyses. Early post-operative TMZ can be safely administered with BCNU wafers following resection of malignant glioma at the 150xa0mg/m2 dose level. Although there was an OS benefit compared to historical control, there was no indication of benefit for BCNU wafers and early TMZ in addition to standard RT/TMZ or early TMZ in addition to regimens of BCNU wafers followed by RT/TMZ.

Dermatofibrosarcoma Protuberans and Small Bowel Adenocarcinoma: Coincidental Occurrence or Genetic Association?

A case of multiple malignancies in a 41 year old African American man is described. After surgical excision and radiotherapy of dermatofibrosarcoma protuberans, the patient developed small bowel adenocarcinoma. We propose a common etiology to these canceres via tumor suppressor gene p53.

ATNT-27ASSESSING THE SAFETY OF COMBINATION THERAPY WITH BEVACIZUMAB AND OPTUNETM FOR HIGH GRADE GLIOMAS.

BACKGROUND: The prognosis for patients with high grade gliomas remains dismal. In addition to cytotoxic therapy, the FDA has approved bevacizumab and OptuneTM (Tumor Treating Fields) for recurrent glioblastoma. Given the prognosis and multiple treatment options, many clinicians have elected to offer combined therapy. We examined our patient population at two institutions where combination therapy has been used. METHODS: We retrospectively reviewed clinical courses of all patients receiving OptuneTM who have been concurrently managed with bevacizumab or experienced prior therapy with bevacizumab. Toxicity was described for those patients. Patients who received OptuneTM for at least 4 weeks with concurrent bevacizumab were analyzed for overall survival from time of initiation of concurrent therapy. RESULTS: We identified 37 patients, 26 males and 11 females. Of those, 33 patients received concurrent therapy, and all of those patients had prior bevacizumab exposure. OptuneTM was started as single therapy in 4 patients after bevacizumab exposure and failure. 6 patients experienced contact dermatitis which did not delay therapy. 1 patient had a small skin erosion which did not delay therapy. 2 patients had small skin erosions which delayed OptuneTM therapy. 1 patient had folliculitis and skin erosions and ulcers which necessitated cessation of therapy. 1 patient had a grade 2 intracranial bleed with no clinical sequelae aside from the need to hold bevacizumab. 29 patients received this therapy for at least 4 weeks. Median duration of concurrent therapy was 4 months. Median OS from initiation of concurrent therapy was 5.3 months. CONCLUSIONS: In our dataset, there was no toxicity appreciated aside from mild skin toxicity in the majority of patients. Combining bevacizumab and OptuneTM does not appear to significantly increase risk of bleeding or stroke. The incidence and severity of skin reactions were comparable to those described previously. Additional trials to investigate this combination are ongoing.