Bicky Thapa

Novel Systemic Treatments for Brain Metastases From Lung Cancer

Purpose of reviewBrain metastases are frequent complication of lung cancer and are associated with poor prognosis. Patients with brain metastases secondary to lung cancer have traditionally been managed with surgery and radiation with limited role for systemic chemotherapy. In the past decade, however, this paradigm has shifted largely due to the advent of targeted therapies and immunotherapies, both of which have demonstrated efficacy in the treatment of brain metastases and extracranial disease.Recent findingsWhile patients with brain metastases secondary to lung cancer have historically been excluded from trials, recent data suggest efficacy of novel targeted therapies and immunotherapies in these patients. In fact, there are multiple ongoing trials to further evaluate these therapies in this patient profile.SummaryTargeted therapies and immunotherapies have the potential to improve outcomes in patients with brain metastases secondary to lung cancer.

Management of Brain Metastases in the New Era of Checkpoint Inhibition

Purpose of the ReviewBrain metastasis is a common complication of advanced malignancies, especially, lung cancer, breast cancer, renal cell carcinoma, and melanoma. Traditionally surgery, when indicated, and radiation therapy, either as whole-brain radiation therapy or stereotactic radiosurgery, constituted the major treatment options for brain metastases. Until recently, most of the systemic chemotherapy agents had limited activity for brain metastases. However, with the advent of small molecule tyrosine kinase inhibitors and immunotherapy agents, there has been renewed interest in using these agents in the management of brain metastases.Recent FindingsImmune checkpoint inhibitors have revolutionized the treatment of metastatic melanoma, lung cancer, kidney cancer, and bladder cancer among others. They modulate the immune system to recognize tumor antigens as “non-self” antigens and mount an immune response against them.SummaryInitial studies of using immune checkpoint inhibitors in brain metastases have shown promising activity, and several clinical trials are currently underway. Studies are also assessing the combination of radiation therapy and immunotherapy in brain metastases. The results of these ongoing clinical trials have the potential to change the therapeutic paradigm in patients with brain metastases.

Colony-stimulating Factor 3 Receptor Mutated Chronic Neutrophilic Leukemia: A Rare Case Report

Chronic neutrophilic leukemia (CNL) is a rare myeloproliferative neoplasm, which is characterized by sustained peripheral leukocytosis with neutrophilia, hepatosplenomegaly, and hypercellularity of the bone marrow, with less than 5% myeloblasts along with normal neutrophil maturation and no dysplasia. In 2016, World Health Organization (WHO) included activating mutations in the gene for colony-stimulating factor 3 receptor (CSF3R) as one of the diagnostic criteria with CSF3RT618I being the most common mutation. We report a rare case of CNL (JAK2V617F negative, BCR-ABL1 negative, CSF3RT618I positive) in an elderly female who had an aggressive clinical course of the disease.

Management of a Rare Variant of Hypertrophic Cardiomyopathy

Apical hypertrophic cardiomyopathy (HCM) is a rare variant of HCM. We present the case of a 26-years-old female who was diagnosed with apical HCM. Her electrocardiogram showed the characteristic T-wave inversions in V2-V5 and her echocardiogram portrayed apical left ventricular hypertrophy. The diagnosis was confirmed with a cardiac magnetic resonance imaging (MRI) scan. She was treated with beta blockers. Our case emphasizes that apical HCM is a relatively benign disease. However, due to the emerging evidence of sudden cardiac deaths in these patients, the risk for sudden death needs to be evaluated.

Daratumumab proves safe and highly effective in AL amyloidosis

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An Excellent Clinical Outcome with Stereotactic Radiosurgery in a Geriatric Patient with Multiple and Recurrent Brain Metastases

The incidence of brain metastases range from 10 to 20% of all adult patients with cancer and lung cancer is associated with one of the highest incidences of brain metastases. In geriatric patients, who already have limited cognitive function, whole brain radiation therapy (WBRT) can be a problem. Stereotactic radiosurgery (SRS) is a one day, outpatient treatment with minimal effect to normal brain and could particularly be useful in elderly patients. We report the case of a geriatric patient with metastatic lung adenocarcinoma who had multiple brain metastases and recurrences, who responded well to the stereotactic radiosurgery (six sessions) with acceptable tumor control.