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NAKAGAKI Y, KAI K, KOMOHARA Y, TAKEZAKI T, KURODA J, SHINOJIMA N, SHIMOMURA M, KAWAKAMI F, MIKAMI Y, MUKASA A. Gliosarcoma with Systemic Metastasis Showing Favorable Response to Ifosfamide, Carboplatin, and Etoposide Chemotherapy: An Autopsy Case Report. NMC Case Rep J 2022; 9:263-268. [PMID: 36186622 PMCID: PMC9484818 DOI: 10.2176/jns-nmc.2022-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/06/2022] [Indexed: 11/20/2022] Open
Abstract
Gliosarcoma is a rare malignant neoplasm. It accounts for approximately 2% of all glioblastomas. To date, there is no established treatment method for gliosarcoma, and a variety of therapies, such as surgical resection, radiotherapy, and chemotherapy, are typically employed. Here, we describe a patient with gliosarcoma who, despite multiple tumor metastases throughout the body, including the lungs and lymph nodes, achieved a relatively long survival due to salvage therapy with local irradiation and remarkably effective chemotherapy with low-dose ifosfamide, carboplatin, and etoposide therapy. When the patient died, we performed autopsy and confirmed the nature of the primary and metastatic tumor cells that had spread throughout the patient's body. Clinical and systemic histological studies also suggested the possibility of re-metastasis to the brain from systemic metastatic foci. Gliosarcoma appears to have characteristics similar to sarcoma as well as a higher risk of systemic metastasis. Therefore, a careful follow-up is necessary in such patients.
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Affiliation(s)
- Yuki NAKAGAKI
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University
| | - Keitaro KAI
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University
| | - Yoshihiro KOMOHARA
- Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University
| | - Tatsuya TAKEZAKI
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University
| | - Junichiro KURODA
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University
| | - Naoki SHINOJIMA
- Department of Diagnostic Pathology, Graduate School of Medical Sciences, Kumamoto University
| | - Mari SHIMOMURA
- Department of Diagnostic Pathology, Graduate School of Medical Sciences, Kumamoto University
| | - Fumi KAWAKAMI
- Department of Diagnostic Pathology, Graduate School of Medical Sciences, Kumamoto University
| | - Yoshiki MIKAMI
- Department of Diagnostic Pathology, Graduate School of Medical Sciences, Kumamoto University
| | - Akitake MUKASA
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University
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Clinical Evidence for Thermometric Parameters to Guide Hyperthermia Treatment. Cancers (Basel) 2022; 14:cancers14030625. [PMID: 35158893 PMCID: PMC8833668 DOI: 10.3390/cancers14030625] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 01/01/2023] Open
Abstract
Hyperthermia (HT) is a cancer treatment modality which targets malignant tissues by heating to 40-43 °C. In addition to its direct antitumor effects, HT potently sensitizes the tumor to radiotherapy (RT) and chemotherapy (CT), thereby enabling complete eradication of some tumor entities as shown in randomized clinical trials. Despite the proven efficacy of HT in combination with classic cancer treatments, there are limited international standards for the delivery of HT in the clinical setting. Consequently, there is a large variability in reported data on thermometric parameters, including the temperature obtained from multiple reference points, heating duration, thermal dose, time interval, and sequence between HT and other treatment modalities. Evidence from some clinical trials indicates that thermal dose, which correlates with heating time and temperature achieved, could be used as a predictive marker for treatment efficacy in future studies. Similarly, other thermometric parameters when chosen optimally are associated with increased antitumor efficacy. This review summarizes the existing clinical evidence for the prognostic and predictive role of the most important thermometric parameters to guide the combined treatment of RT and CT with HT. In conclusion, we call for the standardization of thermometric parameters and stress the importance for their validation in future prospective clinical studies.
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Issels RD, Lindner LH, von Bergwelt-Baildon M, Lang P, Rischpler C, Diem H, Mosetter B, Eckl J, Schendel DJ, Salat C, Stötzer O, Burdach S, von Luettichau-Teichert I, Handgretinger R, Neumann J, Kirchner T, Steiger K, Boxberg M, Mansmann U, Multhoff G, Noessner E. Systemic antitumor effect by regional hyperthermia combined with low-dose chemotherapy and immunologic correlates in an adolescent patient with rhabdomyosarcoma - a case report. Int J Hyperthermia 2020; 37:55-65. [PMID: 31918587 DOI: 10.1080/02656736.2019.1709666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Introduction: An abscopal effect is a clinical observation whereby a local treatment is associated with regression of metastatic cancer at a site distant from the primary location of treatment. Here, we describe the clinical systemic effect induced by regional hyperthermia combined with low-dose chemotherapy and provide immunologic correlates.Case presentation: A 15-year-old patient had been diagnosed with alveolar rhabdomyosarcoma (ARMS). All previous treatment options failed in the patient including haploidentical stem cell transplantation and donor lymphocyte infusion. The patient presented with local and metastatic disease, and upon admission, underwent regional hyperthermia combined with low-dose chemotherapy. Immediately following therapy severe skin reactions were observed. Skin biopsies revealed an intraepithelial lymphocytic infiltration dominated by CD3+/CD8+ T cells with a regular network of dendritic cells. Clinical images compared before and during sequential treatment cycles showed complete metabolic response of the local tumor for more than 10 months of therapy. In addition, metastases completely regressed although they were not direct targets of regional hyperthermia. The systemic effect was associated with enhanced frequency of NK cells and T cells expressing the lectin-like natural-killer group 2 D activating receptor (NKG2D), an increase of the CD56bright subset of NK cells, as well as an increase of effector/memory and effector CD8+ and CD4+ T cells in the blood while the percentage of CD25+FOXP3+ regulatory T cells declined.Conclusions: Regional hyperthermia combined with low-dose chemotherapy had the potential to create a systemic effect which was associated with activation of NK cells and T cells.
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Affiliation(s)
- Rolf D Issels
- Department of Medicine III, University Hospital, Munich, Germany
| | - Lars H Lindner
- Department of Medicine III, University Hospital, Munich, Germany
| | | | - Peter Lang
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital, Tuebingenthe, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, Technical University Munich, Munich, Germany
| | - Heinz Diem
- Laboratory for Hematological Diagnostics, Gauting, Germany
| | - Barbara Mosetter
- Immunoanalytics Research Group - Tissue Control of Immunocytes & Core Facility, Helmholtz Center, Munich, Germany
| | | | | | - Christoph Salat
- Medical Center for Hematology and Oncology Munich, Munich, Germany
| | - Oliver Stötzer
- Medical Center for Hematology and Oncology Munich, Munich, Germany
| | - Stefan Burdach
- Department of Pediatrics and Children's Cancer Research Center, Technical University of Munich, Munich, Germany
| | | | - Rupert Handgretinger
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital, Tuebingenthe, Germany
| | | | | | - Katja Steiger
- Institute of Pathology, Technical University Munich, Munich, Germany
| | - Melanie Boxberg
- Institute of Pathology, Technical University Munich, Munich, Germany
| | - Ulrich Mansmann
- Institute of Biostatistics and Epidemiology, LMU, Munich, Germany
| | - Gabriele Multhoff
- Radiation Immune-Oncology Group, Center for Translational Cancer Research, Technical University Munich, Munich, Germany
| | - Elfriede Noessner
- Immunoanalytics Research Group - Tissue Control of Immunocytes & Core Facility, Helmholtz Center, Munich, Germany
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Ifosfamide, Carboplatin, and Etoposide (ICE) in Combination with Regional Hyperthermia as Salvage Therapy in Patients with Locally Advanced Nonmetastatic and Metastatic Soft-Tissue Sarcoma. Sarcoma 2020; 2020:6901678. [PMID: 32189990 PMCID: PMC7068144 DOI: 10.1155/2020/6901678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 01/23/2020] [Indexed: 11/18/2022] Open
Abstract
Patients with localized relapse of soft-tissue sarcoma (STS) after anthracycline-based chemotherapy have a dismal prognosis, particularly when surgery is not possible. To facilitate resection and improve long-term tumor control, we applied an intensified perioperative treatment consisting of ICE (ifosfamide 6 g/m2, carboplatin 400 mg/m2, and etoposide 600 mg/m2) in combination with regional hyperthermia (RHT) to maximize local control. Here, we retrospectively evaluate the safety and efficacy of this strategy. Patients aged ≥18 years with locally advanced high-risk STS, either with or without metastasis, treated with ICE + RHT after the failure of first-line anthracycline-based chemotherapy were included in this analysis. Radiographic response, toxicity, progression-free survival (PFS), and overall survival (OS) were assessed. Between 1996 and 2018, 213 sarcoma patients received ICE at our centre. Of these, 110 patients met the selection criteria (progressive disease, suitable high-grade STS histology, anthracycline pretreatment, RHT treatment) for this analysis. Fifty-four patients had locally advanced disease without metastases (LA-STS), and 56 patients had additional metastatic disease (M-STS). Disease control was achieved in 59% of LA-STS patients and in 47% of M-STS patients. For LA-STS, 21% of the patients achieved radiographic response, facilitating resection in 4 patients (7%), compared with 11% of the M-STS patients, facilitating resection in 5 patients (9%). PFS was significantly longer in LA-STS than in M-STS (10 vs. 4 months, p < 0.0001). Median OS was 26 months in LA-STS and 12 months in M-STS. Disease control was the only independent prognostic factor for improved OS in multivariate analysis. Toxicity was high with neutropenic fever occurring in 25% of the patients and three therapy-related deaths (3%). ICE + RHT demonstrated activity in high-risk STS and facilitated resection in selected patients after anthracycline failure. Disease control was associated with improved OS. Based on the observed toxicities, the dose should be reduced to 75%.
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Abstract
Metal-based drugs and imaging agents are extensively used in the clinic for the treatment and diagnosis of cancers and a wide range of other diseases. The current clinical arsenal of compounds operate via a limited number of mechanisms, whereas new putative compounds explore alternative mechanisms of action, which could potentially bring new chemotherapeutic approaches into the clinic. In this review, metal-based drugs and imaging agents are characterized according to their primary mode of action and the key properties and features of each class of compounds are defined, wherever possible. A better understanding of the roles played by metal compounds at a mechanistic level will help to deliver new metal-based therapies to the clinic, by providing an alternative, targeted and rational approach, to supplement non-targeted screening of novel chemical entities for biological activity.
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Clavel CM, Nowak-Sliwinska P, Păunescu E, Dyson PJ. Thermoresponsive fluorinated small-molecule drugs: a new concept for efficient localized chemotherapy. MEDCHEMCOMM 2015. [DOI: 10.1039/c5md00409h] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We review the drugs used in combination with hyperthermia for cancer therapy and recent advances on small thermoresponsive molecules.
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Affiliation(s)
- Catherine M. Clavel
- Institut des Sciences et Ingénierie Chimiques
- Ecole Polytechnique Fédérale de Lausanne (EPFL)
- CH-1015 Lausanne
- Switzerland
| | - Patrycja Nowak-Sliwinska
- Institut des Sciences et Ingénierie Chimiques
- Ecole Polytechnique Fédérale de Lausanne (EPFL)
- CH-1015 Lausanne
- Switzerland
| | - Emilia Păunescu
- Institut des Sciences et Ingénierie Chimiques
- Ecole Polytechnique Fédérale de Lausanne (EPFL)
- CH-1015 Lausanne
- Switzerland
| | - Paul J. Dyson
- Institut des Sciences et Ingénierie Chimiques
- Ecole Polytechnique Fédérale de Lausanne (EPFL)
- CH-1015 Lausanne
- Switzerland
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Radaelli S, Stacchiotti S, Casali PG, Gronchi A. Emerging therapies for adult soft tissue sarcoma. Expert Rev Anticancer Ther 2014; 14:689-704. [DOI: 10.1586/14737140.2014.885840] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Wismeth C, Dudel C, Pascher C, Ramm P, Pietsch T, Hirschmann B, Reinert C, Proescholdt M, Rümmele P, Schuierer G, Bogdahn U, Hau P. Transcranial electro-hyperthermia combined with alkylating chemotherapy in patients with relapsed high-grade gliomas: phase I clinical results. J Neurooncol 2009; 98:395-405. [PMID: 20033471 DOI: 10.1007/s11060-009-0093-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Accepted: 12/07/2009] [Indexed: 10/20/2022]
Abstract
Non-invasive loco-regional electro-hyperthermia (EHT) plus alkylating chemotherapy is occasionally used as salvage treatment in the relapse of patients with high-grade gliomas. Experimental data and retrospective studies suggest potential effects. However, no prospective clinical results are available. We performed a single-center prospective non-controlled single-arm Phase I trial. Main inclusion criteria were recurrent high-grade glioma WHO Grade III or IV, age 18-70, and Karnofsky performance score > or = 70. Primary endpoints were dose-limiting toxicities (DLT) and maximum tolerated dose (MTD) with the combined regimen. Groups of 3 or 4 patients were treated 2-5 times a week in a dose-escalation scheme with EHT. Alkylating chemotherapy (ACNU, nimustin) was administered at a dose of 90 mg/m(2) on day 1 of 42 days for up to six cycles or until tumor progression (PD) or DLT occurred. Fifteen patients with high-grade gliomas were included. Relevant toxicities were local pain and increased focal neurological signs or intracranial pressure. No DLT occurred. In some patients, the administration of mannitol during EHT or long-term use of corticosteroids was necessary to resolve symptoms. Although some patients showed responses in their primarily treated sites, the pattern of response was not well defined. EHT plus alkylating chemotherapy is tolerable in patients with relapse of high-grade gliomas. Episodes of intracranial pressure were, at least, possibly attributed to EHT but did not cause DLTs. A Phase II trial targeting treatment effects is warranted on the basis of the results raised in this trial.
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Affiliation(s)
- Caecilia Wismeth
- Department of Neurology, University of Regensburg Medical School (UKR), Universitätsstrasse 84, 93053, Regensburg, Germany
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Moussavian PA, Solimando DA, Waddell JA. Ifosfamide, Carboplatin, and Etoposide (ICE) for Metastatic Soft Tissue Sarcoma. Hosp Pharm 2008. [DOI: 10.1310/hpj4311-878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The complexity of cancer chemotherapy requires that pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparation, dispensing, and administration of antineoplastic therapy and the agents, both commercially available and investigational, used to treat malignant diseases. The views expressed in this article are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense, or the United States Government.
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Affiliation(s)
- Parvaneh A. Moussavian
- Hematology-Oncology Pharmacy Service, Department of Pharmacy, Walter Reed Army Medical Center, Washington, DC
| | - Dominic A. Solimando
- Oncology Pharmacy Services, Inc., 4201 Wilson Blvd. #110-545, Arlington, VA 22203
| | - J. Aubrey Waddell
- University of Tennessee College of Pharmacy; Oncology Pharmacist, Pharmacy Department, Blount Memorial Hospital, 907 E. Lamar Alexander Parkway, Maryville, TN 37804
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Issels RD. Hyperthermia adds to chemotherapy. Eur J Cancer 2008; 44:2546-54. [PMID: 18789678 DOI: 10.1016/j.ejca.2008.07.038] [Citation(s) in RCA: 395] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Revised: 07/17/2008] [Accepted: 07/24/2008] [Indexed: 01/11/2023]
Abstract
The hallmarks of hyperthermia and its pleotropic effects are in favour of its combined use with chemotherapy. Preclinical research reveals that for heat killing and synergistic effects the thermal dose is most critical. Thermal enhancement of drug cytotoxicity is accompanied by cellular death and necrosis without increasing its oncogenic potential. The induction of genetically defined stress responses can deliver danger signals to activate the host's immune system. The positive results of randomised trials have definitely established hyperthermia in combination with chemotherapy as a novel clinical modality for the treatment of cancer. Hyperthermia targets the action of chemotherapy within the heated tumour region without affecting systemic toxicity. In specific clinical settings regional hyperthermia (RHT) or hyperthermic perfusion has proved its value and deserve a greater focus and investigation in other malignancies. In Europe, more specialised centres should be created and maintained as network of excellence for hyperthermia in the field of oncology.
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Affiliation(s)
- Rolf D Issels
- University of Munich, Campus Grosshadern, Medical Clinic III, Munich, Germany.
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Ebeling P, Eisele L, Schuett P, Bauer S, Schuette J, Moritz T, Seeber S, Flasshove M. Docetaxel and Gemcitabine in the Treatment of Soft Tissue Sarcoma – A Single-Center Experience. ACTA ACUST UNITED AC 2008; 31:11-6. [DOI: 10.1159/000111756] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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