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Brzezniak CE, Vietor N, Hogan PE, Oronsky B, Thilagar B, Ray CM, Caroen S, Lybeck M, Oronsky N, Carter CA. A Case of Paraneoplastic Cushing Syndrome Presenting as Hyperglycemic Hyperosmolar Nonketotic Syndrome. Case Rep Oncol 2017; 10:321-324. [PMID: 28512417 PMCID: PMC5422740 DOI: 10.1159/000467390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/01/2017] [Indexed: 11/19/2022] Open
Abstract
Carcinoid tumors are neuroendocrine tumors that mainly arise in the gastrointestinal tract, lungs, and bronchi. Bronchopulmonary carcinoids have been associated with Cushing syndrome, which results from ectopic adrenocorticotrophic hormone (ACTH) secretion. We report the case of a 65-year-old man, a colonel in the US Air Force, with metastatic bronchopulmonary carcinoid tumors treated on a clinical trial who was hospitalized for complaints of increasing thirst, polydipsia, polyuria, weakness, and visual changes. Decompensated hyperglycemia suggested a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Additional findings, which included hypokalemia, hypernatremia, hypertension, metabolic alkalosis, moon facies, and striae, raised a red flag for an ectopic ACTH syndrome. Elevated ACTH levels confirmed Cushing syndrome. Treatment with a fluid replacement and insulin drip resulted in immediate symptomatic improvement. Cushing syndrome should be considered in carcinoid patients with physical stigmata such as moon facies and striae. HHNS may be the presenting clinical feature in patients with impaired glucose metabolism.
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Affiliation(s)
| | - Nicole Vietor
- aWalter Reed National Military Medical Center, Bethesda, MD, USA
| | - Patricia E Hogan
- aWalter Reed National Military Medical Center, Bethesda, MD, USA
| | | | | | | | | | | | | | - Corey A Carter
- aWalter Reed National Military Medical Center, Bethesda, MD, USA
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Oronsky B, Ray CM, Spira AI, Trepel JB, Carter CA, Cottrill HM. A brief review of the management of platinum-resistant-platinum-refractory ovarian cancer. Med Oncol 2017; 34:103. [PMID: 28444622 DOI: 10.1007/s12032-017-0960-z] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 04/12/2017] [Indexed: 11/25/2022]
Abstract
Ovarian cancer, which ranks fifth in cancer deaths among women, is the most lethal gynecologic malignancy. Epithelial ovarian cancer (EOC) is the most common histologic type, with the 5-year survival for all stages estimated at 45.6%. This rate increases to more than 70% in the minority of patients who are diagnosed at an early stage, but declines to 35% in the vast majority of patients diagnosed at advanced stage. Recurrent EOC is incurable. Platinum sensitivity (or lack thereof) is a major determinant of prognosis. The current standard treatment is primary surgery followed by platinum-based chemotherapy. In recurrent platinum-resistant/platinum-refractory EOC, sequential single-agent salvage chemotherapy is superior to multiagent chemotherapy. Multiagent regimens increase toxicity without clear benefit; however, no preferred sequence of single agents is recommended. The impact of targeted therapies and immunotherapies on progression-free survival and overall survival, which remains dismal, is under active investigation. Currently, clinical trials offer the best hope for the development of a new treatment paradigm in this recalcitrant disease.
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Affiliation(s)
- Bryan Oronsky
- EpicentRx Inc, 4445 Eastgate Mall, Suite 200, San Diego, CA, 92121, USA.
| | | | | | - Jane B Trepel
- Developmental Therapeutics Branch NIH, Bethesda, MD, USA
| | - Corey A Carter
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Hope M Cottrill
- Baptist Health Medical Group, Gynecologic Oncology, Lexington, KY, USA
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Oronsky N, Thilagar B, Ray CM, Caroen S, Lybeck MM, Ferry L, Voves RA, Oronsky B. Cushing’s Syndrome, Cortisol, and Cognitive Competency: A Case Report. Case Rep Oncol 2017; 10:325-327. [PMID: 28512418 PMCID: PMC5422746 DOI: 10.1159/000470833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 03/10/2017] [Indexed: 11/19/2022] Open
Abstract
Glucocorticoids are associated with immunosuppression and neuropsychiatric complications. We describe the case of a carcinoid patient with Cushing's syndrome (CS) and neurocognitive impairment due to ectopic ACTH production who developed sepsis and died because of his family's decision to withdraw antibiotic treatment. This report is presented to illustrate the importance of advanced-care planning in patients with CS.
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Affiliation(s)
| | - Bennett Thilagar
- bEpicentRx, Inc., San Diego, CA, USA
- *Bennett Thilagar, MD, EpicentRx, Inc., 4445 Eastgate Mall, Suite 200, San Diego, CA 92121 (USA), E-Mail
| | - Carolyn M. Ray
- cSt. Francis Hospital and Medical Center Hartford, Hartford, CT, USA
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Oronsky B, Paulmurugan R, Foygel K, Scicinski J, Knox SJ, Peehl D, Zhao H, Ning S, Cabrales P, Summers TA, Reid TR, Fitch WL, Kim MM, Trepel JB, Lee MJ, Kesari S, Abrouk ND, Day RM, Oronsky A, Ray CM, Carter CA. RRx-001: a systemically non-toxic M2-to-M1 macrophage stimulating and prosensitizing agent in Phase II clinical trials. Expert Opin Investig Drugs 2017; 26:109-119. [PMID: 27935336 DOI: 10.1080/13543784.2017.1268600] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION According to Hanahan and Weinberg, cancer manifests as six essential physiologic hallmarks: (1) self-sufficiency in growth signals, (2) insensitivity to growth-inhibitory signals, (3) evasion of programmed cell death, (4) limitless replicative potential, (5) sustained angiogenesis, and (6) invasion and metastasis. As a facilitator of these traits as well as immunosuppression and chemoresistance, the presence of tumor-associated macrophages (TAMs) may serve as the seventh hallmark of cancer. Anticancer agents that successfully reprogram TAMs to target rather than support tumor cells may hold the key to better therapeutic outcomes. Areas covered: This article summarizes the characteristics of the macrophage-stimulating agent RRx-001, a molecular iconoclast, sourced from the aerospace industry, with a particular emphasis on the cell-to-cell transfer mechanism of action (RBCs to TAMs) underlying its antitumor activity as well as its chemo and radioprotective properties, consolidated from various preclinical and clinical studies. Expert opinion: RRx-001 is macrophage-stimulating agent with the potential to synergize with chemotherapy, radiotherapy and immunotherapy while simultaneously protecting normal tissues from their cytotoxic effects. Given the promising indications of activity in multiple tumor types and these normal tissue protective properties, RRx-001 may be used to treat a broad spectrum of malignancies, if it is approved in the future.
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Affiliation(s)
| | | | - Kira Foygel
- b Department of Radiology , Stanford University , Palo Alto , CA , USA
| | | | - Susan J Knox
- c Department of Radiation Oncology , Stanford University , Palo Alto , CA , USA
| | - Donna Peehl
- d Department of Urology , Stanford University , Palo Alto , CA , USA
| | - Hongjuan Zhao
- d Department of Urology , Stanford University , Palo Alto , CA , USA
| | - Shoucheng Ning
- c Department of Radiation Oncology , Stanford University , Palo Alto , CA , USA
| | - Pedro Cabrales
- f Department of Bioengineering , University of California at San Diego (UCSD ) , La Jolla , CA , USA
| | - Thomas A Summers
- g Murtha Cancer Center , Walter Reed National Military Medical Center ; Bethesda , MD , USA
| | - Tony R Reid
- h Moores Cancer Center , University of California at San Diego (UCSD) , CA , USA
| | - William L Fitch
- e Department of Anesthesia , Stanford University , Palo Alto , CA , USA
| | | | - Jane B Trepel
- i National Cancer Institute , National Institutes of Health , Bethesda , MD , USA
| | - Min-Jung Lee
- i National Cancer Institute , National Institutes of Health , Bethesda , MD , USA
| | - Santosh Kesari
- j John Wayne Cancer Institute, Providence Saint John's Health Center , CA , USA
| | | | - Regina M Day
- l Department of pharmacology , Uniformed Services University , Bethesda , MD , USA
| | | | - Carolyn M Ray
- n Cancer Center, St. Francis Hospital , Hartford , CT , USA
| | - Corey A Carter
- g Murtha Cancer Center , Walter Reed National Military Medical Center ; Bethesda , MD , USA
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Abstract
BACKGROUND Current treatment recommendations for malignant melanoma in situ include surgical excision with at least 0.5 cm margins. On the head or neck, obtaining adequate surgical margins for melanoma can be challenging and often disfiguring. In addition, some elderly patients may not be good surgical candidates and may request less aggressive interventions. METHODS We report herein three cases of malignant melanoma in situ on the face treated with topical imiquimod cream. RESULTS Complete regression of malignant melanoma in situ was observed on treatment with 5% topical imiquimod cream. The varied treatment regimens, rationale for using imiquimod rather than performing surgery, and the possible mechanisms of action are discussed. CONCLUSIONS Topical imiquimod can be used successfully for the treatment of malignant melanoma in situ on the face.
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Affiliation(s)
- Carolyn M Ray
- University of Connecticut Health Center, Department of Hematology/Oncology, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
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Dye L, Harris T, Ray CM, Waldhalm S. Computer use in private veterinary practice. J Am Vet Med Assoc 1994; 204:888-90. [PMID: 8188510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- L Dye
- Department of Business Education and Office Administration, Ball State University, Muncie, IN 47306
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