Extraordinary clinical response to ibrutinib in low-grade ovarian cancer guided by organoid drug testing

Low-grade serous ovarian cancer (LGSOC) typically responds poorly to standard platinum-based chemotherapy and new therapeutic approaches are needed. We describe a remarkable response to targeted therapy in a patient with platinum-resistant, advanced LGSOC who had failed standard-of-care chemotherapy and two surgeries. The patient was in rapid decline and entering hospice care on home intravenous (i.v.) opioid analgesics and a malignant bowel obstruction requiring a G-tube. Genomic analysis of the patient's tumor did not indicate obvious therapeutic options. In contrast, a CLIA-certified drug sensitivity assay of an organoid culture derived from the patient's tumor identified several therapeutic choices, including Bruton's tyrosine kinase (BTK) inhibitor ibrutinib, as well as the EGFR inhibitors afatinib and erlotinib. Following off-label administration of daily ibrutinib as monotherapy, the patient had an exceptional clinical turnaround over the following 65 weeks with normalization of CA-125 levels, resolution of the malignant bowel obstruction, halting of pain medications, and improvement of performance status from ECOG 3 to ECOG 1. After 65 weeks of stable disease, the patient's CA-125 levels began to rise, at which point the patient discontinued ibrutinib and began taking afatinib as monotherapy. The patient's CA-125 levels remained stable for an additional 38 weeks but due to anemia and rising CA-125 levels, the patient switched to erlotinib and is currently being monitored. This case highlights the clinical utility of ex vivo drug testing of patient-derived tumor organoids as a new functional precision medicine approach to identify effective personalized therapies for patients who have failed standard-of-care treatments.

[New possibility of genetic characterization of human papillomavirus in pathology of male and female genitalia]

Several epidemiologic studies point to the role of different sublines of Human Papillomavirus (HPV) in the development of neoplasias of the genito-rectal tract. The spread of the virus in the population makes it necessary to constantly investigate this pathogen in order to adopt a correct therapeutic approach and follow the evolution of associated disease. This paper gives an epidemiologic outline of HPV infection in the adult population--males and females--based on a correlated study of the relationship between the lesion and the presence of the virus and its sublines. The methods used both traditional examinations (colposcopy, cytology, histology) and innovative chemiluminescence molecular biology techniques. Chemiluminescence molecular hybridization includes the use of RNA probes which, on the basis the identification of different viral strains, allow a subdivision of infections into low and high/medium risk. The test resulted positive in 60.7% of the cases in which there was clinical and cyto-histopathological evidence of HPV infection. Notwithstanding the high percentage of negative results in the cases of condylomatous disease, the method used has proved to be easily applicable and more sensitive than other molecular biology techniques (comparison by in situ hybridization and Southern blot analysis). Moreover, from the clinical point of view, it seems to provide useful data for a correct diagnosis and monitoring of patients.

[A clinical study of cyclopyroxolamine versus clotrimazole in the treatment of mycotic vulvovaginitis]

The therapeutic efficacy and tolerability of the antifungal agent ciclopiroxolamine have been verified with a double-blind study versus clotrimazole in 46 patients affected by vulvovaginal candidiasis. The patients of the first group (23) have been treated with ciclopiroxolamine globules, one 100 mg globule nightly for six days; the second group (23 patients) received clotrimazole vaginal tablets, one 200 mg tablet nightly for six days. Ciclopiroxolamine treatment showed an equivalent effectiveness to that of clotrimazole both on signs and symptoms and on vaginal smear culture. No local or systemic adverse reaction was observed.

[Experience with preoperative preventive care in obstetrics and gynecology]

The clinical behaviour and post-operative course of 60 patients who had undergone obstetrics or gynaecological surgery is compared. In 30 cases (20 obstetric and 10 gynaecological), antibiotic prophylaxis took the form of a single i.m. injection of 600 mg of lincomycin and 80 mg of gentamycin, 30 minutes before the operation. In the remaining 30 cases (20 obstetric, 10 gynacological), the antibiotic cover was administered postoperatively by i.v. injection of doxicyclin (100 mg every 12 hours for 3 days and 100 mg every 12 hours per os for a further 2 days). From a comparison of the 2 groups, and keeping obstetric and gynaecological cases separate, it is concluded that preoperative antibiotic prophylaxis is comparable in its results to post-operative antibiotic cover. Postoperative haematochemical tests were also done and, as has been reported, showed no significant alterations from the tests administered preoperatively, thus confirming the high tolerance of the drugs in question in the above-stated doses. No cochleovestibular disturbances were encountered nor were drug-resistant bacteriological strains. The efficacy of this prophylactic treatment is confirmed and though comparable in results to the alternative postoperative types is indubitably advantageous both in the lower cost to the community and the short duration of the treatment itself.