Sofosbuvir shows a protective effect against vertical transmission of Zika virus and the associated congenital syndrome in rhesus monkeys

The outbreaks of Zika virus (ZIKV) infection in Brazil, 2015-2016, were associated with severe congenital malformations. Our translational study aimed to test the efficacy of the antiviral agent sofosbuvir (SOF) against vertical transmission of ZIKV and the associated congenital syndrome (CZS), using a rhesus monkey model. Eight pregnant macaques were successfully infected during the organogenesis phase with a Brazilian ZIKV strain; five of them received SOF from two to fifteen days post-infection. Both groups of dams showed ZIKV-associated clinical signals, detectable ZIKV RNA in several specimens, specific anti-ZIKV IgM and IgG antibodies, and maternal neutralizing antibodies. However, malformations occurred only among non-treated dam offspring. Compared to non-treated animals, all SOF-treated dams had a shorter ZIKV viremia and four of five neonates had undetectable ZIKV RNA in blood and tissue samples. These results support further clinical evaluations aiming for the prevention of CZS.

Cerebrospinal fluid gastrin releasing peptide in the diagnosis of leptomeningeal metastases from small cell carcinoma

BACKGROUND

The clinical diagnosis of leptomeningeal metastases is often difficult to substantiate. Patients with an underlying malignancy typically present with neurologic symptoms referable to multiple levels of the neuraxis. Although most patients have an abnormal cerebrospinal fluid (CSF), less than 60% have evidence of malignant cells on cytologic examination from a single lumbar puncture, and the disease is usually advanced in patients with positive results. An elevated serum level of gastrin releasing peptide (GRP) in patients with small cell carcinoma has emerged as one of the most useful markers for disease activity.

METHODS

A patient with small cell carcinoma presented with signs of meningitis and an abnormal CSF. However, the CSF gave repeatedly negative cytologic results. Hence, serum and CSF were analyzed for GRP.

RESULTS

The CSF GRP level was elevated by more than six orders of magnitude above the serum level. An autopsy demonstrated extensive meningeal and parenchymal brain involvement by small cell carcinoma.

CONCLUSIONS

The diagnosis of leptomeningeal metastases in patients with small cell carcinoma can be established by CSF GRP testing, even when cytologic examination is negative.

Acute tumor lysis syndrome associated with concurrent biochemotherapy of metastatic melanoma: a case report and review of the literature

BACKGROUND

Treatment of solid tumors rarely has been associated with tumor lysis syndrome. However, to the authors' knowledge the clinical scenario has not been reported previously in melanoma patients.

METHODS

A patient with bulky metastatic melanoma was treated with concurrent biochemotherapy using interleukin-2, interferon-alpha, and a combination of cisplatin, vinblastine, and dacarbazine.

RESULTS

Within 24 hours of the initiation of treatment, brisk tumor lysis occurred and led to a fatal outcome.

CONCLUSIONS

Improvements in the treatment of solid tumors may increase the incidence of tumor lysis syndrome for tumors once believed to be marginally responsive. Oncologists should remain cognizant of this problem as more active regimens become available.

Efficacy of gemcitabine in the treatment of patients with gallbladder carcinoma: a case report

BACKGROUND

Advanced carcinoma of the gallbladder typically is unresponsive to chemotherapy, and patients with progressive metastatic disease have a short survival.

METHODS

A patient with advanced metastatic carcinoma of the gallbladder causing peritoneal carcinomatosis and hepatic metastases is reported. This patient achieved a dramatic remission with gemcitabine after failing two other chemotherapeutic regimens.

RESULTS

Response included reversal of complete small bowel obstruction with resumption of the ability to eat and the disappearance of liver metastases.

CONCLUSIONS

Gemcitabine appears to be worthy of organized clinical trials in patients with this notoriously chemotherapy-resistant malignancy.