Artcile about the ASPS case on a trial with pseudoprogression
Posted: Fri Mar 01, 2019 1:55 pm
I found an excellent article about the ASPS patient from Oregon on this trial, well written with the detailed descr. of the case overall. Of great interest is the reporting of the pseudoprogression after six doses - which is usually expected be occur in the beginning of the trial, first few doses.
Pseudoprogression of CNS metastatic disease of alveolar soft part sarcoma during anti-PDL1 treatment
https://www.sciencedirect.com/science/a ... 3318301687
"After six doses, she began to experience worsening headaches. Brain MRI confirmed enlargement of multiple brain metastases, most notably in the right temporal lobe (Fig. 1A-D) and right cerebellum, with extensive surrounding edema and 5-mm midline shift. Nineteen months prior, the temporal lobe lesion had been treated to 30 Gy and 5 months prior, to 20 Gy. The cerebellar lesion had been treated 13 months prior to 20 Gy. The patient then underwent uncomplicated diagnostic and therapeutic right temporal and cerebellar craniotomies for resection of these two lesions with 3 days of corticosteroids administered perioperatively. Upon pathologic review, no viable tumor was identified. The surgical specimens contained primarily necrotic tissue with extensive lymphocytic infiltrate as denoted by histology results of increase CD8 staining post-treatment"
They used contrast-enhanced MRI and were unable to find out that the mets were dead till they were resected as both enhancement and diameter were found as increased on the contrast-enhanced MRI.
Pseudoprogression of CNS metastatic disease of alveolar soft part sarcoma during anti-PDL1 treatment
https://www.sciencedirect.com/science/a ... 3318301687
"After six doses, she began to experience worsening headaches. Brain MRI confirmed enlargement of multiple brain metastases, most notably in the right temporal lobe (Fig. 1A-D) and right cerebellum, with extensive surrounding edema and 5-mm midline shift. Nineteen months prior, the temporal lobe lesion had been treated to 30 Gy and 5 months prior, to 20 Gy. The cerebellar lesion had been treated 13 months prior to 20 Gy. The patient then underwent uncomplicated diagnostic and therapeutic right temporal and cerebellar craniotomies for resection of these two lesions with 3 days of corticosteroids administered perioperatively. Upon pathologic review, no viable tumor was identified. The surgical specimens contained primarily necrotic tissue with extensive lymphocytic infiltrate as denoted by histology results of increase CD8 staining post-treatment"
They used contrast-enhanced MRI and were unable to find out that the mets were dead till they were resected as both enhancement and diameter were found as increased on the contrast-enhanced MRI.