Abstract YO28P
Case summary
ATC is an undifferentiated tumour and lethal. Conventional treatment has not demonstrated clear therapeutic efficacy in prolonging the survival in metastatic ATC. There are growing interest in the new molecular targeted therapies. We present the case of a patient with metastatic ATC who had a good response to ALK inhibitor.
The patient was a 44 years old woman who presented with the left neck swelling for two months that had progressed rapidly to the bilateral neck swelling, the axillary swelling and subsequently to an episode of seizure.
The CT brain showed a focal enhancing brain lesion at the left frontal lobe measuring 25x18mm. The positron emission tomography (PET) scan demonstrated metabolic active diseases at the thyroid gland, left frontal lobe of cerebrum, left lower lobe of lung and multiple nodal metastasis.
The histopathology of the right cervical lymph node biopsy showed metastatic carcinoma. Immunohistochemistry staining were positive for TTF-1, p40, p63, and thyroglobulin but were negative for CD30, Napsin A, BCL-2 and EBV-LMP-1. Based on all the findings stage IVC ATC was diagnosed.
The patient had a stereotactic radiosurgery (SRS) to the brain lesion. An extended NGS panel showed positive result for ALK-EML4 mutation. She was started on 250mg BD of the crizotinib and had noticed reduction in the size of the cervical node swelling however the treatment was then stopped as she developed crizotinib induced interstitial pneumonitis.
Ceritinib was started on the 9th November 2018. The cervical node swelling noticeably became smaller fourteen days later. Her condition remained stable during the subsequent clinics follow up.
A scheduled CT scan was performed at six months post treatment and showed a new metastatic deposit at right lower lobe lung nodule (1.4cm) with smaller and stable disease elsewhere. She had a radiofrequency ablation (RFA) to the right lower lung nodule, and the ceritinib was continued. She remained clinically stable to date.
ALK inhibitor was effective in controlling the disease in this patient with estimated progression free survival of approximately six months with the good quality of life. Molecular targeted therapy could be a new way forward in managing metastatic ATC.
Clinical trial identification
Editorial acknowledgement
Resources from the same session
YO31 - Primary pulmonary sarcoma
Presenter: Khilola Ubaydullaeva
Session: Poster display session
Resources:
Abstract
YO32 - prostatic rhabdomyosarcoma in an adult patient: A case study
Presenter: Muhammad Rafiqul Islam
Session: Poster display session
Resources:
Abstract
YO33 - Hyponatremia – slaying the dragon or chasing a mirage- a Case report
Presenter: Rahul D. Arora
Session: Poster display session
Resources:
Abstract
YO34 - A rare endocrinological syndrome presenting with weakness in Soft tissue sarcoma - a Case report
Presenter: Rahul D. Arora
Session: Poster display session
Resources:
Abstract
YO35 - Gefitinib induced movement disorder - a Case report
Presenter: Rahul D. Arora
Session: Poster display session
Resources:
Abstract
YO36 - A case of BRAF V600E mutated non-small-cell lung cancer with pleomorphic features
Presenter: Reiko Matsuzawa
Session: Poster display session
Resources:
Abstract
YO37 - Intraventricular metastasis as the first presentation of non-small cell lung cancer
Presenter: Siraphong Putraveephong
Session: Poster display session
Resources:
Abstract
YO38 - Cerebral metastases from a thymic malignancy: a case report
Presenter: Marfu'au Nik Eezamuddeen
Session: Poster display session
Resources:
Abstract
YO39 - Primary Follicular Thyroid Carcinoma Metastatic to the Kidney Mimicking Renal Cell Carcinoma: A Case Report
Presenter: Jestoni Aranilla
Session: Poster display session
Resources:
Abstract
YO40 - A Rare Case of Primary Malignant Giant Cell Tumor of Tibia
Presenter: Gowthami Venugopal
Session: Poster display session
Resources:
Abstract