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Pembrolizumab, a programmed death 1 inhibitor, has been shown to have clinically significant efficacy in different types of cancer, providing long-term survival benefit for patients with lung cancer. Herein, we report the development of a primary thyroid cancer in a lung cancer patient that was being treated with pembrolizumab. Primary thyroid malignancy (and not only metastatic disease or immunotherapy-induced thyroiditis) should be considered in patients with lung cancer being treated with immune checkpoint inhibitors who develop new incidental thyroid lesions on imaging studies.

BACKGROUND: Fibroblast growth factors (FGFs) have a fundamental role in cancer. Sequestering FGFs with GSK3052230 (FP-1039) blocks their ability to activate FGFRs while avoiding toxicities associated with small molecule inhibitors of FGFR, including hyperphosphatemia and retinal, nail, and skin toxicities. METHODS: A multicenter, open-label, phase Ib study evaluated weekly GSK3052230 added to pemetrexed/cisplatin in patients with treatment-naive, unresectable malignant pleural mesothelioma. Doses were escalated according to a 3 + 3 design, followed by cohort expansion at the maximum tolerated dose (MTD). Endpoints included safety, overall response rate, progression-free survival, and pharmacokinetics. RESULTS: 36 patients were dosed at 10, 15, and 20 mg/kg doses of GSK3052230. Three dose-limiting toxicities were observed at 20 mg/kg and one at 15 mg/kg. The MTD was defined as 15 mg/kg and used for cohort expansion. The most common treatment-related adverse events (AEs) were nausea (56%), decreased appetite (36%), infusion reactions (36%), decreased neutrophil counts (36%), and fatigue (33%). The confirmed ORR was 39% (95% CI: 23.1–56.5) (14/36 PRs) and 47% had stable disease (17/36), giving a disease control rate of 86%. At 15 mg/kg GSK3052230 (n = 25), the ORR was 44% (95% CI: 24.4–65.1), and the median PFS was 7.4 months (95% CI: 6.7–13.4). Four patients had disease control for over 1 year, and three were still ongoing. CONCLUSION: At 15 mg/kg weekly, GSK3052230 was well tolerated in combination with pemetrexed/cisplatin and durable responses were observed. Importantly, AEs associated with small molecule inhibitors of FGFR were not observed, as predicted by the unique mechanism of action of this drug.

Resumen Introduccion Los inhibidores del factor de crecimiento epidermico (EGFR) son unos nuevos agentes antineoplasicos en creciente desarrollo. Se utilizan fundamentalmente como tratamiento de segunda linea de tumores en estadios avanzados. La aparicion de una erupcion acneiforme facial en pacientes tratados con estos farmacos es frecuente y caracteristica. La literatura propone multiples opciones de tratamiento, tanto topico como sistemico. Hasta el momento, no hay una evidencia clara sobre ninguno de ellos. Pacientes y metodos Realizamos un estudio descriptivo de 6 pacientes que han sido tratados con doxiciclina en dosis de 100 mg diarios durante 3 semanas. Analizamos las caracteristicas clinicas de los pacientes y la eficacia del tratamiento. Resultados Cinco de los seis pacientes alcanzan la curacion total de la erupcion acneiforme con este tratamiento. Un paciente alcanza una respuesta parcial. Tras largos periodos de seguimiento, y a pesar de continuar el tratamiento con los inhibidores del EGFR, no se observa recaida. Conclusiones La doxicilina se plantea como un tratamiento eficaz en esta patologia. A pesar de ser una serie corta, los resultados en nuestros pacientes avalan dicha eficacia.

Epidermal growth factor inhibitors (EGFR) are new antineoplastic agents that are increasingly being developed. They are basically used as second line treatment in advanced stage tumors. Appearance of a facial acneiform rash in patients treated with these drugs is common and characteristic. The literature proposes multiple topical and systemic treatment options. Up to now, there is no clear evidence on any of them.A descriptive study of 6 patients who were treated with 100 mg daily dose of doxycycline for 3 weeks was conducted. Clinical characteristics of the patients and treatment efficacy were analyzed.Five of the six patients achieved total resolution of the acneiform rash with this treatment. One patient achieved partial response. After long follow-up periods and in spite of following treatment with the EGFR inhibitors, no relapse was observed.Doxycycline is suggested as an effective treatment in this disease. Even though it is a short series, the results in our patients support this efficacy.