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Cervical cancer; Checkpoint inhibitor; Immunotherapy Cáncer de cuello uterino; Inhibidor de puntos de control; Inmunoterapia Càncer cervical; Inhibidor de punts de control; Immunoteràpia Objective This phase II clinical trial evaluated the safety and antitumor activity of balstilimab, an anti-PD-1 antibody, in patients with previously-treated, recurrent/metastatic cervical cancer. Methods Eligible patients were 18 years or older with recurrent and/or metastatic cervical cancer and who had relapsed after a prior platinum-based treatment regimen for advanced disease. Balstilimab was administered intravenously at 3 mg/kg once every two weeks, for up to 24 months. The primary endpoint was objective response rate (ORR, RECIST v1.1) as assessed by an independent review committee. Results At data cutoff, 161 women (median age, 53 years [range 25–81]) were enrolled and treated with balstilimab. Of these, 140 had measurable disease at baseline and one prior line of platinum-based therapy in the metastatic, persistent, or recurrent setting; these patients were included in the efficacy analyses. The ORR was 15% (95% CI, 10.0%–21.8%) and included 5 patients with a complete response and 16 with a partial response. The median duration of response was 15.4 months. In patients with PD-L1-positive tumors the ORR was 20%, however patients with PD-L1-negative tumors also responded to balstilimab (ORR, 7.9%). Responses were not restricted to tumors of squamous cell histology, and an ORR of 12.5% was seen in the subset of patients with cervical adenocarcinoma. The disease control rate was 49.3% (95% CI, 41.1%–57.5%). Immune-mediated enterocolitis (3.1%) and diarrhea (1.9%) were the most common grade 3 or higher treatment-related adverse events. Conclusion Balstilimab demonstrated meaningful and durable clinical activity, with manageable safety, in patients with previously-treated, recurrent/metastatic cervical cancer. This study was funded by Agenus Inc.

Meningeal carcinomatosis (MC) occurs in up to 5% of breast cancer patients. Few studies have evaluated prognostic markers in breast cancer patients with MC. Our aim was to describe the treatment of breast cancer patients with MC, and identify prognostic factors related to survival. Sixty breast cancer patients that had a diagnosis of MC between January 2003 and December 2009 were included. The median age was 46 years (range 27-76). Most patients had invasive ductal carcinoma (78.3%) and high histological/nuclear grade (61.7/53.3%). Estrogen and progesterone receptors were positive in 51.7 and 43.3% of patients, respectively, and 15% were HER-2-positive. Symptoms at presentation were headache, cranial nerve dysfunction, seizures, and intracranial hypertension signals. Diagnosis was made by CSF cytology in 66.7% of cases and by MRI in 71.7%. Intrathecal (IT) chemotherapy was used in 68.3% of patients, and 21.6% received a new systemic treatment (chemo- or hormone therapy). Median survival was 3.3 months (range 0.03-90.4). There was no survival difference according to age, nuclear grade, hormonal and HER-2 status, CSF features, sites of metastasis, systemic and IT chemotherapy, or radiotherapy. However, histological grade and performance status had a significant impact on survival in the multivariate analysis. Only four papers have addressed prognostic factors in breast cancer patients with MC in the last two decades. The results of those reports are discussed here. High histological grade and poor performance status seem to impact survival of breast cancer patients with MC. Prospective studies are necessary to clarify the role of IT and systemic treatment in the treatment of those patients.

ObjectiveCervical cancer is a public health problem. A large proportion of patients have locally advanced (LA) disease at presentation and for this group, neoadjuvant chemotherapy (NACT) has an undefined role in the era of chemoradiotherapy. In countries with restricted access to radiotherapy, NACT may precipitate patients’ access to an effective treatment approach. We carried out a systematic review to evaluate available data about NACT followed by chemoradiation.MethodsStudies evaluated the use of NACT followed by chemoradiotherapy. Search strategy was performed in MEDLINE, LILACS, and Cochrane Library from 2003 to 2013. Conference proceedings of American Society of Clinical Oncology annual meeting, International Journal of Gynecological Cancer Society biennial meeting, and European Society of Gynecological Oncology biennial meeting were also reviewed. Key words used were “cervical uterine cancer,” “cervical uterine neoplasm,” “neoadjuvant therapy,” “neoadjuvant treatment,” and “locally advanced.” Data collected included author information, year of publication, study design, number of participants, eligibility criteria, treatment, response rate (RR), disease-free survival, overall survival, and toxicities.ResultsInitial searches retrieved 7670 references. There were 7 eligible trials. Only 2 studies were published and a total of 323 participants were recruited. Patients with LA disease were eligible in most of them. Neoadjuvant chemotherapy consisted of paclitaxel combined with a platinum compound. Compliance was more than 90% in published trials. Response rate to NACT ranged from 67.8% to 70%. Major toxicity was hematological. Survival was evaluated in different points in time. Overall survival was up to 93% in 2 years, and in a poor prognostic group, 81% of patients were alive after 22 months. However, we must interpret these results with caution because of data limitation.ConclusionsOur result raises the possibility of NACT as an alternative upfront treatment for these patients with a small risk of disease progression. In countries where radiotherapy network is limited, randomized clinical trials should clarify its role.

CONTEXT: Non-small cell lung cancer (NSCLC) progresses to distant metastases in most cases. The most frequent sites for distant metastases are the bones, central nervous system, adrenal glands and liver. Dissemination to the skin, myocardium, thyroid gland and intestine may occur, but is rare. CASE REPORT: We describe a case of squamous cell carcinoma in the lungs, with metastases in the colon and thyroid, in a 66-year-old female patient. The lesion was unresectable and chemotherapy was started. The patient evolved with intestinal subocclusion, and colonoscopy showed the presence of a polyp. Biopsy and immunohistochemical analysis on the polyp showed that it was compatible with squamous cell carcinoma of pulmonary origin. At a follow-up consultation, the patient presented a thyroid nodule. A aspiration biopsy and cellblock immunohistochemistry confirmed the squamous cell carcinoma of pulmonary origin. After third-line chemotherapy, the patient progressed with acute obstructive abdomen due to a retroperitoneal mass. She underwent exploratory laparotomy and died due to surgical complications. Metastases to the thyroid and colon are rarely reported in cases of epidermoid carcinoma of the lungs. Gastrointestinal involvement in pulmonary metastases may affect the stomach, small intestine and colon, and cases of bleeding and perforation have already been reported. Although richly vascularized, the thyroid is an infrequent site for metastases. Such sites reflect poor prognoses for the clinical evolution. We did not find any previous reports in the literature, on lung cancer with metastases concomitantly in the colon and thyroid, in a single patient.