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Impact of the Identification of Nonhuman Genetic Signatures in the Diagnosis and Management of Carcinoma of Unknown Primary.
- Source :
-
Journal of the National Comprehensive Cancer Network : JNCCN [J Natl Compr Canc Netw] 2023 Dec 27; Vol. 22 (1D), pp. e237079. Date of Electronic Publication: 2023 Dec 27. - Publication Year :
- 2023
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Abstract
- This report presents the case of a 62-year-old woman who was diagnosed in 1999 with stage I cervical carcinoma treated by surgical resection. In 2021, she presented to the emergency department with a complaint of predominantly right-sided lower back pain. A CT scan of the lumbosacral region revealed a bone lesion in the L5 vertebra and retroperitoneal lymphadenopathies suggestive of malignancy. Histology of the L5 vertebra biopsy showed a poorly differentiated carcinoma with an inconclusive immunophenotypic profile. Treatment for carcinoma of unknown primary was started with a combination of carboplatin and paclitaxel every 21 days. A genomic study of the biopsy specimen performed on the FoundationOne CDx platform identified a nonhuman genetic signature compatible with HPV. The presence of HPV 18 DNA in the specimen was confirmed by PCR-reverse dot blot, and the immunophenotypic profile was expanded, revealing strong and diffuse p16 expression, thus corroborating the molecular findings. In view of these findings, the case was reclassified as a recurrence of the cervical adenocarcinoma that had been diagnosed and treated 23 years earlier. Based on the new results, and according to first-line cervical carcinoma protocols, bevacizumab at 15 mg/kg every 21 days was added to her chemotherapy regimen. The identification of HPV DNA sequences by next-generation sequencing facilitated the correct diagnosis and led to a modification of the first-line therapeutic approach.
Details
- Language :
- English
- ISSN :
- 1540-1413
- Volume :
- 22
- Issue :
- 1D
- Database :
- MEDLINE
- Journal :
- Journal of the National Comprehensive Cancer Network : JNCCN
- Publication Type :
- Academic Journal
- Accession number :
- 38150820
- Full Text :
- https://doi.org/10.6004/jnccn.2023.7079