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Complete response to FOLFOX4 therapy in a patient with advanced urothelial cancer: a case report.

Seo YR, Kim SH, Kim HJ, Kim CK, Park SK, Koh ES, Hong DS - J Hematol Oncol (2010)

Bottom Line: However, he had new liver, lung metastases and synchronous two separate primary colon cancer.The lung metastasis lesion was confirmed as a metastatic urothelial cancer via percutaneous transthoracic needle biopsy (PTNB).The patient was still showing a complete response after 4 months.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Hematology & Oncology, Department of Internal Medicine Soonchunhyang University College of Medicine, Bucheon, Korea.

ABSTRACT
No standard has been established for salvage therapy in gemcitabine refractory advanced urothelial cancer. We report the complete response to FOLFOX4 therapy of a metastatic urothelial cancer patient, for whom adjuvant gemcitabine plus cisplatin combination chemotherapy had failed. A 54-year-old male patient with urothelial cancer (transitional cell carcinoma) in the right kidney underwent three rounds of adjuvant gemcitabine-cisplatin chemotherapy after extensive radical nephrectomy. However, he had new liver, lung metastases and synchronous two separate primary colon cancer. The lung metastasis lesion was confirmed as a metastatic urothelial cancer via percutaneous transthoracic needle biopsy (PTNB). Liver and lung metastasis lesions disappeared after the 4th cycle of FOLFOX4 chemotherapy. In addition, colon cancer also disappeared after the 8th cycle of FOLFOX4 chemotherapy. The patient was still showing a complete response after 4 months. Clinical trials using the FOLFOX regimen as salvage therapy for gemcitabine-refractory advanced urothelial cancer are warranted.

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A, B: Chest CT demonstrating hematogenous metastastatic nodule in RML (arrow, A) disappeared after 4th FOLFOX4 cycles (B). C, D: Chest CT demonstrating hematogenous metastastatic nodule in LLL (arrow, C) that formed fibrotic cavity after 4th FOLFOX4 cycles (D).
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Figure 2: A, B: Chest CT demonstrating hematogenous metastastatic nodule in RML (arrow, A) disappeared after 4th FOLFOX4 cycles (B). C, D: Chest CT demonstrating hematogenous metastastatic nodule in LLL (arrow, C) that formed fibrotic cavity after 4th FOLFOX4 cycles (D).

Mentions: While performing a colonoscopy to investigate hematochezia, a second primary cancer, an adenocarcinoma of the colon, was discovered in the transverse (anal verge 50 cm) and sigmoid (anal verge 20 cm) colon. The level of carcinoembryonic antigen (CEA) was normal, and abdominal CT showed 1.7-cm wall thickening in the sigmoid colon, but no measurable changes in the transverse colon. Moreover, multiple lung metastases were seen on chest CT (Figure 2A, 2C). A lung metastasis was confirmed to be urothelial cancer after a percutaneous transthoracic needle biopsy (Figure 1B) performed on a left lower lobe posterior segment metastatic lesion. The patient underwent FOLFOX-4 (oxaliplatin 85 mg/m2 IV over 2 hours D1; leucovorin 200 mg/m2 over 2 hrs, D1, 2; 5-fluorouracil (5-FU) 400 mg/m2 IV bolus, and 5-FU 600 mg/m2 IV over 22 hrs as a continuous infusion repeated every 2 weeks) for colon cancer and metastatic urothelial cancer, because he refused surgery for the colon cancer. After four rounds of chemotherapy, the lung metastases all disappeared, except one fibrotic cavitary lung lesion (Figure 2B, 2D). There was no hematologic or non-hematologic toxicity other than mild grade 1 nausea, and no delayed treatment schedule. Abdominal and chest CT performed after eight rounds of chemotherapy still showed no metastatic lesions, and positron emission tomography-computed tomography (PET-CT) showed no metastatic lesion (Figure 3A), with no 18F- fluoro-2-deoxyglucose (FDG) uptake in the fibrotic cavitary lesion in the lung (Figure 3B). In addition, CR of the colon cancer seen in the transverse and descending colon was also confirmed by colonoscopy and PET-CT after eight rounds of chemotherapy. Nevertheless, regional radiotherapy and rescue chemotherapy are being considered because of enlargement of a left para-aortic lymph node seen on abdominal and chest CT after the twelve rounds of FOLFOX chemotherapy. Therefore complete response was maintained for four months, from after four rounds (11/2008) until twelve rounds (3/2009) of FOLFOX chemotherapy.


Complete response to FOLFOX4 therapy in a patient with advanced urothelial cancer: a case report.

Seo YR, Kim SH, Kim HJ, Kim CK, Park SK, Koh ES, Hong DS - J Hematol Oncol (2010)

A, B: Chest CT demonstrating hematogenous metastastatic nodule in RML (arrow, A) disappeared after 4th FOLFOX4 cycles (B). C, D: Chest CT demonstrating hematogenous metastastatic nodule in LLL (arrow, C) that formed fibrotic cavity after 4th FOLFOX4 cycles (D).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2818621&req=5

Figure 2: A, B: Chest CT demonstrating hematogenous metastastatic nodule in RML (arrow, A) disappeared after 4th FOLFOX4 cycles (B). C, D: Chest CT demonstrating hematogenous metastastatic nodule in LLL (arrow, C) that formed fibrotic cavity after 4th FOLFOX4 cycles (D).
Mentions: While performing a colonoscopy to investigate hematochezia, a second primary cancer, an adenocarcinoma of the colon, was discovered in the transverse (anal verge 50 cm) and sigmoid (anal verge 20 cm) colon. The level of carcinoembryonic antigen (CEA) was normal, and abdominal CT showed 1.7-cm wall thickening in the sigmoid colon, but no measurable changes in the transverse colon. Moreover, multiple lung metastases were seen on chest CT (Figure 2A, 2C). A lung metastasis was confirmed to be urothelial cancer after a percutaneous transthoracic needle biopsy (Figure 1B) performed on a left lower lobe posterior segment metastatic lesion. The patient underwent FOLFOX-4 (oxaliplatin 85 mg/m2 IV over 2 hours D1; leucovorin 200 mg/m2 over 2 hrs, D1, 2; 5-fluorouracil (5-FU) 400 mg/m2 IV bolus, and 5-FU 600 mg/m2 IV over 22 hrs as a continuous infusion repeated every 2 weeks) for colon cancer and metastatic urothelial cancer, because he refused surgery for the colon cancer. After four rounds of chemotherapy, the lung metastases all disappeared, except one fibrotic cavitary lung lesion (Figure 2B, 2D). There was no hematologic or non-hematologic toxicity other than mild grade 1 nausea, and no delayed treatment schedule. Abdominal and chest CT performed after eight rounds of chemotherapy still showed no metastatic lesions, and positron emission tomography-computed tomography (PET-CT) showed no metastatic lesion (Figure 3A), with no 18F- fluoro-2-deoxyglucose (FDG) uptake in the fibrotic cavitary lesion in the lung (Figure 3B). In addition, CR of the colon cancer seen in the transverse and descending colon was also confirmed by colonoscopy and PET-CT after eight rounds of chemotherapy. Nevertheless, regional radiotherapy and rescue chemotherapy are being considered because of enlargement of a left para-aortic lymph node seen on abdominal and chest CT after the twelve rounds of FOLFOX chemotherapy. Therefore complete response was maintained for four months, from after four rounds (11/2008) until twelve rounds (3/2009) of FOLFOX chemotherapy.

Bottom Line: However, he had new liver, lung metastases and synchronous two separate primary colon cancer.The lung metastasis lesion was confirmed as a metastatic urothelial cancer via percutaneous transthoracic needle biopsy (PTNB).The patient was still showing a complete response after 4 months.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Hematology & Oncology, Department of Internal Medicine Soonchunhyang University College of Medicine, Bucheon, Korea.

ABSTRACT
No standard has been established for salvage therapy in gemcitabine refractory advanced urothelial cancer. We report the complete response to FOLFOX4 therapy of a metastatic urothelial cancer patient, for whom adjuvant gemcitabine plus cisplatin combination chemotherapy had failed. A 54-year-old male patient with urothelial cancer (transitional cell carcinoma) in the right kidney underwent three rounds of adjuvant gemcitabine-cisplatin chemotherapy after extensive radical nephrectomy. However, he had new liver, lung metastases and synchronous two separate primary colon cancer. The lung metastasis lesion was confirmed as a metastatic urothelial cancer via percutaneous transthoracic needle biopsy (PTNB). Liver and lung metastasis lesions disappeared after the 4th cycle of FOLFOX4 chemotherapy. In addition, colon cancer also disappeared after the 8th cycle of FOLFOX4 chemotherapy. The patient was still showing a complete response after 4 months. Clinical trials using the FOLFOX regimen as salvage therapy for gemcitabine-refractory advanced urothelial cancer are warranted.

Show MeSH
Related in: MedlinePlus