Khobta Nataliya, Tomasini Pascale, Garcia Marie-Eve, Garcia Stéphane, Barlesi Fabrice
Aix-Marseille Université, Assistance publique - Hôpitaux de Marseille, Service d'oncologie multidisciplinaire & Innovations thérapeutiques, chemin des Bourrely, Marseille cedex, France.
Bull Cancer. 2012 Nov;99(11):1065-8. doi: 10.1684/bdc.2012.1643.
β-HCG belongs to the glycoprotein hormone family and is usually assess to exclude pregnancy for patients potentially eligible to chemotherapy, especially during clinical trials. We studied non-small-cell lung cancer (NSCLC) patients that were found with elevated serum β-HCG level during clinical trial screening. The first case is a 45-year-old woman who presented with a stage IV undifferentiated carcinoma of the lung eligible for chemotherapy. When screening the patient for a clinical trial combining platinum-based chemotherapy and targeted therapy, the plasma β-HCG level was 19 IU/L (0-5 IU/L). The second case is a 64-year-old woman presented with stage IV poorly differentiated adenocarcinoma of the lung. When screening the patient for the same clinical trial combining platinum-based chemotherapy and targeted therapy, the plasma β-HCG level was β-HCG 13 IU/L (0-5 IU/L). The serum dosages were double-checked and confirmed elevated β-HCG level. The gynecological work-up definitely rules out an improbable pregnancy. The pathological examination was also checked and confirmed in the two cases a primary lung cancer. An immuno-histochemical reassessment of the pathological specimens with additional tests was performed: for one patient 25% of tumor cells expressed β-HCG. As pregnancies were ruled out, the two cases were extensively discussed with the promoter and the patients finally treated within this clinical trial. The treatments are ongoing. β-HCG is a specific marker for trophoblastic tumors of placenta and gestational tumors. Ectopic expression of β-HCG was found in 20-40% of all common epithelial carcinoma, especially for tumors of the stomach, ovary, liver and lung. Only few cases have been reported in the literature. However, in a young patient with high serum levels of β-HCG two questions arise: is there a place for pregnancy? Are the pathology results accurate? All this could delay the appropriate management of these patients and also potentially prevents the participation of innovative therapeutic strategies. Therefore, knowing this rare but possible expression of β-HCG by lung tumors may speed out the gynecological work-up and the reevaluation of the histological samples in order to minimize the delay in the care of these patients and give them a chance to have new innovative drugs within clinical trial.
β-HCG属于糖蛋白激素家族，通常用于评估可能适合化疗的患者是否怀孕，尤其是在临床试验期间。我们研究了在临床试验筛查期间血清β-HCG水平升高的非小细胞肺癌（NSCLC）患者。第一例是一名45岁女性，患有IV期未分化肺癌，适合化疗。在对该患者进行铂类化疗联合靶向治疗的临床试验筛查时，血浆β-HCG水平为19 IU/L（0-5 IU/L）。第二例是一名64岁女性，患有IV期低分化肺腺癌。在对该患者进行相同的铂类化疗联合靶向治疗的临床试验筛查时，血浆β-HCG水平为13 IU/L（0-5 IU/L）。血清剂量经过复查，确认β-HCG水平升高。妇科检查明确排除了不可能怀孕的情况。病理检查也在这两例中得到证实为原发性肺癌。对病理标本进行了免疫组织化学重新评估及额外检测：一名患者25%的肿瘤细胞表达β-HCG。由于排除了怀孕，这两例患者与发起者进行了广泛讨论，最终在该临床试验中接受治疗。治疗正在进行中。β-HCG是胎盘滋养层肿瘤和妊娠肿瘤的特异性标志物。在所有常见上皮癌中，20%-40%发现有β-HCG异位表达，尤其是胃、卵巢、肝脏和肺部的肿瘤。文献中仅报道了少数病例。然而，在一名血清β-HCG水平高的年轻患者中会出现两个问题：是否存在怀孕情况？病理结果是否准确？所有这些都可能延迟对这些患者的适当治疗，也可能阻碍创新治疗策略的参与。因此，了解肺肿瘤这种罕见但可能的β-HCG表达情况，可能会加快妇科检查和组织学样本的重新评估，以尽量减少这些患者治疗的延迟，并使他们有机会在临床试验中使用新的创新药物。
