Brunetti Oronzo, Badalamenti Giuseppe, De Summa Simona, Calabrese Angela, Argentiero Antonella, Fucci Livia, Longo Vito, Galetta Domenico, Perrotti Pia Maria Soccorsa, Pinto Rosamaria, Petriella Daniela, Danza Katia, Tommasi Stefania, Leonetti Francesco, Silvestris Nicola
Medical Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco, 65, 70124 Bari, Italy.
Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, 90127 Palermo, Italy.
Cancers (Basel). 2019 May 29;11(6):749. doi: 10.3390/cancers11060749.
The management of multiple primary cancers, an event not so infrequent in oncology practice, is a critical issue due to the lack of literature. In this study, we reported the case of a patient with non-small cell metastatic lung cancer (NSCLC) and pancreatic ductal adenocarcinoma (PDAC) who received gefitinib in combination with gemcitabine plus nab-paclitaxel and with mFOLFOX6 in first and second line, respectively. It achieved a progression-free survival and a28-months overall survival (OS) for NSCLC and PFS-1 and OS of 20 and 13 months, respectively for PDAC. Moreover, the combination of gefitinib and chemotherapy treatmentsshowed a good safety profile. Given the insignificant frequency of this case, we performed a molecular characterization of both neoplasms with the aim to investigate the existence of particular activated pathways and/or similar immunological mutations. It is interesting to note that two neoplasms shared a common mutation ofthe B7-H3 gene, with the consecutive impairment of its expressed protein. In both PDAC and NSCLC, the expression of this protein was associated with a worse survival rate. Since B7-H3 is an anti-apoptotic protein, the reduction of its expression or function should justify a pro-apoptotic activity with a leading justification of the long survival of the patient considered in this report.
多原发性癌症的管理在肿瘤学实践中并非罕见事件，但由于缺乏相关文献，它仍是一个关键问题。在本研究中，我们报告了一例非小细胞转移性肺癌（NSCLC）和胰腺导管腺癌（PDAC）患者的病例，该患者一线接受吉非替尼联合吉西他滨加纳米白蛋白结合型紫杉醇治疗，二线接受mFOLFOX6治疗。NSCLC实现了无进展生存期和28个月的总生存期（OS），PDAC的无进展生存期-1（PFS-1）和总生存期分别为20个月和13个月。此外，吉非替尼与化疗联合治疗显示出良好的安全性。鉴于该病例的发生率较低，我们对两种肿瘤进行了分子特征分析，以研究特定激活途径和/或相似免疫突变的存在情况。值得注意的是，两种肿瘤均存在B7-H3基因的共同突变，其表达蛋白随之受损。在PDAC和NSCLC中，该蛋白的表达均与较差的生存率相关。由于B7-H3是一种抗凋亡蛋白，其表达或功能的降低应能证明具有促凋亡活性，这也是本报告中该患者长期生存的主要原因。
