Articles

Refractory pyrexia caused by BRAF and MEK inhibitors: Colchicine as salvage

BJMO - volume 16, issue 3, may 2022

M. Saerens MD, I. Hilderson MD, L. Brochez MD, PhD, A. Hoorens MD, PhD, C. Jacobs MD

SUMMARY

Pyrexia is a frequent complication of the treatment with BRAF and MEK inhibitors. Its management includes a full infectious workup, initiation of paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), dose interruption and steroids. In rare cases, pyrexia is refractory to steroids. Pathogenesis of pyrexia shows similarities with familial Mediterranean fever, a disease that usually responds well to colchicine. This study presents a case of refractory pyrexia due to BRAF and MEK inhibitors in metastatic melanoma, successfully treated with colchicine, which paved the path for a significant treatment response.

(BELG J MED ONCOL 2022;16(3):128–32)

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RAS-testing in colorectal cancer: Belgian guidelines

BJMO - volume 9, issue 5, september 2015

A. Jouret-Mourin MD, PhD, C. Cuvelier MD, PhD, P. Demetter MD, PhD, N. D’Haene MD, PhD, A. Driessen MD, PhD, A. Hoorens MD, PhD, N. Nagy MD, X. Sagaert MD, P. Pauwels MD, PhD, On behalf of the Working Group of Digestive Pathology and the Belgian Society of Pathology.

There is an urgent need for predictive biomarkers in several cancers. In colorectal cancers, KRAS exon 2 mutation analyses were mandatory when considering anti-epidermal growth factor antibody therapy with agents such as cetuximab or panitumumab. However, since the introduction of this testing, a cohort of patients still did not appear to benefit from this therapy. Recently, additional testing for KRAS exon 3 and 4, and NRAS considerably improved the predictive power for therapy success. Therefore, an update of the Belgian guidelines for RAS testing was urgently needed.

(BELG J MED ONCOL 2015;9(5):183–90)

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Mixed adenoneuroendocrine carcinoma (MANEC) of the colon: molecular pathogenesis and treatment

BJMO - volume 9, issue 1, february 2015

L. Vanacker MD, D. Smeets PhD, A. Hoorens MD, PhD, E. Teugels PhD, R. Algaba MD, M.F. Dehou MD, A. De Becker MD, D. Lambrechts PhD, J. De Grève MD, PhD

We present the case of a 30-year-old male patient with a high grade neuroendocrine carcinoma and an adenocarcinoma developed in a tubulovillous adenoma of the colon, with diffuse liver metastasis. He underwent a right hemicolectomy and received four courses of postoperative chemotherapy with cisplatin and etoposide, followed by high dose chemotherapy with autologous stem cell support. After this treatment there was a complete biochemical and radiological remission. Now, 48 months after diagnosis the patient is alive and in unmaintained complete remission. The occurrence of a high grade neuroendocrine carcinoma in a low grade colon adenocarcinoma without any intermediate phenotypes was intriguing. Comparative exome sequencing of DNA from the malignant components revealed six somatic changes in cancer consensus genes. In both tumours, we detected mutations in APC and KRAS, as well as in BCL9 and FOXP1. Only in the neuroendocrine carcinoma component did we find a mutation in SMARCA4. All mutations were absent in germ-line DNA. The finding of several identical somatic mutations in both components in the subsequent exome sequencing supports a clonal relationship between the neuroendocrine carcinoma and the synchronous adenocarcinoma. We suggest that a mutation in SMARCA4A may be responsible for the abrupt transition to the aggressive neuroendocrine phenotype.

(BELG J MED ONCOL 2015;9(1):31–34)

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