RRx-001 Priming of PD-1 Inhibition in the Treatment of Small Cell Carcinoma of the Vagina : A Rare Gynecological Tumor

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Brzezniak , C , Oronsky , B , Trepel , J , Summers , T A , Cabrales , P , Lee , M-J , Day , R , Jha , S , Caroen , S , Zeman , K , Ferry , L , Harmer , C , Oronsky , N , Lybeck , M , Lybeck , H E , Brown , J F , Reid , T R & Carter , C A 2017 , ' RRx-001 Priming of PD-1 Inhibition in the Treatment of Small Cell Carcinoma of the Vagina : A Rare Gynecological Tumor ' , Case reports in oncology , vol. 10 , no. 1 , pp. 276-280 . https://doi.org/10.1159/000464101

Title: RRx-001 Priming of PD-1 Inhibition in the Treatment of Small Cell Carcinoma of the Vagina : A Rare Gynecological Tumor
Author: Brzezniak, Christina; Oronsky, Bryan; Trepel, Jane; Summers, Thomas A.; Cabrales, Pedro; Lee, Min-Jung; Day, Regina; Jha, Saheli; Caroen, Scott; Zeman, Karen; Ferry, Lindsey; Harmer, Cindy; Oronsky, Neil; Lybeck, Michelle; Lybeck, Harry E.; Brown, James F.; Reid, Tony R.; Carter, Corey A.
Contributor organization: Department of Physiology
Date: 2017
Language: eng
Number of pages: 5
Belongs to series: Case reports in oncology
ISSN: 1662-6575
DOI: https://doi.org/10.1159/000464101
URI: http://hdl.handle.net/10138/299311
Abstract: Small cell carcinoma of the vagina is rare, so rare in fact that the total number reported in English-language journals is less than 30. Due to this extremely low incidence, no specific treatment guidelines have been established, and most of what is clinically known is derived from a handful of single case reports. However, as befitting its highly aggressive histologic features, which are reminiscent of small cell lung cancer (SCLC), first-line treatment is modeled after SCLC. Herein is reported the case of a 51-year-old African-American patient with metastatic biopsy-proven small cell carcinoma of the vagina that progressed through multiple therapies: first-line cisplatin and etoposide (making it platinum-resistant) and radiotherapy, followed by the tumor macrophage-stimulating agent RRx-001 in a clinical trial called QUADRUPLE THREAT, which per protocol preceded a mandated rechallenge with cisplatin and etoposide. RECIST v.1.1 tumor progression on both RRx-001 and cisplatin/etoposide was accompanied by central necrosis in several of the enlarged lymph nodes and hepatic metastases, which may have been evidence of pseudoprogression, accounting for her ongoing longer-than-expected survival, since the necrotic tissue may have primed the activity of the PD-1 inhibitor. The lack of response to RRx-001 is hypothesized to have correlated with sparse tumor macrophage infiltration, seen on pre-and post-treatment biopsies, since the mechanism of action of RRx-001 relates to stimulation of tumor-associated macrophages. (C) 2017 The Author(s) Published by S. Karger AG, Basel
Subject: Small cell carcinoma
Vagina
Tumor-associated macrophage stimulation
Immunotherapy
Chemotherapy
Pseudoprogression
RRx-001
PSEUDOPROGRESSION
PATIENT
3122 Cancers
Peer reviewed: Yes
Rights: cc_by_nc
Usage restriction: openAccess
Self-archived version: publishedVersion


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