Criminal or bystander: imatinib and second primary malignancy in GIST patients

Niigata University Hospital is a regional center institution of cancer therapy where many patients with gastrointestinal stromal tumors （GISTs） are visiting to seek the latest treatment.During the time Ⅰ was treating GIST patients there with imatinib,a tyrosine kinase inhibitor,a small concern was raised：Ⅰ successively encountered patients who were newly diagnosed as having malignant neoplasms during the course of their treatment.Of the 70 GIST patients who were enrolled in our prospective study of imatinib therapy,seven suffered from second primary malignancies （SPMs）.One female GIST patient who suffered from advanced esophageal cancer died of the SPM,whereas the remaining six patients continued with their imatinib therapy and their prognoses were not affected by their SPMs.I reported on the risk of SPMs in GIST patients under imatinib therapy to an international journal of clinical oncology （1）.As the patient cohort of our study was so small in number to apply to statistical analysis,our observation was no more than a clinical alert.

Gastrointestinal stromal tumors and second primary malignancies before and after the introduction of imatinib mesylate

Gastrointestinal stromal tumor （GIST） is the most common mesenchymal malignancy of the gastrointestinal tract.GISTs may coexist with different types of cancer,either synchronous or metachronous （1）.Most GISTs develop in a sporadic fashion,but familial occurrence,such as neurofibromatosis and Carney-triad,has also been reported （2）.The overall frequency of second tumors in different series varied from 4.5% to 33%.The most frequent types of GIST-associated cancers were gastrointestinal carcinomas （47%）,lymphoma/leukemia （7%）,carcinomas of prostate （9%）,breast （7%）,kidney （6%）,lung （5%）,female genital tract （5%）,carcinoid tumors （3%）,soft tissue and bone sarcomas （3%）,malignant melanoma （2%） and seminoma （1%） （1,3-5）.

Risk of second primary lung cancer in patients with thyroid cancer:a meta-analysis based on big population studies

Background:Previous studies have revealed that the number of cancer survivors developing a second primary malignancy is increasing,especially among thyroid cancer patients,and lung cancer is still the main cause of cancer death.Therefore,we aimed to investigate the risk of second primary lung cancer(SPLC)in patients with thyroid cancer.Methods:We searched the PubMed,Web of Science,Embase,and Scopus databases up to November 24,2021,for relevant research and merged the standardized incidence ratios(SIRs)and 95%confidence intervals(95%CIs)to evaluate the risk of developing SPLC in patients with thyroid cancer.Results:Fourteen studies involving 1,480,816 cases were included in our meta-analysis.The pooled result demonstrated that thyroid cancer patients may have a higher risk of SPLC than the general population(SIR=1.21,95%CI:1.07-1.36,P<0.01,I^(2)=81%,P<0.01).Subgroup analysis stratified by sex indicated that female patients may have a markedly higher risk of SPLC than male patients(SIR=1.65,95%CI:1.40-1.94,P<0.01,I^(2)=75%,P<0.01).Conclusions:Thyroid cancer patients are more likely to develop SPLC than the general population,especially women.However,other risk factors must be investigated,and more prospective studies are needed to confirm our results.Registration:International Prospective Register of Systematic Reviews:No.CRD42021285399.

Isolated breast metastasis mimicking as second primary cancer-a case report

Primary carcinoma of breast is common but breast is a rare site of metastasis and metastases from extramammary sites are even rarer.Metastasis to breast from rectal carcinoma is very unusual and till now 19 cases of breast secondaries from colorectal carcinoma have been reported in literature which include 14 cases where the primary site was colon and remaining 5 were from the rectum.Here the authors report a case of adenocarcinoma anorectum who had completed treatment and after 4 months developed a lump in her left breast which was metastatic.Metastatic lesions of breast are usually part of a widely disseminated disease but this case presented as a solitary breast metastasis which mimicked as second primary cancer of the breast.

Therapy-related myeloid leukemia during erlotinib treatment in a non-small cell lung cancer patient:A case report

BACKGROUND Epidermal growth factor receptor tyrosine kinase inhibitors(EGFR-TKIs)are tolerable drugs used for patients with EGFR-mutant advanced non-small cell lung cancer(NSCLC).Serious adverse reactions are uncommon compared with cytotoxic drugs.CASE SUMMARY A 52-year-old man presented with general weakness and cytopenia.He had been taking erlotinib for 11 mo to treat NSCLC.The pathological diagnosis from the right upper lobe mass was adenocarcinoma with an EGFR mutation in exon 21(L858R).He had previously received paclitaxel/carboplatin,gemcitabin/vinorelbine chemotherapy,stereotactic radiosurgery for brain metastasis,and whole-brain radiotherapy as treatment for NSCLC.We diagnosed the patient with acute myeloid leukemia(AML).During the induction and consolidation chemotherapy for AML,the erlotinib was discontinued.When complete remission of the AML was achieved,since the lung masses were increased,pemetrexed/cisplatin for the NSCLC was initiated.After two cycles of chemotherapy,the cytopenia was prolonged.AML relapse occurred with the same karyotype.CONCLUSION Therapy-related acute myeloid neoplasm(t-MN)is a rare but fatal late complication.Although a patient may be taking EGFR-TKIs,the possibility of t-MN should be considered.Further studies are needed to determine whether EGFR-TKI usage is a predisposing factor for t-MN.

Positron-emission tomography/computed tomography imaging in head and neck oncology:An update

Cancers of the head and neck account for more than half a million cases worldwide annually, with a significant majority diagnosed as squamous cell carcinoma(HNSCC). Imaging studies such as contrast-enhanced computed tomography(CT), magnetic resonance imaging(MRI) and ^(18)F-2-fluoro-2-deoxy-D-glucose positron-emission tomography/computed tomography(^(18)F-FDG PET/CT) are widely used to determine the presence and extent of tumors and metastatic disease, both before and after treatment. Advances in PET/CT imaging have allowed it to emerge as a superior imaging modality compared to both CT and MRI, especially in detection of carcinoma of unknown primary, cervical lymph node metastasis, distant metastasis, residual/recurrent cancer and second primary tumors, often leading to alteration in management. PET/CT biomarker may further provide an overall assessment of tumor aggressiveness with prognostic implications. As new developments emerged leading to better understanding and use of PET/CT in head and neck oncology, the aim of this article is to review the roles of PET/CT in both pre- and post-treatment management of HNSCC and PET-derived parameters as prognostic indicators.