Colonna SV

Background: Plasmacytoid urothelial carcinoma (PUC) is a rare but aggressive variant of transitional cell carcinoma. In patients with unresectable disease, the most commonly used treatment is combination chemotherapy with methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) or gemcitabine and cisplatin (GC). However, many patients with urothelial carcinoma are cisplatin-ineligible due to renal dysfunction, poor performance status or other comorbidities. We report a case of a cisplatin-ineligible veteran with metastatic PUC who was treated with pembrolizumab.

Case Report: A 71-year-old male veteran with 30 packyear smoking history, schizoaffective disorder and type 2 diabetes found to have multiple right-sided lung nodules and perihilar lymphadenopathy after presenting with atypical chest pain. Staging CT abdomen and pelvis showed bilateral adrenal masses and a large soft tissue mass in the right iliac fossa. Subsequent biopsy of the soft tissue mass had pathology consistent with PUC. As the patient was cisplatin-ineligible due to poor performance status and multiple medical comorbidities, the decision was made to treat with pembrolizumab 2 mg per kg IV every 3 weeks. Repeat CT chest, abdomen and pelvis showed partial response at 3 months and stable disease at 6 months.

Discussion: The KEYNOTE-052 study found that firstline pembrolizumab in cisplatin-ineligible patients with urothelial cancer resulted in complete or partial response in 24% of patients with few adverse effects. However, it is unclear if patients with plasmacytoid variant were included. To our knowledge, this is the first case report of a patient with metastatic PUC not only treated with pembrolizumab but shown to have clinical response.

Conclusions: Given our patient’s clinical response, pembrolizumab is a promising first-line agent for treating cisplatin-ineligible patients with metastatic PUC. Further evaluation is warranted to confirm the benefit of treatment with pembrolizumab in this patient population.

Background: Plasmacytoid urothelial carcinoma (PUC) is a rare but aggressive variant of transitional cell carcinoma. In patients with unresectable disease, the most commonly used treatment is combination chemotherapy with methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) or gemcitabine and cisplatin (GC). However, many patients with urothelial carcinoma are cisplatin-ineligible due to renal dysfunction, poor performance status or other comorbidities. We report a case of a cisplatin-ineligible veteran with metastatic PUC who was treated with pembrolizumab.

Case Report: A 71-year-old male veteran with 30 packyear smoking history, schizoaffective disorder and type 2 diabetes found to have multiple right-sided lung nodules and perihilar lymphadenopathy after presenting with atypical chest pain. Staging CT abdomen and pelvis showed bilateral adrenal masses and a large soft tissue mass in the right iliac fossa. Subsequent biopsy of the soft tissue mass had pathology consistent with PUC. As the patient was cisplatin-ineligible due to poor performance status and multiple medical comorbidities, the decision was made to treat with pembrolizumab 2 mg per kg IV every 3 weeks. Repeat CT chest, abdomen and pelvis showed partial response at 3 months and stable disease at 6 months.

Discussion: The KEYNOTE-052 study found that firstline pembrolizumab in cisplatin-ineligible patients with urothelial cancer resulted in complete or partial response in 24% of patients with few adverse effects. However, it is unclear if patients with plasmacytoid variant were included. To our knowledge, this is the first case report of a patient with metastatic PUC not only treated with pembrolizumab but shown to have clinical response.

Conclusions: Given our patient’s clinical response, pembrolizumab is a promising first-line agent for treating cisplatin-ineligible patients with metastatic PUC. Further evaluation is warranted to confirm the benefit of treatment with pembrolizumab in this patient population.

Background: Plasmacytoid urothelial carcinoma (PUC) is a rare but aggressive variant of transitional cell carcinoma. In patients with unresectable disease, the most commonly used treatment is combination chemotherapy with methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) or gemcitabine and cisplatin (GC). However, many patients with urothelial carcinoma are cisplatin-ineligible due to renal dysfunction, poor performance status or other comorbidities. We report a case of a cisplatin-ineligible veteran with metastatic PUC who was treated with pembrolizumab.

Case Report: A 71-year-old male veteran with 30 packyear smoking history, schizoaffective disorder and type 2 diabetes found to have multiple right-sided lung nodules and perihilar lymphadenopathy after presenting with atypical chest pain. Staging CT abdomen and pelvis showed bilateral adrenal masses and a large soft tissue mass in the right iliac fossa. Subsequent biopsy of the soft tissue mass had pathology consistent with PUC. As the patient was cisplatin-ineligible due to poor performance status and multiple medical comorbidities, the decision was made to treat with pembrolizumab 2 mg per kg IV every 3 weeks. Repeat CT chest, abdomen and pelvis showed partial response at 3 months and stable disease at 6 months.

Discussion: The KEYNOTE-052 study found that firstline pembrolizumab in cisplatin-ineligible patients with urothelial cancer resulted in complete or partial response in 24% of patients with few adverse effects. However, it is unclear if patients with plasmacytoid variant were included. To our knowledge, this is the first case report of a patient with metastatic PUC not only treated with pembrolizumab but shown to have clinical response.

Conclusions: Given our patient’s clinical response, pembrolizumab is a promising first-line agent for treating cisplatin-ineligible patients with metastatic PUC. Further evaluation is warranted to confirm the benefit of treatment with pembrolizumab in this patient population.

Background: Despite recommended guidelines and available medications to reduce breast cancer risk by up to 50-65%, < 5% of the 10 million eligible women are offered chemoprevention in the U.S. The comfort level, practice patterns, and barriers to breast cancer risk assessment and chemoprevention use within the VA have not been reported.

Methods: We assessed VA primary care providers using a REDcap survey. We obtained provider demographics, use and comfort level with breast cancer risk models and chemoprevention, and knowledge about chemoprevention. Data was analyzed with Fisher exact or chi-square tests.

Results: Of the 200 survey respondents, 167 were included for analysis. Overall, 30% used the Gail model monthly or more often, and 1.5% prescribed chemoprevention in the past 2 years. Fewer than 30% correctly answered chemoprevention knowledge questions. Designated women’s
health providers were more comfortable with risk assessment and chemoprevention (P < .046, P < .004) and used risk models more often (P < .045). 63% expressed interest in education about breast cancer prevention.

Conclusions: Breast cancer risk assessment and chemoprevention use by VA primary care is limited by lack of comfort and familiarity. Women‘s health providers are more comfortable and knowledgeable about breast cancer risk models and chemoprevention, offering an opportunity for partnership with high-risk oncologists to improve breast cancer risk assessment and chemoprevention use among female Veterans.

Background: Despite recommended guidelines and available medications to reduce breast cancer risk by up to 50-65%, < 5% of the 10 million eligible women are offered chemoprevention in the U.S. The comfort level, practice patterns, and barriers to breast cancer risk assessment and chemoprevention use within the VA have not been reported.

Methods: We assessed VA primary care providers using a REDcap survey. We obtained provider demographics, use and comfort level with breast cancer risk models and chemoprevention, and knowledge about chemoprevention. Data was analyzed with Fisher exact or chi-square tests.

Results: Of the 200 survey respondents, 167 were included for analysis. Overall, 30% used the Gail model monthly or more often, and 1.5% prescribed chemoprevention in the past 2 years. Fewer than 30% correctly answered chemoprevention knowledge questions. Designated women’s
health providers were more comfortable with risk assessment and chemoprevention (P < .046, P < .004) and used risk models more often (P < .045). 63% expressed interest in education about breast cancer prevention.

Conclusions: Breast cancer risk assessment and chemoprevention use by VA primary care is limited by lack of comfort and familiarity. Women‘s health providers are more comfortable and knowledgeable about breast cancer risk models and chemoprevention, offering an opportunity for partnership with high-risk oncologists to improve breast cancer risk assessment and chemoprevention use among female Veterans.

Background: Despite recommended guidelines and available medications to reduce breast cancer risk by up to 50-65%, < 5% of the 10 million eligible women are offered chemoprevention in the U.S. The comfort level, practice patterns, and barriers to breast cancer risk assessment and chemoprevention use within the VA have not been reported.

Methods: We assessed VA primary care providers using a REDcap survey. We obtained provider demographics, use and comfort level with breast cancer risk models and chemoprevention, and knowledge about chemoprevention. Data was analyzed with Fisher exact or chi-square tests.

Results: Of the 200 survey respondents, 167 were included for analysis. Overall, 30% used the Gail model monthly or more often, and 1.5% prescribed chemoprevention in the past 2 years. Fewer than 30% correctly answered chemoprevention knowledge questions. Designated women’s
health providers were more comfortable with risk assessment and chemoprevention (P < .046, P < .004) and used risk models more often (P < .045). 63% expressed interest in education about breast cancer prevention.

Conclusions: Breast cancer risk assessment and chemoprevention use by VA primary care is limited by lack of comfort and familiarity. Women‘s health providers are more comfortable and knowledgeable about breast cancer risk models and chemoprevention, offering an opportunity for partnership with high-risk oncologists to improve breast cancer risk assessment and chemoprevention use among female Veterans.

Purpose: Hypersensitivity reactions to platinum-based chemotherapies are well documented and are often a limiting factor in treating a variety of cancers. Allergy skin testing has been used to determine if repeat exposure is safe. We report a case of a false negative skin allergy test in an atypical presentation of cisplatin hypersensitivity reaction.

Case Report: A 64-year-old male diagnosed with stage IVa squamous cell carcinoma of the hypopharynx who developed a delayed reaction of face swelling and dysphagia following exposure to a single dose of cisplatin. Skin allergy testing was performed and was negative. On second dosing of cisplatin, the patient developed an immediate hypersensitivity reaction. Cisplatin was discontinued, and the patient was transitioned to cetuximab. The rest of chemoradiation therapy was completed without further incident.

Discussion: This case demonstrates the limited efficacy of skin allergy testing for cisplatin. Furthermore, it is an atypical presentation of cisplatin related hypersensitivity as it occurred following the patient’s first dose despite no prior exposure to platinum-based chemotherapy.

Conclusions: Skin allergy testing has limited sensitivity for platinum-based chemotherapy and caution should be exercised in weighing risk and benefits of re-exposure. Although rare, cisplatin hypersensitivity can present after first exposure.

Purpose: Hypersensitivity reactions to platinum-based chemotherapies are well documented and are often a limiting factor in treating a variety of cancers. Allergy skin testing has been used to determine if repeat exposure is safe. We report a case of a false negative skin allergy test in an atypical presentation of cisplatin hypersensitivity reaction.

Case Report: A 64-year-old male diagnosed with stage IVa squamous cell carcinoma of the hypopharynx who developed a delayed reaction of face swelling and dysphagia following exposure to a single dose of cisplatin. Skin allergy testing was performed and was negative. On second dosing of cisplatin, the patient developed an immediate hypersensitivity reaction. Cisplatin was discontinued, and the patient was transitioned to cetuximab. The rest of chemoradiation therapy was completed without further incident.

Discussion: This case demonstrates the limited efficacy of skin allergy testing for cisplatin. Furthermore, it is an atypical presentation of cisplatin related hypersensitivity as it occurred following the patient’s first dose despite no prior exposure to platinum-based chemotherapy.

Conclusions: Skin allergy testing has limited sensitivity for platinum-based chemotherapy and caution should be exercised in weighing risk and benefits of re-exposure. Although rare, cisplatin hypersensitivity can present after first exposure.

Purpose: Hypersensitivity reactions to platinum-based chemotherapies are well documented and are often a limiting factor in treating a variety of cancers. Allergy skin testing has been used to determine if repeat exposure is safe. We report a case of a false negative skin allergy test in an atypical presentation of cisplatin hypersensitivity reaction.

Case Report: A 64-year-old male diagnosed with stage IVa squamous cell carcinoma of the hypopharynx who developed a delayed reaction of face swelling and dysphagia following exposure to a single dose of cisplatin. Skin allergy testing was performed and was negative. On second dosing of cisplatin, the patient developed an immediate hypersensitivity reaction. Cisplatin was discontinued, and the patient was transitioned to cetuximab. The rest of chemoradiation therapy was completed without further incident.

Discussion: This case demonstrates the limited efficacy of skin allergy testing for cisplatin. Furthermore, it is an atypical presentation of cisplatin related hypersensitivity as it occurred following the patient’s first dose despite no prior exposure to platinum-based chemotherapy.

Conclusions: Skin allergy testing has limited sensitivity for platinum-based chemotherapy and caution should be exercised in weighing risk and benefits of re-exposure. Although rare, cisplatin hypersensitivity can present after first exposure.