PMC4865168_01
Case illustrating cancer of unknown primary with an intestinal profile.. A) CT Chest at diagnosis shows multiple pulmonary metastases, B) CT Chest after 12 cycles of chemotherapy with 5-Fluorouracil and oxaliplatin showing radiographic response, C) CT Chest after 4 cycles of 5-Fluorouracil and irinotecan and clinical trial involving MEK1-2 inhibitor with progression of disease, D) Trend in tumor marker, carcinoembryonic antigen (CEA).
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CA19-9 and CEA and normal Alpha feto-protein, Beta-HCG and chromogranin-A. CT imaging revealed too-numerous-to count bilateral lung metastases, mediastinal lymphadenopathy, and diffuses bony metastases (Fig 2A). He responded well to this regimen with clinical benefit noted in his cough and pain symptoms and decrease in CEA and CA19-9 (Fig 2D). Repeat CT imaging after 12 cycles of chemotherapy showed excellent partial response and he was on maintenance 5FU after oxaliplatin hypersensitivity (Fig 2B). Cetuximab was not used and an attempt at empiric taxane based therapy and protocol-based MEK1-2 inhibitor showed no response with worsening disease (Fig 2C).
PMC4865168_02
Case illustrating use of tissue of origin profiling in poorly differentiated neoplasms.. A) CT Abdomen at diagnosis shows a large intrabdominal mass, B) CT Abdomen after 3 cycles of chemotherapy with 5-Fluorouracil paclitaxel, and oxaliplatin (T-FOX) shows progressive disease, C) CT Abdomen after 3 cycles of etoposide, adriamycin and ciplatin (EAP) shows radiographic response D) Trend in tumor marker, CA-125.
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Imaging revealed a 21 cm upper abdominal mass and peritoneal carcinomatosis (Fig 3A). She had progression of disease after 3 cycles (Fig 3B). She had response on both imaging and tumor markers after 3 cycles (Fig 3C and 3D) but unfortunately, subsequently had clinical decline and passed away approximately 6 months after her initial diagnosis.