PMC4821154_01
PET scans. a Multiple sites of standardized uptake value (SUV) avidity can be seen in the lungs and bones, especially the spine. SUV avidity at the site of the scalp lesion is also evident. b After 1 cycle of paclitaxel and bevacizumab, the PET scan shows an increase in the number and SUV avidity of lesions consistent with progression. c After 6 weeks of gemcitabine and vinorelbine, there is no remaining SUV avidity at prior metastatic sites. The scalp lesion remains SUV avid.
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F1
After a PET scan done in September 2013 showed widespread progression of tumor in lungs and bones (fig. 1a), he was diagnosed with thrombocytopenia from KMS. A total of three doses were given, with no change in platelet count and evidence of progression on early interval PET scan in October 2013 (fig. 1b). This tumor had not changed much during prior chemotherapies and had remained PET avid even after all sites of metastatic disease had disappeared on PET (fig. 1).
Photographs of scalp recurrence. a Progression of scalp recurrence, March 2013. b Response of scalp recurrence, July 2013. The site of his original primary tumor can be seen in the anterior scalp.
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F2
Interestingly, his scalp tumor also regressed dramatically (fig. 2).
Platelet trend over disease course.
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F3
This regimen produced a prompt normalization of platelet count and resolution of pain (fig. 3). In fact, shortly after beginning the regimen, his platelet count did improve (fig. 3).