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Carter CA, Schmitz B, Peterson PG, et al. Immune Reactivity and Pseudoprogression or Tumor Flare in a Serially Biopsied Neuroendocrine Patient Treated with the Epigenetic Agent RRx-001. Case Rep Oncol. 2016;9(1):164-70doi: 10.1159/000444633.
Carter, C. A., Schmitz, B., Peterson, P. G., Quinn, M., Degesys, A., Jenkins, J., Oronsky, B., Scicinski, J., Caroen, S., Reid, T. R., Cabrales, P., & Brzezniak, C. (2016). Immune Reactivity and Pseudoprogression or Tumor Flare in a Serially Biopsied Neuroendocrine Patient Treated with the Epigenetic Agent RRx-001. Case reports in oncology, 9(1), 164-70. https://doi.org/10.1159/000444633
Carter, Corey A, et al. "Immune Reactivity and Pseudoprogression or Tumor Flare in a Serially Biopsied Neuroendocrine Patient Treated with the Epigenetic Agent RRx-001." Case reports in oncology vol. 9,1 (2016): 164-70. doi: https://doi.org/10.1159/000444633
Carter CA, Schmitz B, Peterson PG, Quinn M, Degesys A, Jenkins J, Oronsky B, Scicinski J, Caroen S, Reid TR, Cabrales P, Brzezniak C. Immune Reactivity and Pseudoprogression or Tumor Flare in a Serially Biopsied Neuroendocrine Patient Treated with the Epigenetic Agent RRx-001. Case Rep Oncol. 2016 Mar 10;9(1):164-70. doi: 10.1159/000444633. eCollection 2016. PMID: 27065848; PMCID: PMC4821155.
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Case Rep Oncol. 2016 Mar 10;9(1):164-70. doi: 10.1159/000444633. eCollection 2016.

Immune Reactivity and Pseudoprogression or Tumor Flare in a Serially Biopsied Neuroendocrine Patient Treated with the Epigenetic Agent RRx-001.

Case reports in oncology

Corey A Carter, Bruno Schmitz, P Gabriel Peterson, Mary Quinn, Aiste Degesys, John Jenkins, Bryan Oronsky, Jan Scicinski, Scott Caroen, Tony R Reid, Pedro Cabrales, Christina Brzezniak

Affiliations

  1. Walter Reed National Military Medical Center, Bethesda, Md., USA.
  2. EpicentRx, Inc., Mountain View, Calif., USA.
  3. Moores Cancer Center, La Jolla, Calif., USA.
  4. Department of Bioengineering, University of California San Diego, La Jolla, Calif., USA.

PMID: 27065848 PMCID: PMC4821155 DOI: 10.1159/000444633

Abstract

Neuroendocrine tumors (NETs) are grouped together as a single class on the basis of histologic appearance, immunoreactivity for the neuroendocrine markers chromogranin A and synaptophysin, and potential secretion of hormones, neurotransmitters, neuromodulators and neuropeptides. Nevertheless, despite these common characteristics, NETs differ widely in terms of their natural histories: high-grade NETs are clinically aggressive and, like small cell lung cancer, which they most closely resemble, tend to respond to cisplatin and etoposide. In contrast, low-grade NETs, which as a rule progress and behave indolently, do not. In either case, the treatment strategy, apart from potentially curative surgical resection, is very poorly defined. This report describes the case of a 28-year-old white male with a diagnosis of high-grade NET of undetermined primary site metastatic to the lymph nodes, skin and paraspinal soft tissues, treated with the experimental anticancer agent RRx-001, in the context of a phase II clinical trial called TRIPLE THREAT (NCT02489903); serial sampling of tumor material through repeat biopsies demonstrated an intratumoral inflammatory response, including the amplification of infiltrating T cells, which correlated with clinical and symptomatic benefit. This case suggests that pseudoprogression or RRx-001-induced enlargement of tumor lesions, which has been previously described for several RRx-001-treated patients, is the result of tumoral lymphocyte infiltration.

Keywords: Immune reactivity; Neuroendocrine tumor; Pseudoprogression; RRx-001; Serial biopsy; Tumor flare

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