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Angelo Paci, Ségolène Hescot, Atmane Seck, Christel Jublanc, Lionel Mercier, Delphine Vezzosi, Delphine Drui, Marcus Quinkler, Martin Fassnacht, Eric Bruckert, Marc Lombès, Sophie Leboulleux, Sophie Broutin and Eric Baudin

Summary

Mitotane (o,p′-DDD) is the standard treatment for advanced adrenocortical carcinoma (ACC). Monitoring of plasma mitotane levels is recommended to look for a therapeutic window between 14 and 20mg/L, but its positive predictive value requires optimization. We report the case of an ACC patient with a history of dyslipidemia treated with mitotane in whom several plasma mitotane levels >30mg/L were found together with an excellent neurological tolerance. This observation led us to compare theoretical or measured o,p′-DDD and o,p′-DDE levels in a series of normolipidemic and dyslipidemic plasma samples to explore potential analytical issues responsible for an overestimation of plasma mitotane levels. We demonstrate an overestimation of mitotane measurements in dyslipidemic patients. Mitotane and o,p′-DDE measurements showed a mean 20% overestimation in hypercholesterolemic and hypertriglyceridemic plasma, compared with normolipidemic plasma. The internal standard p,p′-DDE measurements showed a parallel decrease in hypercholesterolemic and hypertriglyceridemic plasma, suggesting a matrix effect. Finally, diluting plasma samples and/or using phospholipid removal cartridges allowed correcting such interference.

Learning points

  • Hypercholesterolemia (HCH) and hypertriglyceridemia (HTG) induce an overestimation of plasma mitotane measurements.
  • We propose a routine monitoring of lipidemic status.
  • We propose optimized methodology of measurement before interpreting high plasma mitotane levels.

Open access

S Solomou, R Khan, D Propper, D Berney and M Druce

of the pancreatic images. The patient was offered platinum-based chemotherapy, but he initially defaulted from treatment due to academic commitments. He was also commenced on entecavir antiviral therapy. Figure 1 CT scan showing metastatic

Open access

Tu Vinh Luong, Zaibun Nisa, Jennifer Watkins and Aimee R Hayes

more common small cell carcinoma of the lung and platinum-based chemotherapy regimens, commonly cis/carboplatin and etoposide, are typically used. Based on the fact that NECs of colorectal origin have a molecular profile similar to adenocarcinoma ( 1

Open access

Avital Nahmias, Simona Grozinsky-Glasberg, Asher Salmon and David J Gross

streptozocin, dischlorodiammine platinum (DDP), and 5 fluorouracil (5-FU) resulted in resolution of the hypoglycemia and marked regression of the hepatic lesions. However, 18 months later the disease progressed, and despite the administration of salvage PRRT

Open access

Chrisanthi Marakaki, Anna Papadopoulou, Olga Karapanou, Dimitrios T Papadimitriou, Kleanthis Kleanthous and Anastasios Papadimitriou

was amplified with 0.5 U of Platinum Taq polymerase (Invitrogen, Life Technologies) and 0.6 μM of each primer in a final reaction volume of 25 μl using nested PCR (5) . The smaller PCR products were screened for mutations in an ABI genetic analyzer

Open access

Karen Decaestecker, Veerle Wijtvliet, Peter Coremans and Nike Van Doninck

to moderately differentiated tumours. Chemotherapy is used in poorly differentiated, advanced, unresectable, disseminated or recurrent disease ( 7 , 8 ). There is no standard chemotherapy regimen, but platinum-based regimens combined with etoposide

Open access

Sakshi Jhawar, Rahul Lakhotia, Mari Suzuki, James Welch, Sunita K Agarwal, John Sharretts, Maria Merino, Mark Ahlman, Jenny E Blau, William F Simonds and Jaydira Del Rivero

a recent case series of patients with primary ovarian NETs, five patients received treatment with chemotherapy (varying protocols including doxorubicin or capecitabine or capecitabine, etoposide, platinum and temozolomide or cisplatin, 5-fluorouracil

Open access

Carine Ghassan Richa, Khadija Jamal Saad, Georges Habib Halabi, Elie Mekhael Gharios, Fadi Louis Nasr and Marie Tanios Merheb

, weight gain, sedation and hepatotoxicity ( 8 ). First-line chemotherapy for SCLC is platinum–etoposide combination. Failure of initial treatment, extension of the primary tumor, poor performance status and lack of sensitivity to the first chemotherapy