Patient with a rare clinical syndrome related to a pNET. Sequencing treatment for progressive disease
Patient with a rare clinical syndrome related to a pNET. Sequencing treatment for progressive disease
by
Professor Kjell Öberg,
M.D., Ph.D.
Dept. of Endocrine Oncology, University Hospital, Uppsala, Sweden
A 58 year old male, who presented 10 years ago with abdominal pain. Initial evaluation:
CT-scan 5 cm tumor in the pancreatic tail, multiple focal lesions in the liver
FNAB Well differentiated NET (G2)
SRS Grade 3 uptake in the pNET and liver met.
Biochemistry CgA 5.2 nmol/L (N<4)
PP 195 pmol/L (N<100)
- Further diagnostic work-up
- Surgery
- Liver embolization
- Chemotherapy
- Everolimus + SMS
- Primary surgery + liver resection was suggested but the patient refused.
- Chemotherapy streptozotocin + 5FU plus Octreotide LAR, 20 mg q4w
Disease progression after 1 year:
- PEG-Intron A 80 mcg/w was added
- Chemotherapy had to be discontinued after 2.5 years (impaired renal function)
Radiology 10/2005: Stable disease
- CgA 10.5 nmol/L
- PP 300 pmol/L
2006 Hypercalcemia occurred for the first time (s-Ca 2.95 mmol/L) (N 2.15-2.50)
Ionazide Ca 1.43 (N 1.3); hypophosphatemia (p 0.4; 0.64 mmol/L (0.74-1.25); low PTH 0.27 pmol/L (1.10-6.90); PTHrP 84 pmol/L (N<2)
Radiology: Tumor growth in the liver
Octreotide increased to 30 mg q 3w
- CgA 45 nmol/L
- PP 425 pmol/L
2008 PEG-Intron A was discontinued (mental depression)
