Metachronous double primary malignant tumors with nasopharyngeal carcinoma and diffuse malignant peritoneal mesothelioma accompanied with paraneoplastic syndromes treated with nivolumab: A case report

Our plain-English summary of Metachronous double primary malignant tumors with nasopharyngeal carcinoma and diffuse malignant peritoneal mesothelioma accompanied with paraneoplastic syndromes treated with nivolumab: A case report, by L.K. Tang, Z.K. Li, Y.L. Xiang, et al (Medicine, 2023).

The study

• Authors: L.K. Tang, Z.K. Li, Y.L. Xiang, D.Y. Ma, G.B. Du
• Journal: Medicine
• Published: 2023;102(30):e34349
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Rationale: Multiple primary malignant tumors are rare and challenging to diagnose. Diffuse malignant peritoneal mesothelioma (DMPM) originate from the peritoneum, which lacks specific clinical manifestations and is difficult to diagnose, with a short survival about 10 to 13 months for inoperable ones. This is the first report of metachronous double primary malignant tumors in nasopharyngeal carcinoma and DMPM accompanied with paraneoplastic syndromes.

Patient Concerns: A 61-year-old man presented with abdominal discomfort with a history of nasopharyngeal carcinoma 5 years ago.

Diagnoses: The diagnosis of DMPM was finally confirmed by laparoscopic mesenteric biopsies. Paraneoplastic syndromes including increased platelets were present when diagnosis, followed by increased neutrophils after disease progression.

Interventions: Due to intolerable for surgery, he was treated with pemetrexed combined with nivolumab, intraperitoneal infusion of nivolumab, radiotherapy, anlotinib and maintenance treatment of nivolumab.

Outcomes: Progression-free survival in first line is 12 months, overall survival is 23 months.

Lessons: This indicate that comprehensive treatment including immunotherapy may be helpful for inoperable DMPM patients with nasopharyngeal carcinoma accompanied with paraneoplastic syndromes.

Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

In plain English

This was a case report of one patient, from an oncology department in Nanchong, China. A 61-year-old man had been treated with radiotherapy and chemotherapy for nasopharyngeal carcinoma about 5 years before he came to hospital in June 2019 with abdominal swelling and pain. Doctors first suspected that his earlier nasopharyngeal cancer had spread, but he refused further tests and treatment. In June 2020, after large amounts of fluid built up in his abdomen, a laparoscopic biopsy confirmed a second, separate cancer: diffuse epithelioid malignant peritoneal mesothelioma. The article does not mention asbestos or any other exposure history. He was judged unable to have surgery. He received pemetrexed with nivolumab, then nivolumab alone, and later radiotherapy, anlotinib, and nivolumab infused into the abdomen. His platelets were high from diagnosis, and his neutrophils rose as the disease progressed, with no infection found. The authors described these as paraneoplastic syndromes. Progression-free survival on first-line treatment was 12 months, and overall survival was 23 months. The authors concluded that combined treatment including immunotherapy may be a hopeful choice for such patients, which needs further research.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 61-year-old man first admitted in June 2019, previously treated for nasopharyngeal carcinoma 5 years earlier; reported by the Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
• Exposure: Not reported. The article gives no asbestos, fiber, or occupational exposure history. Its only prior treatment history is radiotherapy and chemotherapy for nasopharyngeal carcinoma 5 years earlier.
• Main results:
  • A laparoscopic mesenteric biopsy with staining and immunohistochemistry confirmed diffuse epithelioid malignant peritoneal mesothelioma.
  • After 6 cycles of pemetrexed (800 mg) plus nivolumab (140 mg) every 3 weeks, July to December 2020, the best response in this patient was stable disease.
  • After nivolumab maintenance from December 2020, the disease progressed in July 2021 with new peritoneal lesions. Progression-free survival on first-line treatment was 12 months.
  • Blood counts rose as the disease progressed. The highest leukocyte count was 37.14 and the highest neutrophil count 34.80, both × 10^9/L (printed as "109/L" in the text). No infection was detected.
  • Three intraperitoneal infusions of nivolumab (20 mg) were given from April 29, 2022, and relieved local distension and pain. The patient died on May 26, 2022. Overall survival was 23 months.
• The authors' conclusion: The authors concluded that comprehensive treatment including immunotherapy may be a hopeful choice for inoperable diffuse malignant peritoneal mesothelioma patients with nasopharyngeal carcinoma and paraneoplastic syndromes, and that this needs further research.
• Limitations the authors state:
  • The authors did not measure granulocyte colony-stimulating factor, which they suggested might explain the rising neutrophils.
  • The patient refused further examination, so diagnosis was delayed by about 360 days.
  • The source of the cancer cells in the abdominal fluid could not be identified because there were too few cells.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Carcinoma, Peritoneal Mesothelioma, Nivolumab (Opdivo), Peritoneum, Disease Progression, Pemetrexed (Alimta), Progression-Free Survival, Overall Survival.

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