Anastasia Zherlitsyna — timeline

0015007106 A Dok OE: ITC-IOF

W 25.04.1976 ID: 0006942346

Zherlitsyna, Anastasia

99999 Ukraine

UNIVERSITÄTSmedizin

uct | University Center for

Tumor Diseases MAINZ

Diagnosis

Leiomyosarcoma of the uterus, T2NxM1 (HEP, PER, omentum majus; failed ovary), ED 08/2022

Relevant secondary diagnoses

• chronic disc damage

• gastritis

• medical history after hepatitis and tuberculosis

• Iron deficiency anemia

• Type 2 diabetes

• Vit. D deficiency

• 11.02.23: fracture dist. metaphysis left Radius (slipped on ice)

• 13.02.2023: Port implantation

Therapy and progress

• Leberbiopsie am 29.08.2022 –> LMS

• 4 cycles Gemcitabine 2000 mg + Docetaxel 160 mg 12.09.2022

- Psychosis under Dexamethasone --> Amisulpride, Quetiapine, Levomepromazine, Risperidone

Result: MRI 10/22 + CT 12/22 -> primary stable, PER imaging CR, hepatic. progress

• 1 x Oxaliplatin + Bevacizumab 11/22 in addition for missing secondary malignancy originating in the ovaries

• 11/22 --> 2x ascites puncture

• 12/22 failed liver biopsy

• 12/22 Results from ONCOMINE panel (tissues from 08/22) -> BRCA1/2, CHEK2, PALB2 negative; KIT-Mut. p.Gln556_Val559delinsHis AF 42.5%; KIF5B-MET translocation 284 copies/mill; TMB 4.82 mut/Mb; MSS

• CT skull/thorax/abdomen from 01/04/2023: secondary liver damage, tumor mass in the area of the left mesogastrium and in projection onto the right. Ovary, mild portal hypertension

• Pazopanib 800 mg/day 05.-12.01.2023

- Loss of consciousness, 2x tonic-clonic seizures --> hemorrhagic brain damage, DD PRES (left occipital)

• CT from 09.02.23: hepatic. Mets and RF in left mesogastrium declining, rest stable

• Trabectedin since 09.02.2023

- Ko.: Liver values increased 3-fold

Histology (possibly external)

LMS

Question

Therapy concept/procedure?

Comments (Ad-hoc-Tubo recommendation/therapy suggestion/ext. findings)

• Recommendation UK Freiburg: 3 cycles of Trabectedin, in progress liposomal Doxorubicin

Summary of the discussion:

Third-line therapy with Trabectedin was initiated for hepatic metastatic leiomyosarcoma of the uterus (previously Gemcitabine + Docetaxel, Pazopanib --> discontinued at PRES).

External imaging:

MRI skull: Changes in the frontoparietal right and occipital on both sides with increasing occipital hemorrhage without contrast medium uptake. Very compatible with PRES, unlikely to metastasize.

CT: Large right-hepatic metastasis of constant size, left-hepatic metastasis and large tumor nodules in the left epigastrium gradually regressing. Pelvic images only partially transferred.

Recommendation:

- We recommend the application of two further cycles of Trabectedin with subsequent imaging follow-up.

- In the event of progression, the following therapy options would exist, depending on the general condition: liposomal Doxorubicin, DTIC, ifosfamide.

- To assess the molecular alterations, a separate presentation will be made on our molecular tumor board.

Human genetic counseling recommended: No

Fertility advice recommended: No

Presentation took place: post-therapeutically

Study recommendation: No

Participants:

Dr. med. Bonsignore, Razmin (Clinic and Polyclinic for Neuroradiology); PD Dr.med.habil Bostel, Tilman (Clinic and Polyclinic for Radiation Onco. and Radiation Therapy); Dr. med. Desuki, Alexander (III.

medical clinic and polyclinic); Farah, George (Center for Orthopedics and Trauma Surgery); Dr.med. Fried, Marius (III. Medical Clinic and Polyclinic); Jezycki, Thomas (clinic and policy for diagnostic and interventional radiology); PD Dr. med. Karampinis, loannis (Center for Thoracic Diseases); Dr. med. Oliver Metzig, Marie (Institute of Pathology); Univ.-Prof. dr Roessner, Eric (Centre for Thoracic Diseases); Dr. med. Schadmand-Fischer, Simin (Clinic and policy for diagnostic and interventional radiology); Dr. med. Shmanko, Kateryna (I. Medical Clinic and Polyclinic); Takouchop Yone Epse Teghom, Jeannine Corine (III Medical Clinic and Polyclinic); Prof. Dr. Traub, Frank (Center for Orthopedics and Trauma Surgery)