Microsatellite instability-high/deficient mismatch repair (MSI-H/dMMR) status of tumors is a distinct predictive biomarker of immune checkpoint inhibitors (ICIs) for colorectal and non-colorectal cancer populations. The overall response rate (ORR) varies from approximately 40% to 60%, indicating that nearly half of MSI-H tumors do not respond to ICIs. The mechanism of response heterogeneity in MSI-H/dMMR cancers is unclear. Some patients who have been treated with ICIs have developed a novel pattern of progression called hyperprogression, which is defined as unexpected accelerated tumor growth. No case of MSI-H/dMMR immunotherapy-associated hyperprogression has been reported in the literature. Here, we present the case of a patient with dMMR gastrointestinal cancer who suffered hyperprogressive disease (HPD) after treatment with nivolumab. We explored the potential mechanisms of HPD by clinical, immune, and genomic characteristics. Extremely high levels of serum LDH, low TMB and TILs, and the disruption of TGFβ signaling, may be related to hyperprogression.
Capecitabine (CAP) is widely used to treat gastrointestinal and breast cancer, and is generally well tolerated. Hand-foot syndrome and gastrointestinal intolerance are the most common adverse effects.Capecitabine-induced hypertriglyceridemia (CIHT) is a very rare adverse effect and, from the reported literatures, is often neglected in clinical practice. Here, we report a case of CIHT with angina. A 58-year-old man with metastatic rectal cancer was admitted to the emergency room (ER) due to severe chest pain after treatment with CAP (Xeloda). The blood sample showed separation of blood and lipids, and the lipid profile revealed rapidly increased triglyceride and cholesterol levels. After fenofibrate therapy was administered, the patient's symptoms were relieved, and the repeat lipid test was normalized. Other causes of hyperlipidemia were carefully excluded, considering that the severe adverse effects of CAP had since abated. The earliest onset of the incidence as far as we know, the symptom of angina at the same time with CIHT, and distinct blood-lipid layer in blood sample all suggest the rarity of this case. We also concluded reports of CIHT and found that CIHT accidence was higher than our known. We genuinely hope that this case could awaken clinicians' awareness of the use of CAP.
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