Small-cell Lung Cancer in a Young Adult Nonsmoking Patient with Ectopic Adrenocorticotropin (ACTH) Production

Aoki, Masahiko; Fujisaka, Yasuhito; Tokioka, Satoshi; Hirai, Ai; Henmi, Yujiro; Inoue, Yosuke; Narabayashi, Ken; Yamano, Takeshi; Tamura, Yasuaki; Egashira, Yasuyuki; Higuchi, Kazuhide

doi:10.2169/internalmedicine.55.6139

Cited by 8 publications

(7 citation statements)

References 7 publications

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“…In the Cancer and Leukemia Group B (CALGB) database, less than 40% of all patients with extensive stage SCLC were less than 60 years of age [5]. Nevertheless, there are anecdotal reports of young patients with SCLC -some of whom are never smokers -that have arisen in recent years [6][7][8]. In addition, a recent retrospective analysis of Turkish patients, the risk of developing SCLC was reported to be 1.6 times higher among men younger than 45 years of age compared to older men, with an odds ratio of 1.6 [9].…”

Section: Discussionmentioning

confidence: 99%

Clinical predictors of survival in young patients with small cell lung cancer: Results from the California Cancer Registry

Lara¹,

Brunson

Riess

et al. 2017

Lung Cancer

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A B S T R A C TBackground: Small cell lung cancer (SCLC) is an often lethal disease that commonly occurs in older individuals with a history of heavy tobacco use. Limited epidemiologic and outcomes data are available on young SCLC patients aged less than 50 years of age. We assessed clinical variables related to cause specific survival (CSS) of young patients with SCLC. Methods: SCLC patients in the California Cancer Registry diagnosed between 1998 and 2012 were included. Primary outcome measure was CSS. Hazard ratios (HR) for CSS were calculated using Cox Proportional Hazards (pH) models for all ages & for patients < 50 years, adjusted for baseline variables: age, gender, stage, race, year of diagnosis, initial treatment, socioeconomic status (SES), and location (urban vs. rural). Results: We identified 22,863 SCLC patients, of which 975 were less than 50 years of age (4.2%). Most patients < 50 years of age were male (51%), white race (71%), and had stage IV disease (60%). A lower proportion of patients aged 50 years or younger was diagnosed in later years: from 40% in 1998-2002 to 24% in 2008-2012. For all SCLC patients, age less than 50 years was an independent predictor of improved CSS (HR = 0.82, p < 0.0001). Multivariate Cox pH models showed that in younger patients, female sex (HR = 0.81, p = 0.0045), Asian race (HR = 0.57, p = 0.0075), and rural residence (HR = 0.75, p = 0.042) were associated with better CSS, among other variables. Conclusions: In patients with SCLC, age less than 50 years was an independent predictor of improved CSS. Baseline clinical variables associated with better CSS were identified. These results have potential clinical applications.

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Section: Discussionmentioning

confidence: 99%

Clinical predictors of survival in young patients with small cell lung cancer: Results from the California Cancer Registry

Lara¹,

Brunson

Riess

et al. 2017

Lung Cancer

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“… 2 - 4 The proportion of lung cancer patients aged 50 or younger is estimated to be at most 12%. 5 - 9 In addition, lung cancer has ceased to be an almost exclusively male disease and has become increasingly common among women. Furthermore, this neoplasm occurs more frequently in patients with a history of smoking, and the closing gap in smoking rates between men and women is one of the contributing factors to the increase in the incidence of lung cancer in women.…”

Section: Introductionmentioning

confidence: 99%

Survival in a cohort of patients with lung cancer: the role of age and gender in prognosis

2017

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Objective:To determine the demographic and clinical characteristics of patients with non-small cell lung cancer (NSCLC), as well as their disease course, by age group and gender. Methods:This was a retrospective cohort study of patients diagnosed with NSCLC from 2000 to 2012 and followed until July 2015 in a tertiary referral hospital in the city of São Paulo, Brazil. Based on the 25th and 75th percentiles of the age distribution, patients were stratified into three age groups: < 55 years; ≥ 55 and < 72 years; and ≥ 72 years. Survival time was evaluated during the follow-up period of the study. Functions of overall and gender-specific survival stratified by age groups (event: all-cause mortality) were calculated using the Kaplan-Meier method. Differences among survival curves were assessed via the log-rank test. Results:We included 790 patients with the following age distribution: < 55 years, 165 patients; ≥ 55 and < 72 years, 423; and ≥ 72 years, 202. In the entire sample, there were 493 men (62.4%). Adenocarcinoma was the most common histological pattern in the < 72-year age groups; 575 patients (73%) presented with advanced disease (stages IIIB-IV). The median 5-year survival was 12 months (95% CI: 4-46 months), with no significant differences among the age groups studied. Conclusions:NSCLC remains more common in men, although we found an increase in the proportion of the disease in women in the < 55-year age group. Adenocarcinoma predominated in women. In men, squamous cell carcinoma predominated in the ≥ 72-year age group. Most patients presented with advanced-stage disease at diagnosis. There were no statistical differences in survival between genders or among age groups.

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“…For example, it has been reported that among seven patients, conventional chemotherapy did not reduce plasma ACTH levels in two patients. Although five patients showed a transient reduction of ACTH levels reduced concomitantly with decreased tumour size and a duration of 1.5–3 months to reach normal ACTH levels, there have been no reports regarding adrenal insufficiency during chemotherapy to the best of our knowledge ( 1 , 4 , 5 , 6 , 7 , 8 ).…”

Section: Discussionmentioning

confidence: 90%

Adrenal insufficiency in immunochemotherapy for small-cell lung cancer with ectopic ACTH syndrome

Nakajima

Niida

Hamada

et al. 2021

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary Ectopic ACTH (adrenocorticotrophic hormone) syndrome (EAS) is rarely associated with small-cell lung cancer (SCLC). Although chemotherapy is initially effective for SCLC, complicated EAS scarcely improves. Recently, immune checkpoint inhibitors have been used to treat SCLC. Atezolizumab plus chemotherapy for SCLC improved progression-free survival compared to conventional chemotherapy. However, little has been reported on the efficacy of the combination therapy for SCLC with EAS. We report a 72-year-old male who presented with 4-week history of leg oedema, proximal myopathy, weight loss, and worsened symptoms of diabetes and hypertension. Laboratory findings revealed hypokalaemia, increased plasma ACTH, and serum cortisol levels. Cortisol levels were not suppressed by the high-dose dexamethasone test. Chest and abdominal CT revealed a right lower lobe tumour with multiple metastases on the hilar lymph nodes, liver, lumbar spine, and bilateral enlarged adrenal glands. The patient was diagnosed with stage 4B SCLC with EAS. Hypercortisolaemia was then treated with metyrapone and atezolizumab plus chemotherapy, which was started for SCLC. After 10 days, the tumour shrank noticeably, and the ACTH level drastically decreased concomitantly with low cortisol levels with symptoms of fever, appetite loss, and general fatigue. Hydrocortisone treatment was initiated, and the symptoms resolved immediately. We describe a case of SCLC with EAS treated with atezolizumab plus chemotherapy, presenting with adrenal insufficiency. Close observation is required for patients with adrenal insufficiency receiving atezolizumab plus chemotherapy because of its stronger effect. Furthermore, advances in cancer therapy and care for endocrine paraneoplastic syndrome needs to be adapted. Learning points The immune checkpoint inhibitor atezolizumab has recently been approved for the treatment of small-cell lung cancer (SCLC). Approximately 1–6% of tumour ectopically produce ACTH and cause ectopic ACTH syndrome (EAS) as an endocrine paraneoplastic syndrome. The use of combined chemotherapy and atezolizumab in the ectopic ACTH syndrome secondary to small-cell lung cancer may cause a precipitous fall in circulating ACTH/cortisol, resulting in symptomatic adrenal insufficiency The advances in cancer therapy and treatment for endocrine paraneoplastic syndrome need to be adapted.

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Small-cell Lung Cancer in a Young Adult Nonsmoking Patient with Ectopic Adrenocorticotropin (ACTH) Production

Cited by 8 publications

References 7 publications

Clinical predictors of survival in young patients with small cell lung cancer: Results from the California Cancer Registry

Clinical predictors of survival in young patients with small cell lung cancer: Results from the California Cancer Registry

Survival in a cohort of patients with lung cancer: the role of age and gender in prognosis

Adrenal insufficiency in immunochemotherapy for small-cell lung cancer with ectopic ACTH syndrome

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