Case Report: Initial Treatment Adjustments and Complications in Ovarian Cancer Patient With Inborn Error of Immunity
BackgroundPatients with inborn errors of immunity (IEI) have increased risk of developing cancers secondary to impaired anti-tumor immunity. Treatment of patients with IEI and cancer is challenging as chemotherapy can exacerbate infectious susceptibility. However, the literature on optimal cancer tr...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-06-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.843741/full |
| _version_ | 1828170851975954432 |
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| author | Jamila Mammadova Anna Redden Rachel Cruz Boglarka Ujhazi Sumai Gordon Maryssa Ellison Tyra Gatewood Carla Duff Anthony Cannella Charurut Somboonwit Chakrapol Sriaroon Krisztian Csomos Joseph F. Dasso Terry Harville Roohi Ismail-Khan Jolan E. Walter |
| author_facet | Jamila Mammadova Anna Redden Rachel Cruz Boglarka Ujhazi Sumai Gordon Maryssa Ellison Tyra Gatewood Carla Duff Anthony Cannella Charurut Somboonwit Chakrapol Sriaroon Krisztian Csomos Joseph F. Dasso Terry Harville Roohi Ismail-Khan Jolan E. Walter |
| author_sort | Jamila Mammadova |
| collection | DOAJ |
| description | BackgroundPatients with inborn errors of immunity (IEI) have increased risk of developing cancers secondary to impaired anti-tumor immunity. Treatment of patients with IEI and cancer is challenging as chemotherapy can exacerbate infectious susceptibility. However, the literature on optimal cancer treatment in the setting of IEI is sparse.ObjectivesWe present a patient with specific antibody deficiency with normal immunoglobins (SADNI), immune dysregulation (ID), and stage III ovarian carcinoma as an example of the need to modify conventional treatment in the context of malignancy, IEI, and ongoing infections.MethodsThis is a retrospective chart review of the patient’s clinical manifestations, laboratory evaluation and treatment course.ResultsOur patient is a female with SADNI and ID diagnosed with stage III ovarian carcinoma at 60 years of age. Her ID accounted for antinuclear antibody positive (ANA+) mixed connective tissue diseases, polyarthralgia, autoimmune neutropenia, asthma, autoimmune thyroiditis, and Celiac disease. Due to the lack of precedent in the literature, her treatment was modified with continuous input from infectious disease, allergy/immunology and oncology specialist using a multidisciplinary approach.The patient completed debulking surgery and 6 cycles of chemotherapy. The dosing for immunoglobulin replacement therapy was increased for prophylaxis. Chemotherapy doses were lowered for all cycles preemptively for IEI. The therapy included carboplatin, paclitaxel, bevacizumab, and pegfilgrastim. The patient completed six-months of maintenance medication involving bevacizumab.Her treatment course was complicated by Mycobacterium avium-complex (MAC) infection, elevated bilirubin and liver enzymes attributed to excessive immunoglobulin replacement therapy, and urinary tract infection (UTI) and incontinence.Cancer genetic analysis revealed no targetable markers and primary immunodeficiency gene panel of 407 genes by Invitae was unrevealing. Lab tests revealed no evidence of Epstein-Barr Virus (EBV) infection. Post-chemotherapy imaging revealed no evidence of cancer for 1 year and 4 months, but the disease relapsed subsequently. The patient’s lung scarring requires vigilance.ConclusionsOur patient with ovarian cancer and IEI required modified treatment and prevention of complications. In cases of IEI, optimal chemotherapy should be titrated to minimize immunosuppression yet treat cancer aggressively while decreasing the risk of infection with prophylactic antibiotics and prolonged post-treatment surveillance, including pulmonary evaluation. |
| first_indexed | 2024-04-12T03:16:56Z |
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| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-12T03:16:56Z |
| publishDate | 2022-06-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Oncology |
| spelling | doaj.art-ec47ad3c7ce941f89a295e82ec8221592022-12-22T03:50:03ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-06-011210.3389/fonc.2022.843741843741Case Report: Initial Treatment Adjustments and Complications in Ovarian Cancer Patient With Inborn Error of ImmunityJamila Mammadova0Anna Redden1Rachel Cruz2Boglarka Ujhazi3Sumai Gordon4Maryssa Ellison5Tyra Gatewood6Carla Duff7Anthony Cannella8Charurut Somboonwit9Chakrapol Sriaroon10Krisztian Csomos11Joseph F. Dasso12Terry Harville13Roohi Ismail-Khan14Jolan E. Walter15Morsani College of Medicine, University of South Florida, Tampa, FL, United StatesCharles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United StatesMorsani College of Medicine, University of South Florida, Tampa, FL, United StatesDivision of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United StatesDivision of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United StatesDivision of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United StatesDepartment of Pharmacy at Gynecologic and Neuro Oncology Clinics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United StatesDivision of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United StatesDivision of Infectious Disease and International Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United StatesDivision of Infectious Disease and International Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United StatesDivision of Infectious Disease and International Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United StatesDivision of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United StatesDivision of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United StatesDivision of Hematology, Department of Pathology and Laboratory Services, and Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United StatesDepartment of Cardio-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United StatesDivision of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United StatesBackgroundPatients with inborn errors of immunity (IEI) have increased risk of developing cancers secondary to impaired anti-tumor immunity. Treatment of patients with IEI and cancer is challenging as chemotherapy can exacerbate infectious susceptibility. However, the literature on optimal cancer treatment in the setting of IEI is sparse.ObjectivesWe present a patient with specific antibody deficiency with normal immunoglobins (SADNI), immune dysregulation (ID), and stage III ovarian carcinoma as an example of the need to modify conventional treatment in the context of malignancy, IEI, and ongoing infections.MethodsThis is a retrospective chart review of the patient’s clinical manifestations, laboratory evaluation and treatment course.ResultsOur patient is a female with SADNI and ID diagnosed with stage III ovarian carcinoma at 60 years of age. Her ID accounted for antinuclear antibody positive (ANA+) mixed connective tissue diseases, polyarthralgia, autoimmune neutropenia, asthma, autoimmune thyroiditis, and Celiac disease. Due to the lack of precedent in the literature, her treatment was modified with continuous input from infectious disease, allergy/immunology and oncology specialist using a multidisciplinary approach.The patient completed debulking surgery and 6 cycles of chemotherapy. The dosing for immunoglobulin replacement therapy was increased for prophylaxis. Chemotherapy doses were lowered for all cycles preemptively for IEI. The therapy included carboplatin, paclitaxel, bevacizumab, and pegfilgrastim. The patient completed six-months of maintenance medication involving bevacizumab.Her treatment course was complicated by Mycobacterium avium-complex (MAC) infection, elevated bilirubin and liver enzymes attributed to excessive immunoglobulin replacement therapy, and urinary tract infection (UTI) and incontinence.Cancer genetic analysis revealed no targetable markers and primary immunodeficiency gene panel of 407 genes by Invitae was unrevealing. Lab tests revealed no evidence of Epstein-Barr Virus (EBV) infection. Post-chemotherapy imaging revealed no evidence of cancer for 1 year and 4 months, but the disease relapsed subsequently. The patient’s lung scarring requires vigilance.ConclusionsOur patient with ovarian cancer and IEI required modified treatment and prevention of complications. In cases of IEI, optimal chemotherapy should be titrated to minimize immunosuppression yet treat cancer aggressively while decreasing the risk of infection with prophylactic antibiotics and prolonged post-treatment surveillance, including pulmonary evaluation.https://www.frontiersin.org/articles/10.3389/fonc.2022.843741/fullantibody deficiencyprimary immunodeficiencyovarian cancercase reportinborn error of immunity |
| spellingShingle | Jamila Mammadova Anna Redden Rachel Cruz Boglarka Ujhazi Sumai Gordon Maryssa Ellison Tyra Gatewood Carla Duff Anthony Cannella Charurut Somboonwit Chakrapol Sriaroon Krisztian Csomos Joseph F. Dasso Terry Harville Roohi Ismail-Khan Jolan E. Walter Case Report: Initial Treatment Adjustments and Complications in Ovarian Cancer Patient With Inborn Error of Immunity Frontiers in Oncology antibody deficiency primary immunodeficiency ovarian cancer case report inborn error of immunity |
| title | Case Report: Initial Treatment Adjustments and Complications in Ovarian Cancer Patient With Inborn Error of Immunity |
| title_full | Case Report: Initial Treatment Adjustments and Complications in Ovarian Cancer Patient With Inborn Error of Immunity |
| title_fullStr | Case Report: Initial Treatment Adjustments and Complications in Ovarian Cancer Patient With Inborn Error of Immunity |
| title_full_unstemmed | Case Report: Initial Treatment Adjustments and Complications in Ovarian Cancer Patient With Inborn Error of Immunity |
| title_short | Case Report: Initial Treatment Adjustments and Complications in Ovarian Cancer Patient With Inborn Error of Immunity |
| title_sort | case report initial treatment adjustments and complications in ovarian cancer patient with inborn error of immunity |
| topic | antibody deficiency primary immunodeficiency ovarian cancer case report inborn error of immunity |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.843741/full |
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