Terrible paraneoplastic complications, does targeted therapy work?

Malignant tumors such as lung cancer can have some serious paraneoplastic complications, resulting in a very poor prognosis and affecting normal treatment, such as disseminated intravascular coagulation (DIC), which is a complication characterized by thrombosis, bleeding, and thrombocytopenia, and if not treated in time, the patient's life will be in danger
.

What is disseminated intravascular coagulation?

Patients with advanced lung cancer often have thrombocytopenia, which may be caused by bone marrow invasion, paraneoplastic non-megakaryocytic thrombocytopenia, thrombotic thrombocytopenic purpura, and disseminated intravascular coagulation
.
These conditions can be distinguished
by clinical symptoms and laboratory tests.

Non-small cell lung adenocarcinoma has disseminated intravascular coagulation due to the release of procoagulant substances into the bloodstream by tumor cells, resulting in excessive consumption
of clotting factors and platelets in the blood.
Acute decompensation occurs when the newly created factors in the liver and bone marrow cannot keep up with the consumption, and platelets and clotting factors are over-depleted and bleed
.

Although disseminated intravascular coagulation is uncommon, it can be life-threatening
when it occurs.
Statistics have shown that patients develop disseminated intravascular coagulation during chemotherapy with a median overall survival of only 13 days
.

So, when this critical situation arises during treatment, how should we respond? Let's take a look at the following case

In patients with advanced lung cancer, platelets are severely reduced

A 62-year-old white woman with no history of smoking is admitted to hospital for
headaches.
MRI of the brain reveals multiple lesions in the brain and suggests metastatic tumor
.
Chest CT showed a tumor in the upper left lobe of the lung, and PET-CT showed that the tumor had metastasized to the liver and bone
.

Figure 1.
PET-CT examination shows multiple organ metastases

Lung adenocarcinoma is confirmed by biopsy of bone and soft tissue, and the patient is started with whole-brain radiotherapy
.
Deep vein thrombosis in both lower extremities was found during treatment, and the doctor prescribed apixaban
for her.

After a few weeks, the patient's platelet count gradually decreased, the lowest was 8000/ul, hemoglobin was 10.
1 g/dL, the prothrombin time was 20.
3 seconds (the normal range was 10.
2-12.
9), the D-dimer was also significantly increased, and liver function was severely impaired
.

Although doctors gave the patient platelet transfusions in a timely manner, the problem of thrombocytopenia did not improve
.
Circulating tumor DNA testing using blood samples found that the patient had a mutation in the L858R spot of
the EGFR gene.

The targeted drug osimertinib improves symptoms

According to the results of genetic testing, the patient started taking 80 mg of the third-generation EGFR targeted drug osimertinib per day, and the overall treatment was well tolerated, and thrombocytopenia improved
rapidly.
After two weeks of treatment, the platelet count rose to 149,000/ul, and no recurrent thrombosis was
shown at subsequent follow-up.

After 10 weeks of osimertinib treatment, chest CT showed complete resolution of pulmonary embolism, significant reduction of tumor lesions, and partial clinical remission
.

Figure 2.
Abdominal CT shows remission of liver metastases

Unfortunately, after 5 months of targeted therapy, the patient's condition suddenly deteriorated and unfortunately passed away
.

revelation

The researchers conducted a literature review and investigation, and in 17 patients with non-small cell lung cancer with disseminated intravascular coagulation, disseminated intravascular coagulation resolved after corresponding targeted therapy, and usually improved
after one week of treatment.
A pooled analysis showed that about 69% of patients survived more than
one year.

In the process of treatment, we should be alert to these parasyndromes caused by tumors, such as the symptoms of thrombocytopenia, which cannot be improved by platelet transfusion, then it may be disseminated intravascular coagulation
.
Patients should communicate with the attending doctor in time according to their own conditions, and use symptomatic targeted drug treatment to strive to control adverse reactions while alleviating
the condition.

Cancer, accompany you through every step of the fight against cancer!

References: Justin L.
Pevner, Tawee Tanvetyanon, Targeted therapy for lung cancer with paraneoplastic disseminated intravascular coagulation: A case report and pooled analysis, Clinical Lung Cancer (2022)

Click below to learn more about our clinical trial programs