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      Multiple systemic treatment options in a patient with malignant tenosynovial giant cell tumour

      case-report

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          Abstract

          Tenosynovial giant cell tumour (TGCT) is a group of rare soft tissues neoplasia affecting synovial joints, bursae and tendon sheaths and is classified as localized type or diffuse type. The diffuse type (TGCT-D), also known as ‘pigmented villonodular (teno)synovitis’ is characterized by local aggressivity, with invasion and destruction of adjacent soft-tissue structures, and high local recurrence rate. Radical surgery remains the standard therapy while adjuvant radiotherapy may help to control local spread. Malignant TGCT is characterized by high rate of local recurrences and distant metastasis. Few cases of malignant TGCT and very few evidences on systemic therapies are described in the literature, so, to date, no systemic treatment is approved for this rare disease. We report the case of a malignant TGCT patient treated with many different systemic therapies, including chemotherapy and tyrosine-kinase inhibitors, and performed a review of the literature on the systemic treatment options of this rare tumour.

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          Most cited references26

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          Doxorubicin alone versus intensified doxorubicin plus ifosfamide for first-line treatment of advanced or metastatic soft-tissue sarcoma: a randomised controlled phase 3 trial.

          Effective targeted treatment is unavailable for most sarcomas and doxorubicin and ifosfamide-which have been used to treat soft-tissue sarcoma for more than 30 years-still have an important role. Whether doxorubicin alone or the combination of doxorubicin and ifosfamide should be used routinely is still controversial. We assessed whether dose intensification of doxorubicin with ifosfamide improves survival of patients with advanced soft-tissue sarcoma compared with doxorubicin alone.
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            Anchored multiplex PCR for targeted next-generation sequencing.

            We describe a rapid target enrichment method for next-generation sequencing, termed anchored multiplex PCR (AMP), that is compatible with low nucleic acid input from formalin-fixed paraffin-embedded (FFPE) specimens. AMP is effective in detecting gene rearrangements (without prior knowledge of the fusion partners), single nucleotide variants, insertions, deletions and copy number changes. Validation of a gene rearrangement panel using 319 FFPE samples showed 100% sensitivity (95% confidence limit: 96.5-100%) and 100% specificity (95% confidence limit: 99.3-100%) compared with reference assays. On the basis of our experience with performing AMP on 986 clinical FFPE samples, we show its potential as both a robust clinical assay and a powerful discovery tool, which we used to identify new therapeutically important gene fusions: ARHGEF2-NTRK1 and CHTOP-NTRK1 in glioblastoma, MSN-ROS1, TRIM4-BRAF, VAMP2-NRG1, TPM3-NTRK1 and RUFY2-RET in lung cancer, FGFR2-CREB5 in cholangiocarcinoma and PPL-NTRK1 in thyroid carcinoma. AMP is a scalable and efficient next-generation sequencing target enrichment method for research and clinical applications.
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              CSF1R inhibition with emactuzumab in locally advanced diffuse-type tenosynovial giant cell tumours of the soft tissue: a dose-escalation and dose-expansion phase 1 study.

              Diffuse-type tenosynovial giant cell tumour (dt-GCT) of the soft tissue (alternatively known as pigmented villonodular synovitis), an orphan disease with unmet medical need, is characterised by an overexpression of colony-stimulating factor 1 (CSF1), and is usually caused by a chromosomal translocation involving CSF1. CSF1 receptor (CSF1R) activation leads to the recruitment of CSF1R-expressing cells of the mononuclear phagocyte lineage that constitute the tumor mass in dt-GCT. Emactuzumab (RG7155) is a novel monoclonal antibody that inhibits CSF1R activation. We have assessed the safety, tolerability and activity of emactuzumab in patients with Dt-GCT of the soft tissue.
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                Author and article information

                Journal
                Anticancer Drugs
                Anticancer Drugs
                ACD
                Anti-Cancer Drugs
                Lippincott Williams & Wilkins
                0959-4973
                1473-5741
                January 2020
                06 December 2019
                : 31
                : 1
                : 80-84
                Affiliations
                [a ]Medical Oncology 1, Ospedale Policlinico San Martino, University of Genova, Genova
                [b ]Medical Oncology Unit, University Hospital of Parma, Parma
                [c ]Emergency Radiology, Ospedale Policlinico San Martino, University of Genova, Genova
                [d ]Adult Mesenchymal Tumor Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
                [e ]Health Science Department (DISSAL) and Radiation Oncology, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
                Author notes
                Correspondence to Massimiliano Grassi, MD, Medical Oncology 1, Ospedale Policlinico San Martino, University of Genova, Genova, Italy, Tel: +39 3460822211; fax: 010 5555141; e-mail: massigrassi.mg@ 123456gmail.com
                Article
                00012
                10.1097/CAD.0000000000000844
                6903349
                31567307
                1dffa715-0d58-436f-ab0d-6ab3a31edcf1
                Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

                History
                : 29 May 2019
                : 20 August 2019
                : 20 August 2019
                Categories
                Case Reports
                Custom metadata
                TRUE

                chemotherapy,imatinib,malignant tenosynovial giant cell tumour,pazopanib,pigmented villonodular synovitis,tenosynovial giant cell tumour

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