1. Tumor board session I Clinical cases
Carlos Vargas, MD.
Camilo Fadul MD, FACN.
Andrés Felipe Cardona, MD MSc PhD.
Hernán Carranza, MD MSc.
Javier Segovia, MD.
Álvaro Muñoz, MD.
Juan Fernando Ramón, MD MSc

2. Brain metastasesof BRAF+ melanoma
Case 1
Brain metastasesof BRAF+ melanoma
63-year-old female
Mother and daughter with melanoma (Familial Atypical Multiple Melanoma Syndrome)
Abnormal melanotic lesion in right ear (malignant melanoma, Clark IV, Breslow 3.2 mm)
First genomic evaluation: p16INK4+/BRAFV600K+
Symptoms: numbness and weakness in her left leg
Spinal MRI revealed metastatic disease involving the spinal cord at C5 and T3, and 8 mm focal-enhancing T1 metástasis in T1. A brain MRI scan revealed four metastases, including a dominant 3.5×2.2×2.7 cm lesion in the right posterior parietal cortex

3. Brain metastasesof BRAF+ melanoma
Case 1
Brain metastasesof BRAF+ melanoma
Treatment:
Parietal cortex lesion was surgically removed ( )
SRS (3 aditional lesions; )
TMZ 200 mg/m2 5/28 x 7 cycles (SD + TTP 8.2 months → )
Lung and bone progression
Ipilimumab/Zoledronic acid x 4 cycles (PR + TTP 13 months → )
Edema surrounding previously identified brain and cord metastases
Bevacizumab 7.5 mg/kg x 3 cycles + Celecoxib 200 mg qd (complete regression of edema)
Brain progression (4 additional metastases)
SRS + Ipilimumab reinduction → Ipi maintenance (PR + TTP 9 months → )

4. Pre-Ipi therapy
Post-Ipi therapy

5. Brain metastasesof BRAF+ melanoma
Case 1
Brain metastasesof BRAF+ melanoma
Treatment:
Brain and lung progression
Vemurafenib (SD + TTP 5.6 months → )
Brain, bone and live progression
h. Carboplatin/Weekly paclitaxel (PR + TTP 6.0 months → )

6. Brain metastasesof EGFR+ LAC
Case 2
Brain metastasesof EGFR+ LAC
2012
Case presentation
61 year old man
Former smoker (2 cigarettes/day for 5 years)
Family history: none
Presents with headache related to brain metastases/leptomeningeal
disease
PET/CT shows spiculated LUL mass
Biopsy: lung adenocarcinoma (TTF1+, Napsin A+, Ck7+)
First genomic evaluation: EGFRdel19/T790M basal(-), ALK(-), TS (T1)/ERCC1(T1)

7. Response to erlotinib in first line
Pre-erlotinib
8 weeks post-erlotinib

8. Anaplastic meningioma
Case 3
Anaplastic meningioma
Case presentation
54 year-old female
Previous history of early breast cancer (1996)
Clinical history 4 years (unstable gait, tremor and seizures)
Right parasagittal parietal meningioma adjacent to the right precentral gyrus
Treatment:
Primary resection ( ) → Atypical meningioma (no residual disease)
Secondary resection ( ) → Atypical meningioma (no residual disease)
IMRT ( ; CR → TTP 19 months)
Tertiary resection ( ; Two nodules of residual disease with estimated volume of 36 mm3)
SRS ( ; PR → TTP 14 months)

9. Genomic evaluation (2013): SR2(-)/TSLC1(+)/PDGFR(-)/NF2c. 699G:T (p
Genomic evaluation (2013): SR2(-)/TSLC1(+)/PDGFR(-)/NF2c.699G:T (p.Leu233Leu)

10. Anaplastic meningioma
Case 3
Anaplastic meningioma
Treatment:
f. Everolimus + Octeotride ( ; PR → TTP 26 months)
g. Bevacizumab monotherapy 15 mg/kg q15 days ( ; SD → TTP 9 months)
h. Sunitinib 37 mg qd ( ; PR → TTP 28 months – current treatment)
Overall survival with targeted therapy: 63 months
CD34
VEGF

11. Supratentorial primitive neuroectodermal tumor
Case 4
Supratentorial primitive neuroectodermal tumor
Case presentation
52 year-old female
No previous history
Clinical history 1 month (dense quadriparesis and sensory alteration with T1 level)
Large extramedullary intradural expansive lesion extending from the occipital foramen to C3-4 involving the posterior aspect of the left canal and right frontal lobe nodule (22 mm)
Treatment:
Partial resection ( ) → PNET (positive immunohistochemistry for CD99 and synaptophysin, and negative for NG84, EMA, PFAG and TTF1)
Carboplatin/Etoposide/Cy x 3 cycles ( ; CR)
Craniospinal radiotherapy ( ; CR)