Next Article in Journal
Open Globe Injuries: Classifications and Prognostic Factors for Functional Outcome
Previous Article in Journal
Diagnostic Performance of Dual-Energy Subtraction Radiography for the Detection of Pulmonary Emphysema: An Intra-Individual Comparison
Case Report

Personalized First-Line Treatment of Metastatic Pancreatic Neuroendocrine Carcinoma Facilitated by Liquid Biopsy and Computational Decision Support

1
Department of Clinical Oncology, St. Imre Hospital, 1115 Budapest, Hungary
2
Oncompass Medicine Hungary Ltd., 1024 Budapest, Hungary
3
Centrum Hospital of Southern Pest, National Hematology and Infectology Institute, 1097 Budapest, Hungary
4
Department of Pharmacology and Pharmacotherapy, Semmelweis University, 1089 Budapest, Hungary
5
Department of Pharmaceutical Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Academic Editor: Dario de Biase
Diagnostics 2021, 11(10), 1850; https://doi.org/10.3390/diagnostics11101850
Received: 7 September 2021 / Revised: 28 September 2021 / Accepted: 28 September 2021 / Published: 7 October 2021
(This article belongs to the Section Machine Learning and Artificial Intelligence in Diagnostics)
Background: We present the case of a 50-year-old female whose metastatic pancreatic neuroendocrine tumor (pNET) diagnosis was delayed by the COVID-19 pandemic. The patient was in critical condition at the time of diagnosis due to the extensive tumor burden and failing liver functions. The clinical dilemma was to choose between two registered first-line molecularly-targeted agents (MTAs), sunitinib or everolimus, or to use chemotherapy to quickly reduce tumor burden. Methods: Cell-free DNA (cfDNA) from liquid biopsy was analyzed by next generation sequencing (NGS) using a comprehensive 591-gene panel. Next, a computational method, digital drug-assignment (DDA) was deployed for rapid clinical decision support. Results: NGS analysis identified 38 genetic alterations. DDA identified 6 potential drivers, 24 targets, and 79 MTAs. Everolimus was chosen for first-line therapy based on supporting molecular evidence and the highest DDA ranking among therapies registered in this tumor type. The patient’s general condition and liver functions rapidly improved, and CT control revealed partial response in the lymph nodes and stable disease elsewhere. Conclusion: Deployment of precision oncology using liquid biopsy, comprehensive molecular profiling, and DDA make personalized first-line therapy of advanced pNET feasible in clinical settings. View Full-Text
Keywords: pancreatic neuroendocrine tumor; molecular diagnostics; liquid biopsy; cfDNA; large panel sequencing; clinical decision support system; everolimus; personalized oncology pancreatic neuroendocrine tumor; molecular diagnostics; liquid biopsy; cfDNA; large panel sequencing; clinical decision support system; everolimus; personalized oncology
Show Figures

Figure 1

MDPI and ACS Style

Szkukalek, J.; Dóczi, R.; Dirner, A.; Boldizsár, Á.; Varga, Á.; Déri, J.; Lakatos, D.; Tihanyi, D.; Vodicska, B.; Schwáb, R.; Pajkos, G.; Várkondi, E.; Vályi-Nagy, I.; Valtinyi, D.; Nagy, Z.; Peták, I. Personalized First-Line Treatment of Metastatic Pancreatic Neuroendocrine Carcinoma Facilitated by Liquid Biopsy and Computational Decision Support. Diagnostics 2021, 11, 1850. https://doi.org/10.3390/diagnostics11101850

AMA Style

Szkukalek J, Dóczi R, Dirner A, Boldizsár Á, Varga Á, Déri J, Lakatos D, Tihanyi D, Vodicska B, Schwáb R, Pajkos G, Várkondi E, Vályi-Nagy I, Valtinyi D, Nagy Z, Peták I. Personalized First-Line Treatment of Metastatic Pancreatic Neuroendocrine Carcinoma Facilitated by Liquid Biopsy and Computational Decision Support. Diagnostics. 2021; 11(10):1850. https://doi.org/10.3390/diagnostics11101850

Chicago/Turabian Style

Szkukalek, Judita, Róbert Dóczi, Anna Dirner, Ákos Boldizsár, Ágnes Varga, Júlia Déri, Dóra Lakatos, Dóra Tihanyi, Barbara Vodicska, Richárd Schwáb, Gábor Pajkos, Edit Várkondi, István Vályi-Nagy, Dorottya Valtinyi, Zsuzsanna Nagy, and István Peták. 2021. "Personalized First-Line Treatment of Metastatic Pancreatic Neuroendocrine Carcinoma Facilitated by Liquid Biopsy and Computational Decision Support" Diagnostics 11, no. 10: 1850. https://doi.org/10.3390/diagnostics11101850

Find Other Styles
Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Access Map by Country/Region

1
Back to TopTop