2 CASE REPORT
A 56-year-old female was diagnosed with uterine endometrioid adenocarcinoma stage I2b in April, 2020. She underwent a simple hysterectomy, bilateral salpingo-oophorectomy, greater omentum segmental resection, lymphadenectomy of pelvis, paraaortic, and retroperitoneum. She strongly rejected the standard chemotherapy. We found that her CTC level was high (6.2 cells/6.5 mL by Oncocount RGCC, Research Genetics Cancer Center (RGCC) International GmBH, Switzerland). Pathological tests revealed her CTC to be sensitive to chemotherapeutic agents, i.e., carboplatin and docetaxel, and MSI-high. However, she also rejected treatment with immune-checkpoint inhibitors. Then, we found multiple metastases in both sides of her lungs by computed tomography (CT) (Fig. 1, a-g, series i) and a positive signal in paraaortic lymph nodes on the hilum of left kidney by positron emission tomography (PET)-CT (Fig. 1, h, i) in October, 2020.
We therefore selected AFTV treatment. From November, 2020, to January, 2021, she was treated with three intradermal injections of AFTV, each of them two weeks apart. AFTV was made from the patient’s own resected, formalin-fixed uterine carcinoma tissue, similar to the procedure reported in cases of glioblastoma.1 No problematic adverse event has been observed (erythema and induration at the injection sites, all less than CTCAE grade 2). Subsequently, we found by CT imaging apparently reduced, almost faint, nine lung metastases in December, 2021, as shown in Fig. 1, a-g, series ii. Especially, the lung metastasis observed in Fig. 1, g, i (arrowhead with asterisk) had disappeared in Fig. 1, g, ii, suggesting that AFTV monotherapy was effective towards the lung metastases.
To our surprise, however, she was unwillingly guided towards the standard chemotherapy at a regional big hospital in order to suppress the remaining metastases. Reluctantly, she received one dosis of chemotherapy with carboplatin and docetaxel (70 mg/m2and AUC 5, respectively) that resulted in several typical, severe adverse effects such as nausea, diarrhea, stomatitis, anorexia, numbness, psilosis, and transient leukopenia. She quickly rejected further chemotherapy and was then switched back to two more AFTV injections in January and February, 2021, in our clinic. The CT and PET-CT images revealed complete response of her lung- and paraaortic lymph node metastases, as shown in Fig. 1, a-h, series iii. She is living well at present (cut-off, January 31, 2022).