Background: Participated in two clinical trials earlier this year however they were unsuccessful and I was removed from them after 1 o2 cycles
Reason for Hospitalization: Malignant neoplasm of prostate [C61]. Care, Treatment, and Services Provided: Kevin Klott is a 59 y.o. male from Gladwin, Michigan with metastatic prostate cancer, who has received multiple lines of prior therapies which have proven to be refractory. The patient is now enrolled in clinical trial and was admitted to receive cycle 1 day one of the treatment with BNT152 plus BNT153 (IL-7, IL-2) per protocol 2020-1019
The patient received treatment on 1/4/24. Post infusion, he developed chills and fever which were treated with acetaminophen and demerol. On 1/6/24, it was noted that his ALT and AST are increased - ALT 507, AST 657. On 1/7/24, ALT slightly increased to 554 and AST improved to 344. Total bilirubin 1.6, direct 1.1. INR is WNL.
The patient is feeling well and denies any acute complaints. We obtained an acute hepatitis work-up and consulted gastroenterology.
Reason for Hospitalization: Malignant neoplasm of prostate [C61]
Care, Treatment, and Services Provided:
Kevin Klott is a 59 y.o. male from Gladwin, Michigan with metastatic prostate cancer, who has received multiple lines of prior therapies which have proven to be refractory. The patient is now enrolled in clinical trial and was admitted to receive cycle 1 day one of the treatment with BNT152 plus BNT153 (IL-7, IL-2) per protocol 2020-1019. The patient received treatment on 1/4/24. Post infusion, he developed chills and fever which were treated with acetaminophen and demerol.
On 1/6/24, it was noted that his ALT and AST are increased - ALT 507, AST 657. On 1/7/24, ALT slightly increased to 554 and AST improved to 344. Total bilirubin 1.6, direct 1.1. INR is WNL.
Brief History from incident that occurred on 10/8/2024:
History obtained from chart and Dr Adams.
Mr Klott is a 60 yo M with PMH of metastatic prostate cancer (without known mets to brain per chart and history) who was found altered at his oncology clinic around 120 PM. There are reports in chart of him speaking to another patient at 1248 "normally" and him checking into the desk without trouble speaking at around 110 PM. When they went to get him for his appointment around 120, he was having difficulty responding. EMS brought him to ED. On exam here, had L facial droop, aphasia (speaking gibberish) and generalized weakness.
CTH reviewed with evidence of R sided vasogenic edema with midline shift, causing effacement of the lateral ventricles and concern for uncal herniation with mass effect on the midbrain. CTA was not available at the time of consultation due to IV issues. Patient was not examined, films were reviewed and case discussed with Dr. Adams.
Recommendations:
- Not a candidate for IV thrombolysis due to concern for intracranial mass occupying lesion
- Unable to assess candidacy for MT given no CTA H&N, however, right sided lesion is likely cause of the patients symptoms
- Defer management of suspected brain mass to local ED team.
IV TNK recommended: No
Mechanical thrombectomy candidate: unable to assess candidacy, however likely not a candidate even if LVO was identified given large right sided mass concerning for tumor with midline shift and herniation.
Because I was unable to obtain details regarding the referenced mass lesion, my status was changed from palliative to hospice following roughly 10 cycles of radiation therapy to my skull and brain along with a radical change to opioid meds in an attempt to manage pain.
Anyone have a similar situation or experience? Looking for options related to effectively manage, with minimal pain before taking my final walk home.
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