Response to vismodegib in recurrent meduloblastoma.

Respuesta a vismodegib en un meduloblastoma recurrente.

A 32 year-old female patient was seen in 2006 suffering from headaches, vertical diplopia and a graduallydeveloping unsteady gait. CT scan revealed a 40 x 40 mm intra-axial cerebellar mass affecting the vermis. She underwent gross total resection with histology being compatible with a primitive neuro-ectodermal pattern.The final report was consistent with a desmoplastic nodular medulloblastoma (WHO grade IV), 20% Ki67, with focal reactivity for synaptophysin, neurofilaments and CD99. Bone marrow biopsy and cerebrospinal fluid were negative. She received adjuvant craniospinal radiotherapy, followed by chemotherapy with cyclophosphamide, cisplatin, etoposide and vincristine which was well-tolerated. She was then closely followed-up for 5 years with no evidence of relapse until an MRI then identified a new lesion within the posterior fossa which was biopsied and confirmed recurrent disease. She was evaluated at MD Anderson Cancer Center (MDACC) and in conjunction with our oncology department we decided to treat her with induction chemotherapy involving  yclophosphamide, cisplatin and etoposide.