2025-12-04 11:48:39
Medical Summary Portfolio
Patient: Jan-Marten Daling
Date of Summary: December 3, 2025
Primary Diagnosis: Poorly differentiated carcinoma (anterior mediastinum) with choriocarcinoma-like behavior
🔴 Current Status (Urgent)
Last updated: December 08, 2025 December 03, 2025 Latest β-HCG: 270.0 IU/L (December 01, 2025) Latest PET Scan: None
β-HCG rising again: 9 → 10 → 24 → 42 → 113 → 197 → 270 IU/L over 33 days (Oct 29 → Dec 1)
PET scan (Nov 17): Active disease confirmed - multiple FDG-avid mediastinal/hilar lymph nodes & bilateral lung nodules
Bone marrow: Depleted from intensive chemotherapy - limiting further treatment options
Action required: Immediate treatment escalation
📖 Clinical History
Initial Presentation (March 2025)
Mr. Daling presented in March 2025 with dyspnea, chest pain, and significant weight loss. Emergency imaging revealed severe cardiothoracic involvement requiring urgent intervention.
Key imaging findings:
- 11.4 × 7 × 7.8 cm anterior mediastinal mass
- Bilateral pulmonary nodules
- Left chest wall invasion
- Massive pleural effusion requiring intercostal drain (3L pleural fluid)
- Large pericardial effusion requiring emergency pericardial window drainage (900 mL)
Clinical severity: Life-threatening cardiorespiratory compromise at presentation
View Full Timeline → View Medical Reports →
Pathology & Diagnosis (March 25, 2025)
Lung biopsy diagnosed poorly differentiated metastatic carcinoma, CD5-positive, with features of thymic carcinoma, but inconclusive for germ cell elements. PD-L1 expression was high (CPS 80%).
Diagnostic dilemma: Pathology suggests thymic origin, but clinical and biochemical behavior strongly indicates choriocarcinoma or embryonal non-seminomatous germ cell tumor (NSGCT):
- Extremely elevated β-HCG levels (initial: 70,482 IU/L; peak: 240,422 IU/L)
- Rapid chemosensitivity (99.99% reduction achieved)
- Young male with anterior mediastinal mass
- Aggressive clinical course
Working diagnosis: Choriocarcinoma/NSGCT with atypical features
💊 Treatment History
Phase 1: First-Line Chemotherapy (April-June 2025)
Protocol: Paclitaxel + Carboplatin + Pembrolizumab immunotherapy
Cycles administered:
- Cycle 1 (April 22): 60% Paclitaxel + 60% Carboplatin
- Cycle 2 (May 14): 50% Paclitaxel + 75% Carboplatin
- Cycle 3 (June 25): 50% Paclitaxel + 75% Carboplatin + Pembrolizumab
Complications: Neutropenic sepsis (Streptococcus mitis) after Cycle 1 requiring hospitalization
Response: Partial response, but β-HCG continued to rise to peak of 240,422 IU/L (July 2)
Phase 2: VIP Salvage Protocol (July-October 2025)
Protocol: VIP (Etoposide, Ifosfamide, Cisplatin) - intensive 5-day regimen
Cycles administered:
- VIP #1 (July 21-26): Full dose
- VIP #2 (August 11-16): Full dose
- VIP #3 (September 8-13): Full dose
- VIP #4 (October 6-11): 70% dose reduction due to bone marrow concerns
Response: Excellent - β-HCG dropped from 240,422 → 9 IU/L (99.99% reduction) ✓
Outcome: Treatment deemed unsafe to continue after fourth cycle due to progressive bone marrow fragility (anemia, neutropenia, thrombocytopenia). Bone marrow recovery progressively slower after each cycle.
Phase 3: Current Status & Planning (November-December 2025)
Treatment break: 5+ weeks (October 11 - present)
Disease progression: β-HCG rising rapidly despite excellent initial response:
- October 29: 9 IU/L (nadir)
- November 5: 10 IU/L
- November 14: 24 IU/L
- November 17: 42 IU/L
- November 22: 113 IU/L
Imaging confirmation: PET scan (November 17) confirms active disease with multiple FDG-avid sites
Current planning:
- Oncology hesitant to continue VIP due to bone marrow toxicity
- Considering EP/BEP protocol (Etoposide, Cisplatin, +/- Bleomycin)
- Bone marrow harvest under discussion for potential stem cell rescue
- Surgery not feasible while disease remains widely active
- Targeted radiation planned for residual disease post-chemotherapy response
Integrative treatments: Regular hyperthermia sessions with Dr. James Laporta (May-September 2025, ~20+ sessions). Ketogenic diet adapted due to weight loss (72 kg → 67.8 kg).
📊 Key Biomarkers Summary
| Marker | Latest Value (Dec 01) | Reference Range | Status | Trend |
|---|---|---|---|---|
| β-HCG | 270 IU/L | <2 IU/L | 🔴 Critical | Rising (113 → 197 → 270) |
| Hemoglobin | 10.5 g/dL | 13.0-17.0 g/dL | ⚠️ Low | Stable anemia |
| WBC | 5.60 x10E9/L | 4.0-11.0 x10E9/L | ✓ Normal | Recovered |
| Neutrophils | 4.66 x10E9/L | 2.0-7.5 x10E9/L | ✓ Normal | Recovered |
| Platelets | 84 x10E9/L | 140-420 x10E9/L | 🔴 Low | Falling (163→117→101→84) |
| Lymphocytes | 0.76 x10E9/L | 1.0-4.0 x10E9/L | ⚠️ Low | Persistent |
| CRP | 1.90 mg/L | 0-5.0 mg/L | ✓ Normal | Down from 6.5 |
β-HCG trajectory (peak to nadir to current):
- Peak: 240,422 IU/L (July 2, 2025)
- Nadir: 9 IU/L (October 29, 2025) - 99.99% reduction
- Current: 270 IU/L (December 01, 2025) - recent rise after nadir
View Interactive Biomarker Charts →
🔗 Complete Medical Records
This portal contains comprehensive medical data for review:
Blood Tests & Biomarkers:
- Interactive Biomarker Trends - All blood test results visualized with treatment overlays
- 50+ blood tests processed (March 2021 → November 2025)
- β-HCG, Full Blood Count, CRP, and more
Treatment Documentation:
- Treatment Timeline - Complete intervention history with dates and protocols
- Chemotherapy cycles, hyperthermia sessions, supportive care
Imaging & Reports:
- Medical Reports - CT scans, PET scans, pathology reports, consultation notes
- All reports extracted and indexed with original PDFs available
Research & Analysis:
- Research Section - β-HCG response lag analysis, treatment correlations, statistical analysis
- AI Medical Intelligence - Ask natural language questions about medical history
Portal Access:
- Health Portal: https://health.jmdaling.co.za
- Imaging Portal: Cape Radiology patient portal
- Portal Credentials: Username:
admin| Password:BnA4YF
👥 Care Team
Primary Oncologist: Dr. Davids (currently on 5-week leave)
Hyperthermia Specialist: Dr. James Laporta
Integrative Medicine: Seeking consultation
Supportive Care: Multiple specialists (documented in care team page)
📝 Notes for New Clinicians
Key clinical considerations:
- Disease is chemo-responsive - achieved 99.99% β-HCG reduction with VIP
- Bone marrow is the limiting factor - cannot tolerate full-dose intensive chemotherapy
- Disease is aggressive - rapid recurrence during treatment break
- Window of opportunity - disease burden is currently manageable but deteriorating
- Patient is highly engaged - comprehensive health data tracking, evidence-based approach
Urgent questions for consultation:
- Can we safely administer further chemotherapy given bone marrow status?
- Is bone marrow harvest/stem cell support feasible?
- Alternative protocols for platinum-refractory disease?
- Role for targeted radiation during this treatment break?
- Integrative approaches to support bone marrow recovery?
Last updated: December 08, 2025
This summary is automatically updated with each new blood test or treatment event