ABSTRACT
Purpose@#Although osimertinib is the standard-of-care treatment of epidermal growth factor receptor (EGFR) T790M mutation–positive non–small cell lung cancer, real-world evidence on the efficacy of osimertinib is not enough to reflect the complexity of the entire course of treatment. Herein, we report on the use of osimertinib in patients with EGFR T790M mutation–positive non–small cell lung cancer who had previously received EGFR tyrosine kinase inhibitor (TKI) treatment in Korea. @*Materials and Methods@#Patients with confirmed EGFR T790M after disease progression of prior EGFR-TKI were enrolled and administered osimertinib 80 mg daily. The primary effectiveness outcome was progression-free survival, with time-to-treatment discontinuation, treatment and adverse effects leading to treatment discontinuation, and overall survival being the secondary endpoints. @*Results@#A total of 558 individuals were enrolled, and 55.2% had investigator-assessed responses. The median progression-free survival was 14.2 months (95% confidence interval [CI], 13.0 to 16.4), and the median time-to-treatment discontinuation was 15.0 months (95% CI, 14.1 to 15.9). The median overall survival was 36.7 months (95% CI, 30.9 to not reached). The benefit with osimertinib was consistent regardless of the age, sex, smoking history, and primary EGFR mutation subtype. However, hepatic metastases at the time of diagnosis, the presence of plasma EGFR T790M, and the shorter duration of prior EGFR-TKI treatment were poor predictors of osimertinib treatment. Ten patients (1.8%), including three with pneumonitis, had to discontinue osimertinib due to severe adverse effects. @*Conclusion@#Osimertinib demonstrated its clinical effectiveness and survival benefit for EGFR T790M mutation–positive in Korean patients with no new safety signals.
ABSTRACT
Purpose@#We report a case of Purtscher-like retinopathy after aortic valve replacement surgery.Case summary: A 52-year-old male with bacteremia suspicious of infectious endocarditis was referred to our department for ophthalmic examination. Inflammatory reaction was evident in both anterior chambers. Fundus examination revealed infiltrative lesions with a Roth spot, and the patient was diagnosed with chorioretinitis. After 3 days, aortic valve replacement surgery was performed in the cardiac surgery department using cardioplegic solutions. Ophthalmologic exams were repeated after the valve surgery. The Roth spot had disappeared and infiltrated, leaving a clear margin. An anterior chamber cell was not noted. However, there were newly developed peripapillary superficial cotton-wool spots and delayed hemorrhagic lesions. Based on the medical history and specific pathognomonic fundus findings, the patient was diagnosed with Purtscher-like retinopathy. Four months later, all characteristic funduscopic features of Purtscher-like retinopathy had disappeared, leaving a remaining retinal nerve fiber defect and central visual field defect without any ophthalmologic treatment. @*Conclusions@#Although rare, doctors should be aware of the possibility of Purtscher-like retinopathy after valve replacement surgery. Further studies are needed to understand the unknown pathophysiology of Purtscher-like retinopathy.
ABSTRACT
Purpose@#We explored changes in the various clinical parameters of dry eye disease (DED), including the tear matrix metalloproteinase 9 (MMP-9) level, soon after cataract surgery. We sought correlations between such changes and ocular surface discomfort. @*Methods@#In 106 patients (106 eyes) who underwent cataract surgery, we evaluated meibomian gland dysfunction, tear secretion, corneal sensitivity, tear break-up time, corneal erosion status, the Sjögren’s International Collaborative Clinical Alliance (SICCA) ocular staining score, tear osmolarity, the tear MMP-9 level, and the ocular surface disease index (OSDI) before, and 1 week and 1 month after surgery. All eyes were instilled with topical moxifloxacin, a steroid, and a non-steroidal anti-inflammatory drug daily for 1 month postoperatively. The 1-month delta OSDI scores correlated with the 1-month delta DED parameters. We compared the latter parameters between patients in whom the MMP-9 level decreased (MMP-9-decreased group) at 1 month with those in whom it did not (MMP-9-not decreased group). @*Results@#Overall, 89.5% of total patients exhibited preoperative DED. The tear MMP-9 level fell at 1 month postoperatively, tear secretion (evaluated using the Schirmer I test) decreased at 1 week, and the OSDI scores fell at both 1 week and 1 month. We found no significant correlation between the 1-month delta OSDI scores and the 1-month delta DED parameters. The 1-month OSDI score fell to a significantly greater extent in the MMP-9-decreased group. @*Conclusions@#Routine, local anti-inflammatory treatment after cataract surgery may briefly reduce the tear MMP-9 level and ocular surface discomfort.
ABSTRACT
Purpose@#We report a case of conjunctival pyogenic granuloma that developed after sub-Tenon’s block at the inferotemporal conjunctival quadrant during cataract surgery.Case summary: A 74-year-old male patient with senile cataract, diabetic retinopathy and open-angle glaucoma, who was using a combination of timolol/tafluprost and brimonidine eyedrops, underwent uneventful cataract surgery after sub-Tenon’s block at the inferotemporal conjunctival quadrant of his right eye. Moxifloxacin, 1% prednisolone acetate and 0.1% bromfenac sodium hydrate were administered daily for 1 month post-surgery, by which time a pink-colored, oval-shaped granulomatous mass had developed on the inferotemporal conjunctiva, at the site of the sub-Tenon’s block. Dexamethasone and antibiotic combination eye drops were administered without resection of the mass, which had markedly regressed after 2 weeks and disappeared completely 6 weeks after treatment. @*Conclusions@#Patients should be informed of the possibility of conjunctival pyogenic granuloma prior to cataract surgery using sub-Tenon’s block, and it is important to carefully check the block site and compliance with eyedrops at follow-up visits. Conjunctival pyogenic granuloma can be successfully treated with topical steroids.
ABSTRACT
Purpose@#We report a case of Purtscher-like retinopathy after aortic valve replacement surgery.Case summary: A 52-year-old male with bacteremia suspicious of infectious endocarditis was referred to our department for ophthalmic examination. Inflammatory reaction was evident in both anterior chambers. Fundus examination revealed infiltrative lesions with a Roth spot, and the patient was diagnosed with chorioretinitis. After 3 days, aortic valve replacement surgery was performed in the cardiac surgery department using cardioplegic solutions. Ophthalmologic exams were repeated after the valve surgery. The Roth spot had disappeared and infiltrated, leaving a clear margin. An anterior chamber cell was not noted. However, there were newly developed peripapillary superficial cotton-wool spots and delayed hemorrhagic lesions. Based on the medical history and specific pathognomonic fundus findings, the patient was diagnosed with Purtscher-like retinopathy. Four months later, all characteristic funduscopic features of Purtscher-like retinopathy had disappeared, leaving a remaining retinal nerve fiber defect and central visual field defect without any ophthalmologic treatment. @*Conclusions@#Although rare, doctors should be aware of the possibility of Purtscher-like retinopathy after valve replacement surgery. Further studies are needed to understand the unknown pathophysiology of Purtscher-like retinopathy.
ABSTRACT
Purpose@#We explored changes in the various clinical parameters of dry eye disease (DED), including the tear matrix metalloproteinase 9 (MMP-9) level, soon after cataract surgery. We sought correlations between such changes and ocular surface discomfort. @*Methods@#In 106 patients (106 eyes) who underwent cataract surgery, we evaluated meibomian gland dysfunction, tear secretion, corneal sensitivity, tear break-up time, corneal erosion status, the Sjögren’s International Collaborative Clinical Alliance (SICCA) ocular staining score, tear osmolarity, the tear MMP-9 level, and the ocular surface disease index (OSDI) before, and 1 week and 1 month after surgery. All eyes were instilled with topical moxifloxacin, a steroid, and a non-steroidal anti-inflammatory drug daily for 1 month postoperatively. The 1-month delta OSDI scores correlated with the 1-month delta DED parameters. We compared the latter parameters between patients in whom the MMP-9 level decreased (MMP-9-decreased group) at 1 month with those in whom it did not (MMP-9-not decreased group). @*Results@#Overall, 89.5% of total patients exhibited preoperative DED. The tear MMP-9 level fell at 1 month postoperatively, tear secretion (evaluated using the Schirmer I test) decreased at 1 week, and the OSDI scores fell at both 1 week and 1 month. We found no significant correlation between the 1-month delta OSDI scores and the 1-month delta DED parameters. The 1-month OSDI score fell to a significantly greater extent in the MMP-9-decreased group. @*Conclusions@#Routine, local anti-inflammatory treatment after cataract surgery may briefly reduce the tear MMP-9 level and ocular surface discomfort.
ABSTRACT
Purpose@#We report a case of conjunctival pyogenic granuloma that developed after sub-Tenon’s block at the inferotemporal conjunctival quadrant during cataract surgery.Case summary: A 74-year-old male patient with senile cataract, diabetic retinopathy and open-angle glaucoma, who was using a combination of timolol/tafluprost and brimonidine eyedrops, underwent uneventful cataract surgery after sub-Tenon’s block at the inferotemporal conjunctival quadrant of his right eye. Moxifloxacin, 1% prednisolone acetate and 0.1% bromfenac sodium hydrate were administered daily for 1 month post-surgery, by which time a pink-colored, oval-shaped granulomatous mass had developed on the inferotemporal conjunctiva, at the site of the sub-Tenon’s block. Dexamethasone and antibiotic combination eye drops were administered without resection of the mass, which had markedly regressed after 2 weeks and disappeared completely 6 weeks after treatment. @*Conclusions@#Patients should be informed of the possibility of conjunctival pyogenic granuloma prior to cataract surgery using sub-Tenon’s block, and it is important to carefully check the block site and compliance with eyedrops at follow-up visits. Conjunctival pyogenic granuloma can be successfully treated with topical steroids.
ABSTRACT
Purpose@#We report a case of post-pterygium excisional Pseudallescheria boydii (P. boydii) necrotizing scleritis successfully treated with multi-antifungal agents.Case summary: A 73-year-old female with a history of pterygium excision 6 years prior was referred to our institute because of worsening scleritis in the left eye during high-dose, 2-week steroid treatment. On the initial visit, an oval ulcer was observed in the temporal sclera adjacent to the limbus. All steroids were stopped and 1% voriconazole, 5% natamycin, 2.5% vancomycin, and 5% ceftazidime eyedrops were applied every hour and oral voriconazole 200 mg prescribed once a day, but the scleral necrosis continued to worsen. On day 10, the filamentous fungus P. boydii was isolated; 0.5% caspofungin eyedrops were added and the topical voriconazole concentration increased to 2%. Six weeks later, despite epithelization over the scleral necrosis, choroidal detachment developed. The antifungal treatment was continued and a dispersive, ophthalmic viscosurgical device inserted in the anterior chamber. At 14 weeks of treatment, the scleral necrosis was completely epithelialized and the choroidal detachment had disappeared. @*Conclusions@#When encountering a case of P. boydii-caused necrotizing scleritis developing after pterygium excision surgery, long-term intensive treatment with several antifungal agents must be considered.
ABSTRACT
Purpose@#We describe a patient with Stevens-Johnson syndrome who exhibited recurrent anterior corneal granulomas after corneal perforation (despite multiple amniotic membrane [AM] transplantations); the patient was successfully treated by lamellar grafting of an acellular, preserved human cornea.Case summary: Corneal granulomas developed four times in a 46-year-old man who had been diagnosed with Stevens-Johnson syndrome 17 years priorly and who had undergone multiple AM transplantations after corneal perforation. A corneal granulomatous mass recurred 2 months prior to presentation in our clinic; it rapidly increased in size. With the patient under general anesthesia, the corneal mass was excised and a 4.0-mm-diameter, acellular preserved human cornea (Halo; Eversight Inc., Palo Alto, CA, USA) was grafted. A similarly sized AM was placed over the grafted cornea. Although the engrafted cornea exhibited stromal infiltration 1 month after surgery, the keratitis improved following brief antibiotic treatment. At 8 months postoperatively, the wound was stable; no granuloma recurrence, no graft melting, and no suspected microbial keratitis were observed in the region of the graft. @*Conclusions@#In patients with Stevens-Johnson syndrome and recurrent anterior granulomas (despite multiple AM transplantations), a lamellar graft of acellular, preserved human cornea may be a good therapeutic choice.
ABSTRACT
Purpose@#To report a case of acquired perforated anterior scleral staphyloma treated successfully by lamellar grafting of the acellular preserved human cornea.Case summary: A 39-year-old male patient with anterior scleral staphyloma at the superior scleral area near the corneal limbus of the right eye which occurred after congenital cataract surgery visited our hospital due to bleeding and excessive tearing in his right eye. Slit lamp bio-microscopic examination revealed a Seidel-positive perforation with bleeding at the anterior scleral staphyloma. Under general anesthesia, conjunctiva was dissected from the scleral staphyloma. Amniotic membrane (AM) was transplanted over the perforated area and an acellular preserved human cornea (Halo; Eversight Inc., Palo Alto, CA, USA) was grafted over the AM. To aid the vascularization over the grafts, an advancement flap of the adjacent Tenon’s capsule was constructed. Thereafter, the recipient cornea was tattooed for cosmetic purposes. At 4 months postoperatively, the wound had stabilized without perforation recurrence, and staphyloma protrusion had improved. @*Conclusions@#In a case of a perforated anterior scleral staphyloma, restorative transplantation using acellular preserved human corneal tissue may be a good therapeutic alternative, given that the cornea is easy to suture, is thick enough to compress the protruding area, and has a low risk of graft stretching or melting compared with the sclera.
ABSTRACT
Purpose@#We describe a patient with Stevens-Johnson syndrome who exhibited recurrent anterior corneal granulomas after corneal perforation (despite multiple amniotic membrane [AM] transplantations); the patient was successfully treated by lamellar grafting of an acellular, preserved human cornea.Case summary: Corneal granulomas developed four times in a 46-year-old man who had been diagnosed with Stevens-Johnson syndrome 17 years priorly and who had undergone multiple AM transplantations after corneal perforation. A corneal granulomatous mass recurred 2 months prior to presentation in our clinic; it rapidly increased in size. With the patient under general anesthesia, the corneal mass was excised and a 4.0-mm-diameter, acellular preserved human cornea (Halo; Eversight Inc., Palo Alto, CA, USA) was grafted. A similarly sized AM was placed over the grafted cornea. Although the engrafted cornea exhibited stromal infiltration 1 month after surgery, the keratitis improved following brief antibiotic treatment. At 8 months postoperatively, the wound was stable; no granuloma recurrence, no graft melting, and no suspected microbial keratitis were observed in the region of the graft. @*Conclusions@#In patients with Stevens-Johnson syndrome and recurrent anterior granulomas (despite multiple AM transplantations), a lamellar graft of acellular, preserved human cornea may be a good therapeutic choice.
ABSTRACT
Purpose@#To report a case of acquired perforated anterior scleral staphyloma treated successfully by lamellar grafting of the acellular preserved human cornea.Case summary: A 39-year-old male patient with anterior scleral staphyloma at the superior scleral area near the corneal limbus of the right eye which occurred after congenital cataract surgery visited our hospital due to bleeding and excessive tearing in his right eye. Slit lamp bio-microscopic examination revealed a Seidel-positive perforation with bleeding at the anterior scleral staphyloma. Under general anesthesia, conjunctiva was dissected from the scleral staphyloma. Amniotic membrane (AM) was transplanted over the perforated area and an acellular preserved human cornea (Halo; Eversight Inc., Palo Alto, CA, USA) was grafted over the AM. To aid the vascularization over the grafts, an advancement flap of the adjacent Tenon’s capsule was constructed. Thereafter, the recipient cornea was tattooed for cosmetic purposes. At 4 months postoperatively, the wound had stabilized without perforation recurrence, and staphyloma protrusion had improved. @*Conclusions@#In a case of a perforated anterior scleral staphyloma, restorative transplantation using acellular preserved human corneal tissue may be a good therapeutic alternative, given that the cornea is easy to suture, is thick enough to compress the protruding area, and has a low risk of graft stretching or melting compared with the sclera.
ABSTRACT
Although recent advances in molecular targeted therapy and immuno-oncology have revolutionized the landscape of lung cancer therapeutics, cytotoxic chemotherapy remains an essential component of lung cancer treatment. Extensive evidence has demonstrated the clinical benefit of chemotherapy, either alone or in combination with other treatment modalities, on survival and quality of life of patients with early and advanced lung cancer. Combinational approaches with other classes of anti-neoplastic agents and new drug-delivery systems have revealed promising data and are areas of active investigation. Chemotherapy is recommended as a standard of care in patients that have progressed after tyrosine kinase inhibitors or immune checkpoint inhibitors. Chemotherapy remains the fundamental means of lung cancer management and keeps expanding its clinical implication. This review will discuss the current position and future role of chemotherapy, and specific consideration for its clinical application in the era of precision medicine.
ABSTRACT
Although recent advances in molecular targeted therapy and immuno-oncology have revolutionized the landscape of lung cancer therapeutics, cytotoxic chemotherapy remains an essential component of lung cancer treatment. Extensive evidence has demonstrated the clinical benefit of chemotherapy, either alone or in combination with other treatment modalities, on survival and quality of life of patients with early and advanced lung cancer. Combinational approaches with other classes of anti-neoplastic agents and new drug-delivery systems have revealed promising data and are areas of active investigation. Chemotherapy is recommended as a standard of care in patients that have progressed after tyrosine kinase inhibitors or immune checkpoint inhibitors. Chemotherapy remains the fundamental means of lung cancer management and keeps expanding its clinical implication. This review will discuss the current position and future role of chemotherapy, and specific consideration for its clinical application in the era of precision medicine.
Subject(s)
Humans , Drug Therapy , Immunotherapy , Lung Neoplasms , Lung , Molecular Targeted Therapy , Precision Medicine , Protein-Tyrosine Kinases , Quality of Life , Standard of CareABSTRACT
PURPOSE: Although it has been suggested that pulmonary tuberculosis (TB) is associated with increased risk of lung cancer, the exact mechanism is not clearly identified. We investigated the effect of pulmonary TB on the epidermal growth factor receptor (EGFR) mutational status and clinical outcome in patients with pulmonary adenocarcinoma. MATERIALS AND METHODS: We reviewed data of patients diagnosed with pulmonary adenocarcinoma harboring EGFR mutations and treated at our institution from 2008 to 2015. We divided our population into two groups: patients with pre-existing TB lesions on chest computed tomography scan (TB group) and those without the lesions (non-TB group). We compared the differences in EGFR mutational status, response to tyrosine kinase inhibitors (TKIs) and survival between the two groups. RESULTS: A total of 477 patients with pulmonary adenocarcinoma were analyzed. One hundred eighty-three patients (39%) had EGFR-mutated tumors and 100 (21%) patients had pre-existing TB lesions. The frequency of EGFR mutation was significantly higher in the TB group compared with the non-TB group (56% vs. 34%, p=0.038). Pre-existing TB lesions were independently associated with more frequent EGFR mutations in multivariate analysis (odds ratio, 1.43). In addition, both the progression-free survival (9.1 months vs. 11.6 months, p=0.020) and the overall survival (19.4 months vs. 24.5 months, p=0.014) after first-line EGFR-TKIs were significantly shorter in the TB group than in the non-TB group. CONCLUSION: Previous pulmonary TB may be associated with more frequent EGFR mutations and poorer treatment response to EGFR-TKIs in patients with pulmonary adenocarcinoma.
Subject(s)
Humans , Adenocarcinoma , Disease-Free Survival , Lung Neoplasms , Lung , Multivariate Analysis , Protein-Tyrosine Kinases , ErbB Receptors , Thorax , Tuberculosis , Tuberculosis, PulmonaryABSTRACT
Cancer is the leading cause of death in the Republic of Korea and cancer death accounts for 27.8% of the total deaths, which is not only a social issue but also a concern for the public. Among the cancer death rates, lung cancer mortality account for 34 deaths per 100,000 populations, making it the number one cancer death rate. In a preliminary report on cancer death in 2012, the lung cancer mortality ratio showed the regional variation indicating that there were differences in the qualitative level and the structure among the medical care benefit agency and in the assessment of the treatment process. Therefore, the Health Insurance Review and Assessment Service (HIRA) had begun evaluation of the assessment of lung cancer treatment since 2014 to improve the quality of lung cancer care through evaluation and feeds back the results of lung cancer care process. In this report, authors described the current Indicators for the lung cancer adequacy assessment proposed by HIRA and results of the evaluation reported in 2017.
ABSTRACT
BACKGROUND: Although targeted therapy and immuno-oncology have shifted the treatment paradigm for lung cancer, platinum-based combination is still the standard of care for advanced non-small cell lung cancer (NSCLC). Pemetrexed continuation maintenance therapy has been approved and increasingly used for patients with nonsquamous NSCLC. However, the efficacy of this strategy has not been proven in patients without driving mutations. The objective of this study was to compare the clinical benefit of pemetrexed continuation maintenance to conventional platinum-based doublet in epidermal growth factor receptor (EGFR)-negative lung adenocarcinoma. METHODS: A total of 114 patients with EGFR-negative lung adenocarcinoma who were treated with platinum doublet were retrospectively enrolled. We compared the survival rates between patients received pemetrexed maintenance after four-cycled pemetrexed/cisplatin and those received at least four-cycled platinum doublet without maintenance chemotherapy as a first-line treatment. RESULTS: Forty-one patients received pemetrexed maintenance and 73 received conventional platinum doublet. Median progression-free survival (PFS), which was defined as the time from the day of response evaluation after four cycles of chemotherapy to disease progression or death, was significantly higher in the pemetrexed maintenance group compared to conventional group (5.8 months vs. 2.2 months, p<0.001). Median overall survival showed an increasing trend in the pemetrexed maintenance group (22.3 months vs. 16.1 months, p=0.098). Multivariate analyses showed that pemetrexed maintenance chemotherapy was associated with better PFS (hazard ratio, 0.73; 95% confidence interval, 0.15–0.87). CONCLUSION: Compared to conventional platinum-based chemotherapy, premetrexed continuation maintenance treatment is associated with better clinical outcome for the patients with EGFR wild-type lung adenocarcinoma.
Subject(s)
Humans , Adenocarcinoma , Carcinoma, Non-Small-Cell Lung , Disease Progression , Disease-Free Survival , Drug Therapy , Lung Neoplasms , Lung , Maintenance Chemotherapy , Multivariate Analysis , Pemetrexed , Platinum , ErbB Receptors , Retrospective Studies , Standard of Care , Survival RateABSTRACT
Cancer is the leading cause of death in the Republic of Korea and cancer death accounts for 27.8% of the total deaths, which is not only a social issue but also a concern for the public. Among the cancer death rates, lung cancer mortality account for 34 deaths per 100,000 populations, making it the number one cancer death rate. In a preliminary report on cancer death in 2012, the lung cancer mortality ratio showed the regional variation indicating that there were differences in the qualitative level and the structure among the medical care benefit agency and in the assessment of the treatment process. Therefore, the Health Insurance Review and Assessment Service (HIRA) had begun evaluation of the assessment of lung cancer treatment since 2014 to improve the quality of lung cancer care through evaluation and feeds back the results of lung cancer care process. In this report, authors described the current Indicators for the lung cancer adequacy assessment proposed by HIRA and results of the evaluation reported in 2017.
Subject(s)
Cause of Death , Evaluation Studies as Topic , Insurance, Health , Korea , Lung Neoplasms , Lung , Mortality , Quality Assurance, Health Care , Republic of KoreaABSTRACT
PURPOSE: Reactive oxygen species modulator 1 (Romo1) is a key mediator of intracellular reactive oxygen species production. However, examination of the clinical usefulness of Romo1 in cancers has been limited. We evaluated the association of Romo1 expression with clinical outcomes in advanced non-small cell lung cancer (NSCLC) patients treated with platinum-based chemotherapy. MATERIALS AND METHODS: Romo1 expression in tumor tissue was examined by immunohistochemistry and evaluated by histological score. Survival analyses were performed according to Romo1 expression and the association between Romo1 expression and clinical parameters was evaluated. RESULTS: A total of 88 tumor specimens were analyzed. Significantly shorter median progression-free survival (PFS) was observed in the high Romo1 group compared with the low Romo1 group (4.5 months vs. 9.8 months, p < 0.001), and the median overall survival (OS) of the high Romo1 group was also significantly shorter than that of the low Romo1 group (8.4 months vs. 15.5 months, p < 0.001). Results of multivariate analyses showed significant association of high Romo1 expression with both poor PFS (hazard ratio [HR], 2.75; 95% confidence interval [CI], 1.71 to 4.44) and poor OS (HR, 3.99; 95% CI, 2.36 to 6.74). Results of the subgroup analysis showed a similar association regardless of tumor histology. Romo1 expression showed no association with any clinical parameter including age, sex, smoking status, stage, differentiation, or tumor histology. CONCLUSION: Romo1 overexpression was associated with poor response to treatment and shorter survival in advanced NSCLC patients treated with platinum-based chemotherapy. Romo1 could be a potential adverse predictive marker in this setting.