Résumé
Leptomeningeal metastasis (LM) is a rare but fatal clinical condition with a short survival time. The incidence of LM from epidermal growth factor receptor mutant (EGFRm) non–small cell lung cancer (NSCLC) has increased due to the limited efficacy of first- or second-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) in the central nervous system (CNS). Osimertinib is a third-generation, irreversible, CNS penetrant, oral EGFR TKI that demonstrates promising efficacy in CNS metastases regardless of T790M. Herein, we report four cases of T790M-negative EGFRm NSCLC patients treated with osimertinib combined with systemic chemotherapy, who progressed on prior EGFR TKI and developed LM with extracranial lesions. The combination treatment was well tolerated, and the mean overall survival from LM diagnosis was 14.7 months (95% confidence interval, 10.4 to 19.0). These results suggest that osimertinib combined with systemic chemotherapy would be a reasonable treatment option for T790M-negative EGFRm NSCLC patients who develop LM with extracranial progression to prior EGFR TKI. A further prospective study is warranted.
Résumé
The purpose of this study was to investigate the effect of 3-month nutrition education (First Time Intervention, FI) + additional 3-month nutrition education (Repeated Intervention, RI) which was performed after the 8-month follow-up. FI was conducted during 0-3 months and RI for 11-14 months. Ninety-two subjects completed FI program, and 38 out of 92 subjects who received FI finished the RI. Anthropometric data, dietary assessment (24hr recall) and fasting blood analysis were measured at 0 month, 3 months, 11 months and 14 months time points. After FI (3 mo), waist circumference, triglycerides, total cholesterol were significantly decreased. At 11 month follow-up, body weight, BMI, hip circumference, SBP, DBP were significantly rebounced and HDL cholesterol was significantly decreased. Therefore, the effect of short-term nutrition education was not being sustained. After the secondary nutrition intervention (14 mo), waist circumference and hip circumference were again significantly decreased. Total diet quality index-international (DQI-I) score was significantly increased in both FI group and RI group. The changes in DQI-I scores were significantly correlated with the changes in body weight (r = -0.129, p < 0.05) and counts of nutrition education (r = 0.159, p < 0.05), indicating that effective nutrition education helps improve the diet quality leading to a possible role in CVD prevention among male workers. Although a short-term intervention seems to be a success, the effect was not retained in this study. Therefore, we suggest incorporating nutrition education as a routine program for male worker at worksite.