RESUMO
Introduction: Lung cancer represents the leading cause of cancer death worldwide. At diagnosis, the majority of patients present an advanced or metastatic disease. Despite the improvement in diagnostic and therapeutic strategies, lung cancer prognosis remains poor with less than 15 percent of patients surviving beyond 5 years. Advanced non-small-cell lung cancer [NSCLC] has been always treated by platinum-based regimens with various toxicity profiles However, with the discovery of the PD-1/PD-L1 pathway, novel checkpoint inhibitors emerged as promising agents for treating patients with advanced disease. When evaluated in clinical trials, they showed promising results and durable responses in a subset of patients treated in the first and second lines or beyond. The aim of this study is to assess the efficacy and responses of these agents in real-life practice when used in second line or after
Material and Methods: Patients with advanced [stage III and IV] NSCLC treated with immunotherapy between June 2015 and August 2018 were included. Patients should have received anti-PD-1 or anti-PD-L1 agent in the second, third of fourth line after failure of a prior first line regimen. Each patient should have received a minimum of 3 cycles of treatment and evaluation thereafter
Results: A total of 85 patients were included. The median age of our population was 65 years, and the majority were men [sex ratio = 2.3:1]. Around 95 percent of patients were smokers. Adenocarcinoma was the most frequent histologic subtype in 59.1 percent of cases, followed by squamous cell carcinoma in 35.5 percent of cases. At presentation, 81.7 percent of patients had metastatic deposits mainly in the bone and adrenals in 34.4 percent and 28 percent respectively. PD-L1 expression ranged from 0 to 100 percent with a median value of 45 percent. PD-L1 expression was >/= 50 percent, between1 and 50 percent, and less than 1 percent in 43 percent, 40 percent and 17 percent of patients respectively. Around half of patients [54 percent] underwent radiotherapy, with a curative intent in 42.5 percent and palliative intent in 57.5 percent. Checkpoint inhibitors were used in second line in 74.7 percent, third line in 21.8 percent and fourth line in 3.5 percent, and were balanced between Pembrolizumab and Nivolumab. The majority of patients progressed despite immunotherapy treatment in 41 percent of cases, presented a stability of the disease, partial response and complete response in 29.7 percent, 25.6 percent and 2.7 percent. The median progression-free survival [PFS] was 4.1 months [1-20.7]. Immune-related adverse events were present in around 7 percent of patients, and were mainly grade 2-3 managed with steroids and supportive care, with hormone replacement therapy in the case of thyroiditis
Conclusion: Checkpoint inhibitors represent a new hope for patients with advanced lung cancer who have few available effective treatments beyond first or second line
RESUMO
Aim: The administration of total parenteral nutrition [TPN] in terminally ill cancer patients is aggressive with a relatively high risk of complications. In this paper, we investigated the use of TPN in Lebanese cancer patients at end of life. To our knowledge, this is the first study describing TPN administration to Middle Eastern patients with advanced cancer
Methods: We conducted this observational study at Hotel-Dieu de France University Hospital, Lebanon. Eligible cases included all cancer patients that died at our institution between the 1st of January and the 31st of December 2014. The patients and tumors characteristics as well as the management plan were retrieved from the hospital records
Results: Our study enrolled 129 cancer patients at end of life among which 39 percent had received TPN: 28 percent during the last 6 weeks and 34 percent during the last 3 months. The mean duration of TPN administration was 33 days [range: 1 to 211]. The mean duration between the end of TPN administration and death was 37 days [range: 0 to 315]. TPN administration correlated negatively to hyperlipidemia [OR = 0.33; 95 percent CI [0.12 - 0.87]] and to the presence of three cardiovascular risk factors [OR = 0.28; 95 percent CI [0.10 - 0.80]]. On the other hand, it correlated positively to gastrointestinal tumors [OR = 3.9; 95 percent CI [1.3 - 11.7]] and to imaging studies during the last month of life [OR = 3.4; 95 percent CI [1.3 - 9.0]]. In the multivariate analysis, only hyperlipidemia was found to be a significant determinant of the TPN administration [p = 0.010; ORa= 0.29 [0.11 - 0.74]
Conclusion: The prevalent use of TPN at end of life underlines a difficulty in adopting a palliative care approach in our population. This is truly applicable in Middle Eastern populations that seem to refuse a patient-centered supportive care approach