A prospective, single-arm trial of PD-1 inhibitors plus chemoradiotherapy for solitary metachronous metastasis nasopharyngeal carcinoma.

PURPOSE: Initial treatment for Recurrent/Metastatic Nasopharyngeal Carcinoma (R/M NPC) often involves Gemcitabine plus cisplatin with or without PD-1 inhibitors. However, PD-1 inhibitors' effectiveness varies, prompting for better treatments. This study explores effect and safety of combining PD-1 inhibitors with chemoradiotherapy for oligometastatic NPC patients. METHODS: Oligometastatic NPC patients underwent radical treatment with PD-1 inhibitors and chemotherapy, followed by concurrent PD-1 inhibitors and chemoradiotherapy, and then maintenance PD-1 inhibitors. Objective response rate (ORR) and disease control rate (DCR) were calculated by irRECIST-1.1, and CTCAE-4.0 was used to evaluate the toxicity. RESULTS: The study enrolled 47 patients with a median age of 46. The median follow-up lasted 16.5 months, with metastatic lesions receiving a median radiation dose of 45 Gy. The median courses of PD-1 inhibitors and chemotherapy were 9.5 and 5 respectively. The metastasis sites included lung (40.8 %), liver (21.1 %), mediastinal lymph node (7.9 %), abdominal lymph nodes (3.9 %), bone (21.1 %), adrenal gland (3.9 %), and brain (1.3 %). ORR and DCR were 85.1 % and 100 % at 3 months after radiotherapy. The median survival was not reached yet, and 1 and 2-year OS rates were 93.1 % and 78.4 %. The median PFS was 18 months, with 1 and 2-year PFS rates of 70.2 % and 47.7 % respectively. PD-L1 expression showed a positive correlation for PFS. Twenty-five patients experienced grade 3 or 4 adverse events (AE) that were possibly related to chemotherapy. No grade 5 AE was observed. CONCLUSIONS: The synergy of concurrent PD-1 inhibitors and chemoradiotherapy shows promising efficacy and an acceptable toxicity for oligometastasis NPC patients.

[Extracorporeal membrane oxygenation treatment with high-volume hemofiltration in patients with multiple organ dysfunction syndrome].

OBJECTIVE: To evaluate whether extracorporeal membrane oxygenation (ECMO) with high-volume hemofiltration (HVHF) improves hypoxemia and renal function in patients with multiple organ dysfunction syndrome (MODS). METHODS: The study was executed in 8 MODS patients with acute respiratory distress syndrome (ARDS) and acute renal failure (ARF). They were randomly assigned to either 8 hours of HVHF combined with ECMO or HVHF alone in random order. The changes in arterial oxygen pressure(PO(2)), pulse oxygen saturation (SpO(2)), arterial carbon dioxide pressure (PCO(2)), serum creatinine (SCr) and blood urea nitrogen (BUN) levels were measured. RESULTS: Compared with that of before the treatment, PO(2) was increased significantly at 1, 4, 8 hours, and SpO(2) was increased significantly at 4, 8 hours after ECMO with HVHF in MODS patients, the changes of PO(2), SpO(2)and PCO(2)were not significantly during HVHF (all P>0.05). The average concentrations of BUN and SCr were decreased significantly after HVHF or HVHF with ECMO therapy in MODS patients. CONCLUSION: HVHF with ECMO, which can improve hypoxemia significantly, may be a better option for the treatment of MODS patients.