ABSTRACT
BACKGROUND: Phase III clinical trials have demonstrated the merits of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKI) in the treatment of non-small cell lung cancer (NSCLC) patients with EGFR-activating mutations. Using a cohort of unselected patients treated with erlotinib, we sought to further describe patient and tumour characteristics, and to evaluate their progression-free survival (PFS) and overall survival (OS). METHODS: Overall, 44 pulmonologists included patients with the required characteristics as follows: Stage IIIB-IV NSCLC, EGFR-activating mutation, age≥18 years, and having to start erlotinib therapy or receiving erlotinib therapy as the first-line TKI, regardless of treatment-line. The analyses were performed using R software, with survival rates calculated according to the Kaplan-Meier method. RESULTS: A total of 177 patients, aged 72 years on average, were enrolled over a 2-year period. The cohort included 123 women (69.5%), 158 Caucasians (89.3%), 112 non-smokers (63.2%), and 167 adenocarcinomas (94.3%), at either stage IIIB (21) or IV (156), with a good performance status (PS 0-1, 127). Overall, 40 exhibited brain metastases at baseline (22.6%), while 75 had undergone earlier treatment (42.4%). Median PFS was 11.7 months and OS 25.8 months, with respectively a 1-year rate of 48.6% and 74%. The risk of death correlated with ECOG status (PS=2, HR=4.48, P<0.001) but not with brain metastasis (HR=1.67, P=0.278). CONCLUSIONS: This study has confirmed erlotinib's efficacy and safety for unselected patients, with PFS and OS comparable to those obtained in phase III trials.
Subject(s)
Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Adolescent , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/genetics , Clinical Trials, Phase III as Topic , ErbB Receptors/genetics , Erlotinib Hydrochloride/adverse effects , Female , Humans , Lung Neoplasms/drug therapy , Lung Neoplasms/genetics , MutationABSTRACT
The management of superior sulcus tumors with Pancoast 's syndrome is not well defined, especially in view of their low frequency. Even if surgery performed by "en bloc" resection of the tumor and the chest wall is recommended, neoadjuvant treatment could have a potential benefit on the resecability and pain control. We report five cases of Pancoast tumors (NSCLC), treated by radiotherapy and chemotherapy before surgery. Four tumors was on stage IIIb. A regimen with radiotherapy (50 Gy) and chemotherapy (cisplatinum + etoposide) was initially performed. Four tumors were resected, with 2 complete pathologic responses and good control on pain. Three patients received radiotherapy during surgery. No toxic reaction was observed. This regimen may be discussed with locally advanced tumors and poor prognosis.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/radiotherapy , Intraoperative Care/methods , Lung Neoplasms/drug therapy , Lung Neoplasms/radiotherapy , Neoadjuvant Therapy/methods , Aged , Carcinoma, Non-Small-Cell Lung/complications , Carcinoma, Non-Small-Cell Lung/mortality , Carcinoma, Non-Small-Cell Lung/pathology , Carcinoma, Non-Small-Cell Lung/surgery , Chemotherapy, Adjuvant , Cisplatin/administration & dosage , Etoposide/administration & dosage , Feasibility Studies , Female , Humans , Lung Neoplasms/complications , Lung Neoplasms/mortality , Lung Neoplasms/pathology , Lung Neoplasms/surgery , Male , Middle Aged , Neoplasm Staging , Pain/diagnosis , Pain/etiology , Pancoast Syndrome/etiology , Patient Selection , Pneumonectomy , Prognosis , Radiotherapy, Adjuvant , Retrospective Studies , Survival Analysis , Treatment OutcomeABSTRACT
We report a case of a lung abscess due to Pasteurella multocida, isolated from bronchial secretions by fiberoptic bronchoscopy. Antibodies against Pasteurella multocida were elevated in the patient, and absent in controls (including the patient's wife). The identity of the strain isolated in the patient and that in his cat was proved by molecular method using pulsed field gel electrophoresis.
Subject(s)
Cat Diseases/microbiology , Cat Diseases/transmission , Disease Vectors , Lung Abscess/microbiology , Lung Abscess/transmission , Pasteurella Infections/microbiology , Pasteurella Infections/transmission , Pasteurella multocida , Animals , Antibodies, Bacterial/blood , Bronchoscopy , Cat Diseases/diagnosis , Cats , DNA, Bacterial/analysis , DNA, Bacterial/genetics , Electrophoresis, Gel, Pulsed-Field , Fever/microbiology , Humans , Lung Abscess/diagnosis , Male , Middle Aged , Pasteurella Infections/diagnosis , Pasteurella multocida/genetics , Pasteurella multocida/immunology , Restriction Mapping , Tomography, X-Ray ComputedABSTRACT
Digestive disorders in Legionella pneumophila pneumonia such as nausea, vomiting, diarrhoea, are common; they are clinical arguments to suspect this bacteria to be responsible for this pneumonia. In this case-report, a patient with pneumonia due to Legionella pneumophila serogroup I presented in the follow-up with signs of enteritis with ascites. We looked ahead in literature who made us discover the multiple organ involvement that may happen in Legionnaires' disease. Diagnostic procedures consist in simple tests as ultrasonography, abdominal computerised tomography, that show inflammatory disease signs and sometimes ascites. Exceptionally, Legionella pneumophila has been demonstrated with direct immunofluorescent microscopic study, in inflammatory colitis pieces with haemorrhagic necrosis in different stage processes. Pathogenesis could be explained by the systemic spread of the organism and formation at distance of necrotising enteritis focus. It is initiated by necrotising factors of bacterial origin and hypersensitivity reactions (type I and III).
