Real-world data on efficacy and safety of pembrolizumab in the first-line treatment of metastatic lung cancer in patients with PD-L1 expression >0% - a single center experience.

OBJECTIVE: With the advent of immunotherapy, there has been a significant improvement in the outcomes of non-small cell lung cancer treatment. Several clinical trials have confirmed the efficacy and safety of pembrolizumab, but research with real-world data is needed to confirm the findings from clinical trials. PATIENTS AND METHODS: In this retrospective study, data on the treatment of lung cancer with pembrolizumab were analyzed in 78 patients who started pembrolizumab therapy as first-line treatment for metastatic disease at University Hospital Centre Osijek, from May 15, 2018, until December 31, 2021. November 30, 2022, was set as the last date of data monitoring. Patients who had received less than 3 cycles of pembrolizumab were excluded from the study. The main objectives of the study were OS (overall survival) and PFS (progression-free survival). The differences in the incidence and type of adverse events between the two groups of patients were also compared. RESULTS: Kaplan-Meier analysis of the survival determined that the median OS was 20 months and PFS was 13 months. Although OS and PFS are longer in patients with PD-L1 (programmed death-ligand 1) ≥ 50%, the differences are not statistically significant. The most commonly reported adverse events related to pembrolizumab treatment were gastrointestinal adverse events. No significant differences were found in the frequency of occurrence of certain adverse events between the two groups of patients. CONCLUSIONS: This study demonstrates that real-world data for pembrolizumab treatment of non-small cell lung cancer confirm the efficacy and safety indicated by clinical trials. Nevertheless, it is necessary to assess the patient's general condition more objectively before starting the treatment.

¿Es posible disminuir la mortalidad por cáncer de mama en Chile?: análisis epidemiológico y programático en la región metropolitana, 2000-2007 / Is it possible to decrease breast cancer mortality in Chile?: an analytical study

This analytical study is aimed to analyze breast cancer mortality in the metropohtan región of Santiago serving something more than 6,000,000 people. The hypothesis is that it is possible to decrease breast cancer mortality in Chile (16 million inhabitants) based on the experience of the metropohtan south orient health service (SSMSO) that represents 10 percent of the Chilean population. A comparative analysis of crude and age-adjusted mortality rates for breast cancer in the six metropolitan health services is produced showing the lowest crude and age-adjusted mortality rate in the SSMSO besides to be lower than the mortality rate for Chile. Furthermore the annual proportions of advanced (III and IV) and incipient breast cancers (in situ and I) are established for the SSMSO showing a proportional decrease of advanced stages and a relevant increase of the incipient ones between 1994 and 2007. The authors think that since the population of the metropolitan región represents more than 40 percent of the Chilean population and includes all the socio economic strata the results observed in the SSMSO, the biggest health service in the region besides having both rural and urban districts, may be considered representative for the country as a whole. The original hypothesis has been thus confirmed: it is possible to decrease breast cancer mortality in Chile.

Se trata un estudio analítico sobre la mortalidad por cáncer de mama en la Región Metropolitana. La hipótesis, en base a la experiencia del Servicio de Salud Metropolitano Sur Oriente (SSMSO), señala que es posible disminuir la mortalidad por este cáncer en Chile, extrapolando la experiencia de este servicio de salud con 1,6 millones de población asignada y 1,1 millones de personas inscritas validadas. Ello significa el 10 por ciento de la población chilena. Se hace un análisis comparado de las mortalidades crudas y ajustadas por edad en los seis servicios de salud metropolitanos, período 2000-2007, además de establecer la proporción anual de cánceres de mama avanzados (III y IV) e incipientes (in situ y I) en el total de cánceres mamarios del SSMSO, período 1994-2007. Los seis servicios en conjunto atienden una población que significa algo más del 40 por ciento de la nacional, además de representar todos sus estratos socio-económicos y étnicos. En consecuencia, la comparación entre ellos puede considerarse válida para el país. Los resultados muestran que el SSMSO tiene la mortalidad por cáncer de mama, tasa cruda y ajustada, más baja de la Región Metropolitana, además de inferior a la nacional. Una razón importante es la disminución proporcional de cánceres avanzados y un aumento importante de los incipientes. El programa para cáncer de mama del SSMSO cumple entonces con su objetivo principal: disminuir la mortalidad por este cáncer, ratificando la hipótesis de este estudio. Además, cumple otros objetivos: eficiencia, buena opinión de usuarias y equidad.

Cáncer de mama en Chile: un aporte clínico y epidemiológico según un registro poblacional metropolitano: 1.485 pacientes / Analysis of 1.485 women treated for breast cancer in two public hospitals

Background: Breast cancer was included as a priority in the Chilean health reform, providing universal and guaranteed access to diagnosis and treatment to all women aged 15 years or more. Aim: To analyze the incidence, staging and survival of breast cancer in a cohort of women. Material and Methods: Retrospective analysis of medical records of women operated for breast cancer between 1994 and 2005 in two public hospitals of Metropolitan Santiago. Incidence rates were calculated using statistical information provided by the Ministry of Health. Results: The clinical records of 1.485 women aged 18 to 99 years (median 55 years), were analyzed. The number of lesions detected in early stages (Tl NO), increased progressively over time. The number of lesions in advanced stages was constant along time, but its proportion decreased progressively. The overall fifteen years survival of operated women was 64 percent. Survival was significantly better among women without lymph node involvement. The incidence rates of breast cancer increased steadily during the study period. Mortality slightly increased during the nineties but is decreasing during the present decade, reaching a rate of 12.2 per 100.000 women during 2005. Conclussion: In this series of patients, the diagnosis of breast cancer in early stages increased in the last decade, resulting in better survival rates.

El objetivo de este estudio es entregar un aporte clínico y epidemiológico al relevante problema del cáncer de mama en Chile, en base al registro poblacional o casuística del Servicio de Salud Metropolitano Sur Oriente (SSMSO). Se analizan 1.485 mujeres atendidas entre 1994 y 2005 en el Hospital Sótero del Río y entre 2003 y 2005 en el Hospital Padre Hurtado. En los resultados se presenta la frecuencia de este cáncer en Chile y nuestro servicio, además de su comparación con otros países. En el SSMSO destaca el incremento progresivo, absoluto y relativo, de cánceres incipientes y la mantención absoluta con disminución relativa de cánceres avanzados. Esto es parecido en los dos hospitales pero inferior a lo observado en las pacientes semi-privadas del Sótero del Río, en las cuales predominan los incipientes. La sobrevida global a 15 años sobrepasa el 63 por ciento y es significativamente mayor en las enfermas sin compromiso linfonodal. La mortalidad por cáncer de mama en el SSMSO se elevó moderadamente durante los 90 pero ha bajado en forma moderada en esta década; actualmente es la más baja de la Región Metropolitana y bastante inferior al promedio nacional. Se plantea la hipótesis de que la razón que explica la baja mortalidad por cáncer de mama en el SSMSO, es su alta proporción de cánceres incipientes lo cual a su vez puede deberse a una buena coordinación con la atención primaria y al aumento de mamografías y ecografías mamarias. La principal conclusión es la utilidad de tener un registro de cáncer.

Inadequate use of preventive strategies in patients receiving NSAIDs.

OBJECTIVE: Little is known about the factors that influence the decision to use NSAIDs in combination with gastroprotective drugs. The aims of this observational study were to evaluate the extent to which NSAID users are prescribed concomitant gastroprotective drug regimens ('preventive strategies'), and to determine how patient risk factors for NSAID-associated gastrointestinal toxicity and physician prescribing preferences influenced the decision to prescribe a gastroprotective drug in combination with an NSAID. DESIGN AND PATIENTS: The study was conducted on 29 June 2004 and comprised 109 eligible adult patients hospitalised at the Clinical Hospital Center, Zagreb. Use of NSAIDs and gastroprotective drugs, risk factors for NSAID-associated gastrointestinal toxicity, and physician prescribing preferences were monitored throughout the study. RESULTS: Sixty-six percent of patients receiving proton pump inhibitors or histamine H(2)-receptor antagonists with NSAIDs had no risk factors for gastrointestinal toxicity. Furthermore, 29% of patients who used NSAIDs had risk factors for gastrointestinal toxicity but were not receiving gastroprotective drugs. Even though patients at risk of NSAID-associated gastrointestinal complications had higher odds of receiving preventive strategies (odds ratio 1.25), the absolute rate of utilisation of these therapies in at-risk populations was unacceptably low (69%). However, the strongest independent correlation for gastroprotective drug use was the prescribing physician, with an odds ratio of 6.40. CONCLUSION: This study demonstrates that an individual physician's prescribing style largely determines the odds of receiving preventive strategies with NSAID treatment and is more important than the patient's risk factors for gastrointestinal toxicity.