Antineoplastic treatment class modulates COVID-19 mRNA-BNT162b2 vaccine immunogenicity in cancer patients: a secondary analysis of the prospective Vax-On study.

BACKGROUND: Preliminary analysis from the Vax-On study did not find a correlation between cancer treatment type and antibody response to COVID-19 vaccination. We carried out a secondary subgroup analysis to verify the effects of comprehensive cancer treatment classification on vaccine immunogenicity. METHODS: The Vax-On study prospectively enrolled patients who started a two-dose messenger RNA-BNT162b2 vaccine schedule from 9 March 2021 to 12 April 2021 (timepoint-1). Those on active treatment within the previous 28 days accounted for the exposed cases. Patients who had discontinued such treatment by at least 28 days or received intravesical therapy represented the control cases. Quantification of immunoglobulin G (IgG) antibodies against the receptor binding domain of the S1 subunit of the SARS-CoV-2 spike protein was carried out before the second dose (timepoint-2) and 8 weeks thereafter (timepoint-3). Seroconversion response was defined at ≥50 arbitrary units/ml IgG titer. Classification of antineoplastic agents was based on their pharmacodynamic properties. RESULTS: Three hundred and sixty-six patients were enrolled (86 and 260 as control and exposed cases, respectively). Univariate analysis revealed a significantly lower IgG titer after both doses of vaccine in subgroups treated with tyrosine kinase inhibitors (TKIs), multiple cytotoxic agents, alkylating agents, and topoisomerase inhibitors. At timepoint-3, seroconversion response was significantly impaired in the topoisomerase inhibitors and mechanistic target of rapamycin (mTOR) inhibitors subgroups. After multivariate testing, treatment with alkylating agents and TKIs was significantly associated with a reduced change in IgG titer at timepoint-2. Treatment with mTOR inhibitors resulted in a similar interaction at each timepoint. Cyclin-dependent kinase 4/6 inhibitor treatment was independently correlated with an incremental variation in IgG titer at timepoint-3. Specific subgroups (TKIs, antimetabolites, alkylating agents, and multiple-agent chemotherapy) predicted lack of seroconversion at timepoint-2, but their effect was not retained at timepoint-3. Eastern Cooperative Oncology Group performance status 2, immunosuppressive corticosteroid dosing, and granulocyte colony-stimulating factor use were independently linked to lower IgG titer after either dose of vaccine. CONCLUSIONS: Drugs interfering with DNA synthesis, multiple-agent cytotoxic chemotherapy, TKIs, mTOR and cyclin-dependent kinase 4/6 inhibitors differentially modulate humoral response to messenger RNA-BNT162b2 vaccine.

Plantar fat pad atrophy after corticosteroid injection for an interdigital neuroma: a case report.

A case of bilateral interdigital (Morton's) neuroma treated with steroid injection therapy developed plantar fat pad atrophy, shown on magnetic resonance imaging. Some pathologic changes at the site of injection (such as subcutaneous fat atrophy, depigmentation of the skin, and telangiectasias) are well known disadvantages of local steroid injection for the treatment of the Morton's neuroma. Scientific literature reports these problems (mainly as an aesthetic problem) in the dorsal aspect of the foot. In this work, the authors describe a case in which the steroid injection therapy has caused some changes in the plantar aspect of the feet, with serious functional problems. Fat pad atrophy is a serious problem in the foot and can cause a painful metatarsal syndrome with some important effects on the gait.

[Postoperative morbidity/mortality in gastric cancer according to the rules of the Japanese Society: preliminary report]. / Morbi-mortalidad post-operatoria en cáncer gástrico aplicando las reglas de la Sociedad Japonesa: reporte preliminar.

With the purpose of evaluate the Morbi-mortality related with the kind of surgery recommended by the Japanese Research Society for Gastric Cancer (JRSGC), 13 patients treated surgically by the Rules of that Society were reviewed. Eleven patients were males and 2 females, with ages between 24 and 72 years old. Twelve of them were operated at the Hospital "Dr. Luis Gómez López" (MSAS) and one in a private clinic, both centers located in Barquisimeto, Lara State. Twelve (92.3%) of the patients had advanced Gastric Cancer and only one case was an Early Gastric Cancer. Nine patients received a Distal Gastrectomy (69.23%) and 4 a Total Gastrectomy. Eight among the 13 also underwent a combined resection of another organ(s) (Spleen; 4: Transverse Colon: 1; some kind of Pancreatic resection: 3; Gallbladder: 2). Considering the kind of Radicality (= D2: lymph Node Level Dissection, based on the JRSGC), 10 patients (76.9%) received a D2 type (the Radicality recommended by the JRSGC), being also disected another Lymph Groups (ALFA), and the Paraortics one in 6 of them. The Post-operative Stages founded were: Ia: one case; II:2 cases; IIIb: 3 cases; IV a:2 cases and IVb: 5 cases (38.46%). In relation with the Post-operative Morbidity, directly related with this kind of surgery, only one patient with a severe Desnutrion developed a Fistula, but it healed spontaneously, after a conservative treatment. Two patients received a second surgery; one during the immediate Post-operative period because a Mesentery Rotation, and the other at the 20th. Post-operative day due to an eventration plus an abdominal wall abscess. Both patients were discharge in good conditions. None of the 13 cases stayed in an Intensive or Intermediate Care Unit. There was no case of Post-operative Mortality. It is important to reassure the low risk of Post-operative Complications with this kind of Radical surgery, for Gastric Cancer patients, even in those with nutrional deficit and with a minimal hospital conditions.

A rare case of splenic hematoma following chronic pancreatitis--the diagnostic and therapeutic procedures.

We describe herein a clinical case in which a subcapsular splenic hematoma complicated chronic relapsing pancreatitis. A pathogenetic mechanism is postulated that explains the subacute insorgence of the liquid collection with the diffusion of proteolytic enzymes between the splenic capsule and parenchyma. Radical therapy, consisting of exeresis of the cystic formation, splenectomy and caudal pancreatectomy, is recommended for this extremely rare complication.

Subcapsular splenic hematoma complicating chronic relapsing pancreatitis. Case report.

A case of subcapsular splenic hematoma complicating chronic relapsing pancreatitis is described. A pathogenetic mechanism is postulated to explain the subacute evolution of fluid collection with diffusion of proteolytic enzymes between the splenic capsule and parenchyma. Radical treatment comprised exercsis of the cystic structure, splenectomy and caudal pancreatectomy.

[Digestive physiopathology of the pancreatectomized patient. Comparison of the results of total pancreatectomy and pancreaticoduodenectomy with preservation of the pylorus]. / La fisiopatologia digestiva del paziente pancreatectomizzato. Confronto dei risultati tra pancreatectomia totale e duodenocefalopancreatectomia con conservazione del piloro.

The authors analyze their experience with pancreatectomy, pointing out the digestive pathophysiologic sequelae of the operated patients. A follow-up protocol based on upper digestive endoscopy, laboratory tests, scintigraphic and pH-metric tests compares the results achieved after total pancreatectomy with the results of pancreaticoduodenectomy. Total pancreatectomy is complicated by peptic ulcer, stump gastritis and gastroenteric dyskinesia. The preservation of the pylorus and the separation of the gastric anastomosis from the biliary one avoid the pathologic biliary reflux and minimize the functional and organic sequelae of the operation.