ABSTRACT
With the increased use of granulocyte colony-stimulating factor (G-CSF) preparations, there is concern about the increase in G-CSF-associated large-vessel vasculitis; however, there have been no previous reports of vasculitis caused by multiple types of G-CSF preparations. We experienced a case of drug-induced large-vessel vasculitis caused by two different G-CSF products, which was difficult to diagnose. When treating patients with a history of large-vessel vasculitis caused by pegfilgrastim, we need to pay attention to its recurrence when using other G-CSF preparations.
ABSTRACT
Background: Radiation-induced lung injury (RILI) occurs after chest radiation therapy, which ranges from acute radiation pneumonia to subsequent radiation pulmonary fibrosis. However, they are difficult to predict. The study aimed to examine the predictive utility of serum levels of transforming growth factor-beta (TGF-ß) for radiation-induced lung injury. Methods: This single-center prospective observational study enrolled 21 patients with locally advanced lung cancer who underwent chest radiation therapy. We measured the serum levels of TGF-ß, Krebs von Denlungen-6, and granulocyte colony-stimulating factor (GCSF) eight times immediately before irradiation. Results: Seven, four, eight, and one patient had Grade 0, 1, 2, and 3 radiation-induced lung injury, respectively. Compared with the Grade 0 and 1 RILI groups (RP- group), the Grade 2 and 3 RILI groups (RP+ group) had a significantly higher relative ratio of TGF-ß values from immediately before irradiation to the time of 30-48 Gy irradiation (P=0.011). The cut-off value of the TGF-ß relative ratio of the RP+ group measured from the receiver operating characteristic curve was 1.31; moreover, the sensitivity, specificity, and positive predictive value were 75%, 100%, and 75%, respectively. There was no significant between-group difference in the levels of the other cytokines. Conclusions: For patients undergoing radiation therapy for locally advanced lung cancer, the ratio of TGF-ß levels before and after 30-48 Gy irradiation may predict the onset of RILI. Our findings may facilitate the identification of predictors of the onset of radiation-induced lung injury.
ABSTRACT
BACKGROUND: Over 40% Japanese patients with lung cancer are above 75 years of age. A specific strategy to treat such older patients is necessary because most trials exclude older patients with poor physical health. Herein, we aimed to identify predictive factors associated with overall survival (OS) in older patients by evaluating patient backgrounds and laboratory data before the start of treatment. METHODS: This multicenter retrospective medical chart review study was conducted at three Japanese institutions and involved patients aged 75 years and above with epidermal growth factor receptor (EGFR) mutation-negative advanced non-small cell lung cancer (NSCLC). Of the patients, 75 had received best supportive care (BSC) and 49 mono-chemotherapy or platinum-doublet chemotherapy, including immune checkpoint inhibitors (ICIs). OS after diagnosis was analyzed using the Kaplan-Meier survival analysis. Cox proportional hazard models, which included age, Eastern Cooperative Oncology Group performance status (ECOG PS), staging, serum albumin levels, and receipt of chemotherapy were analyzed. RESULTS: Age at diagnosis was not shown to be related to OS in patients receiving BSC. In patients aged 81 years and above, the chemotherapy group tended to have longer survival than did the BSC group, but there was no statistically significant difference in the median OS between the two groups due to the very small number of subjects (n: 30 vs. 12, median: 52 vs. 30 weeks, hazard ratio: 0.512, 95% confidence interval: 0.232-1.130, P=0.088). The patients' performance status and albumin levels at lung cancer diagnosis had the highest impact on OS in the BSC group. CONCLUSIONS: Careful consideration should be given to the indications of chemotherapy for patients aged 81 years and above with wild-type EGFR advanced non-small lung cancer.
ABSTRACT
Objective Patients with suspected lung cancer often experience adverse side effects such as anxiety, depression, and a decreased appetite. These side effects influence the patients' quality of life and their ability to make decisions concerning appropriate treatment. This study examined the psychological status and quality of life of patients with suspected lung cancer before and after bronchoscopy treatment and evaluated the effect of mirtazapine prescribed to patients with depression. Methods To assess patient characteristics (e.g. age, gender, and medical history), a questionnaire including the Hospital Anxiety and Depression Scale - Japanese version and the Functional Assessment of Cancer Therapy-L was administered. Patients Forty-three patients admitted for bronchoscopy treatment between May 2017 and April 2018 were included. Results The results showed that patients with depression reported a worse quality of life than those without depression. Compared with no medication, the administration of mirtazapine alleviated depressive symptoms. Furthermore, the patients' depressive status was affected by their physical symptoms, including coughing, tightness of chest, and dyspnea. Conclusion Our results emphasize the importance of detecting depression in the early stages of a cancer diagnosis and have significant implications concerning pharmacological intervention in patients with cancer displaying signs of depression.
