Simultaneous development of pneumonitis and autoimmune diabetes secondary to immune checkpoint inhibitor treatment with durvalumab in an advanced small cell lung cancer patient: A case report.

RATIONALE: Immune checkpoint inhibitors (ICIs) have been widely used in the treatment of various types of cancers worldwide, which is the most significant breakthrough in cancer therapy in recent years. Despite their excellent benefits in anti-tumor efficacy, a subset of patients will experience various autoimmune toxicities, termed as immune-related adverse events (irAEs), which can affect almost any organ systems, but related to the pulmonary and pancreatic islets simultaneously has rarely been reported and discussed. PATIENT CONCERNS: In this report, we describe a rare case of a 65-year-old man patient with advanced small cell lung cancer (SCLC) who suffered general fatigue, dry cough, chest tightness, shortness of breath and polyuria-polydipsia syndrome after the eighth cycle treatment with programmed cell death ligand-1 (PD-L1) inhibitor durvalumab. DIAGNOSES: According to the results of laboratory tests, chest computed tomography and multidisciplinary discussion, the patient was eventually diagnosed with ICI-related pneumonitis and autoimmune diabetes mellitus. INTERVENTIONS: Multiple daily subcutaneous insulin injections, empirical anti-infection and immunosuppression treatment with corticosteroids were performed. OUTCOMES: After the cessation of durvalumab and comprehensive treatment, the patient's respiratory condition was relieved significantly and his blood glucose was well controlled with insulin therapy. LESSONS: With the widespread use of ICIs, there will be more patients developing these rare but severe irAEs in clinical practice, which should attract great attention of both clinicians and patients.

[Clinical study of integrative treatment for ninety-one elderly patients with advanced non-small cell lung cancer].

OBJECTIVE: To observe the effects of integrative therapy on elderly patients with advanced nonsmall cell lung cancer (NSCLC), thus providing clinical evidence for further studies. METHODS: Totally 91 elderly patients with advanced NSCLC were randomly assigned to three groups, i.e., the Chinese medicine (CM) group (Group I, 31 cases), the chemotherapy group (Group II, 30 cases), and the CM and chemotherapy combination group (Group III, 30 cases). Oral administration of CM decoction and intravenous dripping of Chinese patent medicine were given to patients in Group I. Patients in Group II received chemotherapeutic protocol alone. Patients in Group III received chemotherapeutic protocol while taking CM decoction. Twenty-eight days were taken as one therapeutic course, and two courses in total. They were observed for two treatment courses by taking Symptoms Scale of CM to Primary Lung Cancer, bone marrow depression score, and progression-free survival (PFS) as therapeutic efficacy indices. Meanwhile, the Cox's proportional hazards regression model was established to analyze the favorable factors and risk factors that influenced patients' PFS. RESULTS: The CM symptom integral of Group I and Group III was superior to that before treatment, showing statistical difference (P < 0.01). The occurrence of bone marrow depression in Group III was lower than that in Group II. The degree of bone marrow depression was also milder in Group III than in Group II, but there was no statistical difference in inter-group comparison (P = 0.097, P = 0.299). The PFS was 202 days in Group III, 168 days in Group I, and 129 days in Group II. It was better in Group III than in Group II (P = 0.0157). The Cox regression analysis showed that positive factors to longer PFS included CM + chemotherapy, no surgical management, and PS = 1. CONCLUSIONS: CM therapy could improve the symptoms of elderly patients with advanced NSCLC. It might extend the PFS of the elderly patients by CM therapy combined with chemotherapy.

[Assessment of therapeutic efficacy on treating advanced non-small cell lung cancer in the aged by Chinese medicine adopting the international questionnaire of quality of life].

OBJECTIVE: To assess the therapeutic efficacy of treating advanced non-small cell lung cancer (NSCLC) in the aged by Chinese medicine (CM) adopting the international questionnaire of quality of life (QOL). METHODS: 91 aged patients with advanced NSCLC were randomly assigned to three groups. There were 31 in the CM group (Group I), 30 in the chemotherapy group (Group II), and 30 in the CM and chemotherapy combination group (Group III). Oral administration of CM decoction and intravenous dripping of Chinese patent medicine was given to those in Group I. Patients in Group II received chemotherapeutic protocol alone. Patients in Group III received chemotherapeutic protocol while orally taking CM decoction. Twenty-eight days were taken as one therapeutic course, and two courses in total. Assessment was performed using European Organization for Research and Treatment of Lung Cancer Quality of Life Questionnaire LC-43 (EORTC QLQ-LC43) before treatment, the 10th day of the second therapeutic course, and the 28th day of the second therapeutic course, respectively. RESULTS: After two therapeutic courses of treatment, compared with Group II, better effects were obtained in Group I and Group III in the aspects of the physical function, roles function, emotional functions, social functions, general health state, and short breath, cough, fatigue, insomnia, poor appetite, and constipation (P<0.05, P<0.01). CONCLUSIONS: CM therapy could relieve the clinical symptoms of aged patients with advanced NSCLC and improve their QOL.