Patients with lung cancer undergoing immune checkpoint inhibitors: A meta-analysis of dermatological toxicities.

Immune checkpoint inhibitors are affirming as standard care for advanced lung cancer treatment. Despite their proved efficacy, alone or in combination, they are capable to provoke several cutaneous immune-mediated adverse events. This systematic review aimed to determine the prevalence of cutaneous toxicity in patients with lung cancer undergoing immune checkpoint inhibitors alone, combined, or associated with chemotherapy and/or radiotherapy. The searches were performed in CINAHL, Cochrane CENTRAL, LILACS, LILIVO, PubMed, Scopus, and Web of Science. We included both clinical trials and observational studies that described cutaneous toxicities presented by patients during treatment with immunological checkpoint inhibitors. The final sample consisted of 24 studies in which 9127 patients were evaluated. In included studies, the drug under consideration were ipilimumab, pembrolizumab nivolumab, and atezolizumab, at different dosages. The most prevalent dermatological toxicities were alopecia (27%), pruritus, and rash (10%). Remarkably, the prevalent severity was graded 1-2 for both alopecia, pruritus and rash.

Interventions for Occluded Central Venous Catheters: A Meta-analysis.

CONTEXT: Thrombotic occlusion is 1 of the most frequent complications in catheters implanted in children. OBJECTIVE: To identify the interventions used to treat thrombotic events in long-term central venous catheters in pediatric patients with cancer. DATA SOURCES: Electronic searches were performed in the Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Latin American and Caribbean Health Sciences Literature, LIVIVO, PubMed, Scopus, Web of Science, Google Scholar, OpenGrey, and ProQuest databases. There were no restrictions on language or publication period. STUDY SELECTION: This systematic review was performed in 2 phases and included clinical trials and observational studies on drugs used to treat thrombotic catheter events in pediatric patients with cancer. The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist, and the protocol was registered at PROSPERO (identifier CRD42018083555). DATA EXTRACTION: The authors evaluated the quality of included studies using the Methodological Index for Nonrandomized Studies and Grading of Recommendations Assessment, Development and Evaluation methods. The meta-analysis was performed by using Stata software. RESULTS: Ten studies were included. The drugs used to restore catheter function were alteplase, urokinase, and streptokinase. A meta-analysis of 6 studies revealed an overall restoration rate of 88% for alteplase. LIMITATIONS: Reference studies were excluded when it was not possible to reliably extract data that met the inclusion criteria of this review. Sampling issues (absence of randomization, blinding, or a control group) were the main methodologic concerns for the included articles. CONCLUSIONS: On the basis of the evidence obtained, thrombolysis is effective and potentially safe in this population.

Interventions to obstructive long-term central venous catheter in cancer patients: a meta-analysis.

PURPOSE: The aim of this systematic review was to identify the interventions used to treat obstructive events, whether thrombotic or non-thrombotic, in long-term central venous catheters (LT-CVC) in cancer patients. METHODS: This review included clinical trials and observational studies reporting the drugs used to treat obstructive catheter events in cancer patients. The authors developed specific search strategies for CINAHL, Cochrane CENTRAL, LILACS, PubMed, Scopus, Web of Science, Google Scholar, Open Grey, and ProQuest. The authors evaluated methodological quality of included studies using criteria from Cochrane's Collaboration Tool and the Methodological Index for non-randomized studies (MINORS). The quality of evidence was analyzed by using GRADE's software. RESULTS: More than 9000 articles were found across the databases. After duplicates removed, the studies were selected in 2 phases. After that, only 15 studies were included. The drugs used to restoration of catheter function were urokinase (53.3%), alteplase (20%), tenecteplase (13.3%), reteplase (6.7%), recombinant urokinase (6.7%), and staphylokinase (6.7%). The results of meta-analysis of 14 studies showed an overall restoration rate of ~ 84%. The drug type meta-analysis demonstrates a success rate of ~ 84%, ~ 92%, and ~ 84% for urokinase, alteplase, and tenecteplase groups, respectively. The main methodological problem in included articles concerns the sample. The quality of evidence ranged from very low to high. CONCLUSION: The most common interventions used to treat thrombotic catheter occlusion in cancer patients were urokinase and alteplase. No evidence was found about the treatment for non-thrombotic occlusion, thus elucidating an important gap to be investigated.