Immunogenicity of SARS-CoV-2 messenger RNA vaccines in patients with cancer.

Patients with cancer experience a higher burden of SARS-CoV-2 infection, disease severity, complications, and mortality, than the general population. SARS-CoV-2 mRNA vaccines are highly effective in the general population; however, few data are available on their efficacy in patients with cancer. Using a prospective cohort, we assessed the seroconversion rates and anti-SARS-CoV-2 spike protein antibody titers following the first and second dose of BNT162b2 and mRNA-1273 SARS-CoV-2 vaccines in patients with cancer in US and Europe from January to April 2021. Among 131 patients, most (94%) achieved seroconversion after receipt of two vaccine doses. Seroconversion rates and antibody titers in patients with hematological malignancy were significantly lower than those with solid tumors. None of the patients with history of anti-CD-20 antibody in the 6 months before vaccination developed antibody response. Antibody titers were highest for clinical surveillance or endocrine therapy groups and lowest for cytotoxic chemotherapy or monoclonal antibody groups.

[Recommendations for the use of antiemetic drugs by the general practitioner]. / Utilisation des antiémétiques par le praticien.

Nausea is a common symptom among patients affected by chronic diseases or undergoing various treatments. Because nausea can result from many origins, there is a large differential diagnosis to explore. Its pathophysiology relies on numerous neurotransmitters, on which 5 types of antiemetic antagonists are effective (NK-1 receptor antagonists, antiserotoninergic, antidopaminergic, antihistaminic and anticholinergic agents). Glucocorticoids and benzodiazepines are also used to treat some types of nausea. Choosing the appropriate antiemetic can improve quality of life and treatment compliance.

Les nausées sont un symptôme retrouvé fréquemment en consultation chez les patients atteints de maladies chroniques et/ou traités par certains médicaments. L'absence de spécificité des nausées doit faire ouvrir un large diagnostic différentiel à explorer. Le mécanisme physiopathologique fait intervenir de nombreux neurotransmetteurs, que 5 familles d'antiémétiques antagonisent (antisérotoninergiques, antidopaminergiques, antagonistes du récepteur NK-1, antihistaminiques, anticholinergiques). Les glucocorticoïdes et les benzodiazépines sont également utilisés pour traiter certains types de nausées. Le choix du traitement le plus adéquat amène une amélioration de la qualité de vie et une meilleure compliance thérapeutique.

Upfront targeted therapy for symptomatic melanoma brain metastases: paradigm changing?

The standard management of a single brain metastasis is usually maximal resection when feasible followed by radiotherapy. In case of multiple lesions, several options have to be considered depending on the natural behavior of the primary tumor, the localization of brain lesions, their functional impact and related symptoms. In case of life-threatening brain metastasis, debulking surgery is often proposed first, with the risk of major bleeding and postponing the initiation of other treatments. This approach is now challenged by the rapid tumor shrinkage that could be observed with novel targeted therapies. Here we report the case of a patient suffering from a melanoma with multiple brain metastasis, treated with BRAF and MEK double blockade, with impressive and rapid response.