Immune checkpoint inhibitors-associated thrombosis in patients with lung cancer and melanoma: a study of the Spanish society of medical oncology (SEOM) thrombosis and cancer group

Purpose: Immune Checkpoint Inhibitors (ICI) can be associated with thrombotic events, both venous and arterial (VTE/AT). However, there is a paucity of information regarding patients in routine clinical practice.Methods/patientsRetrospective, multicenter study promoted by the Thrombosis and Cancer Section of the Spanish Society of Medical Oncology (SEOM). Patients with melanoma and lung cancer who initiated ICI between 01/01/2015 and 31/12/2019 were recruited. Minimum follow-up was 6 months (unless it was not possible because of death). The primary objective was to calculate the incidence of ICI-associated VTE/AT and the secondary objectives included to analyze its impact on survival and to identify predictor variables for VTE/AT.Results665 patients with lung cancer were enrolled. The incidence of VTE/AT during follow-up was 8.4%. Median overall survival (OS) was lower in the VTE/AT group (12 months 95% CI 4.84–19.16 vs. 19 months 95% CI 16.11–21.9; p = 0.0049). Neutrophil/lymphocyte ratio (NLR) and anemia upon initiation of IT, as well as a history of thrombosis between cancer diagnosis and the start of ICI, were predictive variables for developing of VTE/AT (p < 0.05). 291 patients with melanoma were enrolled. There was a 5.8% incidence rate of VTE/AT during follow-up. Median OS was lower in the VTE/AT group (10 months 95% CI 0.0–20.27 vs. 29 months 95% CI 19.58–36.42; p = 0.034). NLR and lactate dehydrogenase (LDH) at the beginning of ICI were predictor variables for VTE/AT (p < 0.05).ConclusionsICI increases the risk of VTE/AT in patients with lung cancer and melanoma, which impact OS. (AU)

Are there differences by sex in lung cancer characteristics at diagnosis? -a nationwide study.

BACKGROUND: Lung cancer causes approximately 25% of all cancer deaths. Despite its relevance, few studies have analyzed differences by sex at the time of diagnosis in terms of symptoms, stage, age or smoking status. We aim to assess if there are differences between men and women on these characteristics at diagnosis. METHODS: We analyzed the Thoracic Tumour Registry (TTR), sponsored by the Spanish Lung Cancer Group using a case-series design. This is a nationwide registry of lung cancer cases which started recruitment in 2016. For each case included, clinicians fulfilled an electronic record registering demographic data, symptoms, exposure to lung cancer risk factors, and treatment received in detail. We compared men and women using descriptive statistics. RESULTS: A total of 13,590 participants took part in this study, 25.6% women. Women were 4 years younger than men (64 vs. 69), and men had smoked more frequently. Adenocarcinoma was the most frequent histological type in both sexes. Stage IV at diagnosis was 50.8% in women compared to 43.6% in men. Weight loss/anorexia/asthenia was the most frequent symptom in both sexes and there were no differences in the number of symptoms at diagnosis. There were no relevant differences in the frequency or number of symptoms by sex when non-small cell lung cancer (NSCLC) and small-cell lung cancer (SCLC) were analyzed separately. Smoking status did not appear to cause different lung cancer presentation in men compared to women. CONCLUSIONS: There seems to be no differences in lung cancer characteristics by sex at the time at diagnosis on stage, specific symptoms or number of symptoms.

Utilización de haloperidol en un paciente con síndrome de encefalomiopatía mitocondrial, acidosis láctica y episodios parecidos a ictus (síndrome MELAS) / Using haloperidol in a patient with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS síndrome)

El síndrome de MELAS (del inglés: mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes) es una enfermedad de herencia materna caracterizada por una alteración en la cadena respiratoria mitocondrial. Además de la encefalopatía, la miopatía y los fenómenos que simulan ictus, entre sus síntomas también se encuentran manifestaciones psiquiátricas, sobre todo deterioro cognitivo, trastornos afectivos, psicosis y ansiedad. Debido a la escasa prevalencia de esta enfermedad, existen pocas referencias respecto al tratamiento de sus síntomas psiquiátricos. Muchos de los neurolépticos empleados en la práctica clínica habitual han demostrado toxicidad únicamente in vitro sobre la cadena respiratoria mitocondrial, por lo que su uso se desaconseja en estos pacientes. Presentamos un caso de un varón con diagnóstico de síndrome de MELAS mediante estudio genético que demostró la mutación A3243G de MELAS en el gen MT-TL1 del ADN mitocondrial. El paciente, además de las manifestaciones clásicas de la enfermedad, presentaba agitación psicomotriz, insomnio y alteraciones conductuales agudas con heteroagresividad, que, tras el ensayo de múltiples fármacos, únicamente lograron controlarse mediante la administración intravenosa de haloperidol, sin empeorar las manifestaciones neurológicas de la enfermedad. El presente caso evidencia que el empleo de haloperidol en el tratamiento agudo de las manifestaciones psiquiátricas de las enfermedades mitocondriales puede ser seguro y eficaz (AU)

Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) syndrome is a maternally inherited disease characterised by an anomaly in the mitochondrial respiratory chain complex. Apart from encephalopathy, myopathy and stroke-like episodes, these patients can also develop psychiatric symptoms such as dementia, affective disorders, psychosis, and anxiety phenomena. Because of the low prevalence of this syndrome, there are few references about the management of its psychiatric comorbidity. In mitochondrial diseases, neuroleptic agents are not recommended because they have demonstrated in vitro toxicity over the mitochondrial respiratory chain. The case is presented of a patient with a diagnosis of MELAS syndrome confirmed by the detection of a A3243G mutation in the MT-TL1 gene encoding part of the mitochondrial DNA. This patient did not only show the classic manifestations of the disease, but also presented with psychomotor agitation, insomnia and behavioural disturbances with aggressiveness. Several drugs were ineffective, but intravenous haloperidol induced remission without worsening of the neurological manifestations. This case suggests that haloperidol may be safe and effective for the acute control of psychiatric symptoms in mitochondrial syndromes (AU)