Metronomic oral vinorelbine in a real-world population of advanced non-small cell lung cancer patients.

INTRODUCTION: An increasing body of evidence from clinical trials and real-world studies suggests that metronomic oral vinorelbine (VNR) is a promising treatment option for elderly and unfit advanced non-small cell lung cancer (NSCLC) patients. The aim of this multicenter study was to present real-world data about the experience in treatment of NSCLC with metronomic VNR in Portugal. MATERIAL AND METHODS: Retrospective data from NSCLC patients not eligible for conventional chemotherapy or tyrosine kinase inhibitors who received oral metronomic VNR irrespective of treatment line and dose was retrieved from 19 Portuguese Oncology Centers between 2016 and 2018. RESULTS: A total of 293 patients were included, with a median of 76 (39 - 94) years; 71% were ≥70 years old. Patients had a median of 3 comorbidities and predominantly (61%) ECOG PS 2. Most (42%) received metronomic oral VNR as first-line treatment. Overall response rate was 18%, with 42 (18%) partial and no (0%) complete responses. A total of 54% of patients experienced stable disease and 28% of patients, disease progression. Disease control rate was 72%. Patients were a median of 4 (1 - 40) months on treatment. Treatment discontinuation was observed in 90%, mostly (67%) due to disease progression, followed by death (16%). Adverse events leading to treatment discontinuation were only reported in 5% of patients. Female gender (HR 0.601, 95% CI 0.434 - 0.832; p = 0.002) and ECOG PS 1 (HR 0.625, 95% CI [0.443 - 0.881]; p = 0.007) were significantly associated with a lower risk of metronomic oral VNR discontinuation. Overall, 21% of patients experienced G3/4 toxicity. CONCLUSION: The present real-world results agree with what has been previously reported by other international Centers and support the concept that metronomic scheduling is a relevant and safe approach to treat advanced NSCLC patients.

Characterization and management of elderly and very elderly patients with non-small cell lung cancer.

OBJECTIVES: Despite non-small cell lung cancer (NSCLC) high prevalence and increasing incidence, evidence specific to the elderly and very elderly is sparse. To retrospectively compare characterization and approach of NSCLC patients (pts) aged 70-79 and ≥80 years. METHODS: We performed a retrospective analysis of 297 adult NSCLC pts who registered and initiated NSCLC management in our Pulmonology Oncology Unit from January 2013 to December 2016 corresponding to 38.2% of all NSCLC patients (n = 778). Demographic data and lung cancer management were analysed. RESULTS: Pts were categorized as elderly (n = 211, 71.0%) and very elderly (n = 86, 29.0%). Very elderly pts had worse Eastern Cooperative Oncology Group performance status (P = 0.047), higher Charlson age comorbidity index (P < 0.001) and the majority had stage IV cancer (66.3%, P = 0.04). The first management option in very elderly pts was chemotherapy (CTX) (30.2%, P = 0.37) and in elderly pts was multimodal therapy (30.3%, P ≤ 0.001). Support therapy and first-line targeted (EGFR or ALK-positive) were more common in the very elderly (23.6%, P = 0.01; 17.4% P = 0.002, respectively). Curative radiation or surgery rates did not differ between groups. Reasons for premature first-line CTX stop, toxicity and hospitalization did not differ. Death rate (69.7% vs 63.5% for very elderly and elderly, respectively) and mean survival since diagnosis (11.5 vs 11.6 months for very elderly and elderly, respectively) did not differ. CONCLUSIONS: There were significant differences in pts characteristics having the very elderly more multimorbidity and advanced state of disease. First management options were significantly different with respect to multimodal, targeted and support therapy.

Angiosarcoma of the lung.

Angiosarcoma is a rare malignant vascular tumor. Pulmonary involvement is usually attributable to metastasis from other primary sites, primary pulmonary angiosarcoma therefore being quite uncommon. We report a case of angiosarcoma with pulmonary involvement, probably primary to the lung, which had gone untreated for more than two years. We describe this rare neoplasm and its growth, as well as the extensive local invasion and hematogenous metastasis at presentation. We also discuss its poor prognosis.

Angiosarcoma of the lung / Angiossarcoma pulmonar

Angiosarcoma is a rare malignant vascular tumor. Pulmonary involvement is usually attributable to metastasis from other primary sites, primary pulmonary angiosarcoma therefore being quite uncommon. We report a case of angiosarcoma with pulmonary involvement, probably primary to the lung, which had gone untreated for more than two years. We describe this rare neoplasm and its growth, as well as the extensive local invasion and hematogenous metastasis at presentation. We also discuss its poor prognosis.

O angiosarcoma é um tumor vascular maligno. O envolvimento pulmonar é geralmente atribuído à metástase de outros sítios primários, sendo o angiossarcoma pulmonar primário extremamente raro. Relatamos um caso de angiossarcoma com envolvimento pulmonar, provavelmente primário no pulmão com mais de dois anos de evolução. Descrevemos seu crescimento e sua extensa invasão local e hematogênica na apresentação. Documentamos ainda seu mau prognóstico.

[Pulmonary disease in polymyositis]. / Envolvimento pulmonar na polimiosite.

INTRODUCTION: Polymyositis and dermatomyositis are classified as idiopathic inflammatory myopathies. Interstitial lung disease is rare and is described in the literature in about 10% of cases. The authors describes a case of 75 year old woman presenting with one month evolution of fever, weight loss, arthralgia, myalgia and symmetric and proximal muscle weakness of upper and lower limbs. Nonspecific interstitial changes was found in chest X -ray. After exhaustive study, the diagnosis of pulmonary involvement in the form of organizing pneumonia by polymyositis, was established. Glucocorticoids and mycophenolate were prescribed with good clinical, analytical and radiological outcome. CONCLUSION: In this case, it was the changes in the chest X -ray in a patient without respiratory symptomatology, that conducted to exhaustive study to polymyositis diagnosis, enhancing once again the importance of X -ray in the screening of pathologies of other systems.