Estudio retrospectivo del uso de antimicrobianos en pacientes que fallecen en un servicio de oncología / A retrospective study of the use of antimicrobials in patients dying in an oncology department

Introducción: Las infecciones al final de la vida constituyen una importante causa de morbimor- talidad y las indicaciones de antibioterapia en este contexto no están claras. Objetivos: El objetivo del estudio es describir el uso de antibióticos en la etapa final de la vida en pacientes hospitalizados por cáncer y analizar su relación con las características de la en- fermedad oncológica, el estado funcional y la probabilidad de alta al ingreso. Metodología: Se trata de un estudio retrospectivo de todos los pacientes fallecidos en planta de oncología médica acotado a un periodo de 7 meses comprendidos entre el 1 de mayo y el 31 de diciembre de 2019. El número total de pacientes incluidos fue 101. Se evaluó el porcentaje de pacientes que recibieron tratamiento antibiótico durante su ingreso y el tiempo transcurrido entre la última dosis y el exitus letalis. Resultados: La edad media fue de 65,3 años y el 54,5 % eran hombres. El 23,7 % de los pacientes presentaban ECOG < 2, el 63,3 % ECOG ≥ 2. La localización más frecuente de tumor primario fue el pulmón (38,6 %). El 53 % de los pacientes recibían tratamiento oncológico con quimioterapia paliativa en el momento del ingreso, encontrándose el 66,3 % en situación de progresión de la enfermedad. En el 72,3 % de los pacientes la probabilidad de alta al ingreso era baja. El foco infeccioso de sospecha principal fue el respiratorio (27,7 %) seguido del abdominal (18,8 %). El 58,4 % recibió tratamiento antibiótico durante el ingreso en el que fallecieron. El antimicrobiano usado con mayor frecuencia fue la amoxicilina-clavulánico (36,2 %). Respecto a la búsqueda del microorganismo responsable del probable cuadro infeccioso del paciente, se extrajo he- mocultivo en 23 pacientes (23 %), urocultivo en 12 (12 %), coprocultivo en 7 (7 %) y cultivo de esputo, en 10 pacientes (10 %). Se aislaron microorganismos en 9 hemocultivos, 4 urocultivos, un coprocultivo y 2 cultivos de esputo respectivamente. [...]. (AU)

Objectives: To describe the use of antibiotics at the end of life and analyze its relationship with the characteristics of the oncological disease, functional status and probability of discharge upon admission. Methodology: A retrospective study of deceased patients in the oncology ward limited to a period of 7 months between May 1 and December 31, 2019. The number of patients included was 101. The percentage of patients who received antibiotic treatment during their admission and the time elapsed between the last dose and exitus lethalis were evaluated. Results: Mean age was 65.3 years and 54.5 % were men; 23.7 % had an ECOG < 2, 63.3 % ≥ 2. The most frequent location of the primary tumor was the lung (38.6 %); 53 % of the patients received palliative chemotherapy at the time of admission, and 66.3 % were in disease progression. In 72.3 % the probability of discharge upon admission was low. The main suspected infectious focus was respiratory (27.7 %) followed by the abdomen (18.8 %); 58.4 % received antibiotic treatment. The most frequently used antimicrobial was amoxicillin-clavulanate (36.2 %). Regarding the search for the microorganism responsible for the patient’s probable infectious condition, a blood culture was obtained in 23 patients (23 %), a urine culture in 12 (12 %), a stool culture in 7 (7 %) and a sputum culture in 10 patients (10 %). Microorganisms were isolated in 9 blood cultures, 4 urine cultures, one stool culture, and 2 sputum cultures, respectively. The most frequently isolated microorganisms in the positive cultures were: Escherichia coli (4), Pseudomonas aeruginosa (2) and Clostridium perfringens (2). [...] (AU)

How Could Antibiotics, Probiotics, and Corticoids Modify Microbiota and Its Influence in Cancer Immune Checkpoint Inhibitors: A Review.

Immunotherapy has become a new paradigm in oncology, improving outcomes for several types of cancer. However, there are some aspects about its management that remain uncertain. One of the key points that needs better understanding is the interaction between immunotherapy and gut microbiome and how modulation of the microbiome might modify the efficacy of immunotherapy. Consequently, the negative impact of systemic antibiotics and corticosteroids on the efficacy of immunotherapy needs to be clarified.

From Tumor Mutational Burden to Blood T Cell Receptor: Looking for the Best Predictive Biomarker in Lung Cancer Treated with Immunotherapy.

Despite therapeutic advances, lung cancer (LC) is one of the leading causes of cancer morbidity and mortality worldwide. Recently, the treatment of advanced LC has experienced important changes in survival benefit due to immune checkpoint inhibitors (ICIs). However, overall response rates (ORR) remain low in unselected patients and a large proportion of patients undergo disease progression in the first weeks of treatment. Therefore, there is a need of biomarkers to identify patients who will benefit from ICIs. The programmed cell death ligand 1 (PD-L1) expression has been the first biomarker developed. However, its use as a robust predictive biomarker has been limited due to the variability of techniques used, with different antibodies and thresholds. In this context, tumor mutational burden (TMB) has emerged as an additional powerful biomarker based on the observation of successful response to ICIs in solid tumors with high TMB. TMB can be defined as the total number of nonsynonymous mutations per DNA megabases being a mechanism generating neoantigens conditioning the tumor immunogenicity and response to ICIs. However, the latest data provide conflicting results regarding its role as a biomarker. Moreover, considering the results of the recent data, the use of peripheral blood T cell receptor (TCR) repertoire could be a new predictive biomarker. This review summarises recent findings describing the clinical utility of TMB and TCRß (TCRB) and concludes that immune, neontigen, and checkpoint targeted variables are required in combination for accurately identifying patients who most likely will benefit of ICIs.

Intratumoral Versus Circulating Lymphoid Cells as Predictive Biomarkers in Lung Cancer Patients Treated with Immune Checkpoint Inhibitors: Is the Easiest Path the Best One?

The molecular and cell determinants that modulate immune checkpoint (ICI) efficacy in lung cancer are still not well understood. However, there is a necessity to select those patients that will most benefit from these new treatments. Recent studies suggest the presence and/or the relative balance of specific lymphoid cells in the tumor microenvironment (TEM) including the T cell (activated, memory, and regulatory) and NK cell (CD56dim/bright) subsets, and correlate with a better response to ICI. The analyses of these cell subsets in peripheral blood, as a more accessible and homogeneous sample, might facilitate clinical decisions concerning fast prediction of ICI efficacy. Despite recent studies suggesting that lymphoid circulating cells might correlate with ICI efficacy and toxicity, more analyses and investigation are required to confirm if circulating lymphoid cells are a relevant picture of the lung TME and could be instrumental as ICI response biomarkers. This short review is aimed to discuss the recent advances in this fast-growing field.