A retrospective cohort study of neoadjuvant chemoradiotherapy combined with immune checkpoint inhibitors in locally advanced rectal cancer.

INTRODUCTION: This study aimed to investigate the safety and efficacy of neoadjuvant chemoradiotherapy combined with immune checkpoint inhibitors (ICIs) in patients with locally advanced rectal cancer (LARC). Patients diagnosed with LARC and treated with programmed cell death protein-1 (PD-1) inhibitors were recruited. METHODS: Four different treatment strategies were employed in this study: plan A [long-course radiotherapy + PD-1 inhibitor/capecitabine + PD-1 inhibitor/XELOX+ total mesorectal excision (TME)], plan B (long-course radiotherapy + capecitabine + PD-1 inhibitor/XELOX + TME), plan C (short-course radiotherapy + PD-1 inhibitor/XELOX + TME), and plan D (PD-1 inhibitor/XELOX + short-course radiotherapy + TME). The basic information about patients, pathological indicators, adverse events, and efficacy indexes of treatment plans were analyzed. RESULTS: 96.8 % of patients were mismatch repair proficient (pMMR) and only 2 patients belonged to mismatch repair deficient (dMMR). The 2 patients with dMMR showed a pathological complete response (pCR) rate of 100 %, while the pCR rate of pMMR patients was 43.3 %. The overall tumor descending rate reached 79 %, and the anus-retained rate was 88.7 % in all LARC patients. Plan A exhibited the highest pCR rate of 60 %, and plan C had the highest tumor descending rate and anal preservation rate. Radiation enteritis was the most common adverse event in LARC patients after neoadjuvant therapy, and its incidence was the highest in Plan A. CONCLUSION: Neoadjuvant chemoradiotherapy combined with ICIs demonstrated favorable efficacy and safety in treating LARC patients.

Efficacy of treatment with N-acetylcysteine inhalation for AECOPD: A propensity-score-matched cohort study.

INTRODUCTION: N-acetylcysteine (NAC) prevents acute exacerbations of chronic obstructive pulmonary disease (AECOPD). However, the value of NAC inhalation in the treatment of patients with AECOPD is still poorly understood. The study was conducted to evaluate the efficacy of NAC inhalation in AECOPD patients requiring hospitalization. METHODS: In this single institutional, retrospective cohort study, all patients with AECOPD requiring hospitalization between January 2021 and January 2022 were included. Patients were divided into NAC group and Non-NAC group according to whether being treated with NAC inhalation and were matched using the propensity score. The primary outcome was a composite of progression to ventilation requirement, in-hospital mortality and readmission for AECOPD within 30 days. The effect on the mean hospitalized days, blood gas indexes and the incidence rate of adverse drug events were compared between the two groups. RESULTS: Ninety-six patients in the NAC group were matched with 96 patients in the Non-NAC group. The differences in the primary composite end point (NAC group vs Non-NAC group, 5.2% vs 16.7%; P = 0.011) were significant. The median time to discharge was shorter in the NAC group (8.3 vs. 9.1 days, P = 0.030). The NAC group presented a larger increase in partial pressure of arterial oxygen (Pa O2 ) and a higher ratio of self-reported symptomatic improvement from admission to day 5. There was no definite difference between the two groups in the frequency of adverse event. CONCLUSION: NAC inhalation is associated with an improved clinical outcome. A further study should be conducted to confirm the clinical usefulness of NAC inhalation in AECOPD patients.

Meta-Analysis of Atezolizumab vs Docetaxel in Non-Small Cell Lung Cancer Treatment Outcomes.

Objective: We aimed to investigate the clinical efficacy of atezolizumab and docetaxel in the treatment of non-small cell lung cancer (NSCLC) via meta-analysis and systematic review. Methods: Publications were searched from China National Knowledge Infrastructure (CNKI), Chongqing Vipers Chinese Science and Technology Journal database (VIP), Wanfang database, PubMed database, Embase database, Cochrane Library and Web of Science. Randomized controlled trials (RCTs) of atezolizumab and docetaxel in the treatment of patients with NSCLC were collected. The retrieval period was from the establishment of the database to November 2021 and updated on 22 April 2023. According to the inclusion and exclusion criteria, the included studies were screened and quality evaluated. Meta-analysis was performed using RevMan 5.4.3 (Cochrane Training, Summertown, Oxford UK) software. Results: A total of 6 RCTs were included in our analysis, including 6348 patients with NSCLC. Our results showed that the atezolizumab group had significantly longer overall survival (OS) than the docetaxel group (hazard ratio [HR] = 0.77; 95% CI, 0.73-0.81); P < .00001). In terms of progression-free survival (PFS) and objective response rate (ORR), the atezolizumab group was not significantly superior to the docetaxel group (HR = 0.96; 95% CI, 0.90-1.02; P = .20), (relative ratio [RR] = 1.10, 95% CI, 0.95-1.26; P = .20). In terms of treatment-related adverse events (TRAEs), after treatment, the number of patients with TRAEs in the atezolizumab group was significantly lower than in the docetaxel group (RR = 0.65; 95% CI, 0.54-0.79; P < .00001). Conclusion: Compared with docetaxel, atezolizumab can significantly prolong OS in patients with NSCLC and reduce the occurrence of TRAEs, but there is no advantage in PFS or ORR remission rate. Due to some limitations in case numbers and quality of included studies, multicenter, large sample, high-quality RCTs are still needed for further validation.