Immunotherapy failure in adrenocortical cancer: where next?

Excerpt: Adrenocortical carcinoma (ACC) is a rare endocrine neoplasia, characterized by an overall dismal prognosis and its clinical manifestations are the consequence of either steroid excess or tumor mass progression. Surgery is the mainstay of therapy. For patients with locally advanced or metastatic ACC, not amenable to surgery, Mitotane and cytotoxic chemotherapy (with etoposide, doxorubicin and cisplatin - EDP scheme) are the systemic treatments currently in use

Expiratory flow limitation in intensive care: prevalence and risk factors

Expiratory flow limitation (EFL) is characterised by a markedly reduced expiratory flow insensitive to the expiratory driving pressure. The presence of EFL can influence the respiratory and cardiovascular function and damage the small airways; its occurrence has been demonstrated in different diseases, such as COPD, asthma, obesity, cardiac failure, ARDS, and cystic fibrosis. Our aim was to evaluate the prevalence of EFL in patients requiring mechanical ventilation for acute respiratory failure and to determine the main clinical characteristics, the risk factors and clinical outcome associated with the presence of EFL

Pathological Complete Response to Pembrolizumab plus Axitinib Combination following Serious Immune-Related Adverse Events in an Advanced Renal Cell Carcinoma Patient with a History of Rheumatoid Arthritis

Immune checkpoint inhibitors (ICIs)-based combinations have improved survival outcomes of advanced renal cell carcinoma (RCC) patients and are currently recommended as first-line treatment options. Rheumatoid arthritis (RA) is a systemic autoimmune disease (AD) of unknown etiology characterized by a chronic inflammatory process involving joints and extra-articular organs. Patients with AD are usually excluded from large randomized clinical trials investigating immunotherapeutic drugs. Therefore, little is known about clinical outcomes of patients with a history of RA treated with ICIs in real-world practice. In the present study, we report the clinical outcome of an advanced RCC patient with a history of RA treated with pembrolizumab in combination with axitinib. The patient experienced serious immune-related adverse events (irAEs) and achieved pathological complete response following only one ICI administration. Our case report shows that ICI-based combinations can be administered efficaciously in advanced RCC patients with a history of AD. However, a close monitoring of these patients is required, given the risk of irAEs and clinical exacerbations of symptoms associated with the preexisting AD. Moreover, prospective clinical data are needed to assess the hypothesis of a correlation between the onset of irAEs and AD flares and responses and survival outcomes to ICIs

Biological bases of radical prostatectomy in the management of prostate cancer patients with oligometastatic disease

International audienceLes processus de développement territorial permettent une adaptation des nations et des territoires à la mondialisation plutôt qu'un repli sans issue. La problématique ainsi déployée dans cet ouvrage s'attache à montrer que si l'intersection dans le marché mondial est naturelle pour les zones rurales "favorables", le développement territorial peut permettre aux zones "difficiles" et "intermédiaires" de trouver leur propre voie en contournant les logiques globalisées et déterritorialisées. En faisant le point sur la question du développement territorial en milieu rural, cet ouvrage en révèle toute la vigueur et l'originalité, à savoir l'émergence de nouvelles activités - issues de la valorisation de ressources spécifiques - et une gouvernance particulière. C'est à l'émergence d'un nouveau modèle de développement que nous convient les auteurs. Fruit de la rencontre entre un homme de terrain devenu universitaire et un universitaire préoccupé de terrain, ce livre n'a pas seulement la tonalité du croisement des origines et des expériences : il participe d'un effort de théorisation de la pensée sur le développement

Maintenance of androgen deprivation therapy or testosterone supplementation in the management of castration-resistant prostate cancer: that is the question

Purpose Whether or not androgen receptor (AR) axis could still be targetable in castration resistant prostate cancer (CRPC) patients with disease progression to next generation hormonal agents (NGHAs) is a controversial issue. Results Serum testosterone in CRPC patients has a positive prognostic role and increasing testosterone levels after androgen deprivation therapy (ADT) withdrawal or testosterone supplementation, as part of a bipolar androgen therapy (BAT) strategy, has been shown to potentially restore sensitivity to previous lines of NGHAs. Conclusion These data suggest that maintenance of ADT in CRPC patients receiving further lines of treatment, as recommended by current international guidelines, could be questionable. Conversely, testosterone supplementation aimed to re-sensitize CRPC to further hormonal manipulation is a strategy worth to be explored in future clinical trials