Fatigue in lung cancer patients: symptom burden and management of challenges.

Lung cancer (LC) remains the most common cause of cancer death in several countries across the world. Fatigue is the most frequently reported symptom in LC patients throughout the entire course of disease, and all international guidelines recommend early screening for cancer-related fatigue (CRF) and symptoms that can affect patients’ quality of life. In patients with LC, fatigue belongs to the symptom cluster of pain, depression, and insomnia, which are commonly observed simultaneously, but are typically treated as separate although they may have common biological mechanisms. The treatment of CRF remains one of the difficult areas in the oncology field: scarce evidence supports pharmacological therapies, while some interesting data arising indicates alternative remedies and physical exercise seem to be one of the most effective approaches for CRF at any stage of LC

Prognostic and predictive biomarkers in early stage non-small cell lung cancer: Tumor based approaches including gene signatures

In early stage non-small cell lung cancer (NSCLC) large randomized trials have demonstrated that in patients with radically resected disease adjuvant chemotherapy improves 5-year survival rates. However, a customization of systemic treatment is needed to avoid treatments in patients cured by surgery alone or to justify the use of adjuvant chemotherapy in high risk patients, including those in stage IA. Recently, the possibility of identifying prognostic and predictive factors related to the genetic signatures of the tumor that could affect adjuvant and neo-adjuvant treatment choices for resectable non-small cell lung cancer (NSCLC) has been of interest. This review summarizes the current status and future opportunities for clinical application of genotyping and genomic tests in early NSCLC

Written narrative practices: speech-language pathology intervention

OBJETIVO: analisar a efetividade de um Programa de Promoção de Narrativas Escritas, em escolares da terceira série do Ensino Fundamental de uma escola pública. MÉTODO: vinte e um escolares de 3ª séries (14 meninas e sete meninos), entre oito anos e sete meses e 10 anos, foram avaliados quanto à produção escrita livre com base em um tema proposto antes e após um Programa de Práticas de Narrativas Escritas. As produções escritas foram analisadas qualitativa e quantitativamente por meio dos critérios das Competências Comunicativas (Genérica, Enciclopédica e Linguística), sendo o desempenho classificado como Ruim, Regular, Bom e Ótimo de acordo com a pontuação adquirida. Estes dados foram classificados e comparados nos momentos inicial e final do programa e receberam tratamento estatístico. RESULTADOS: houve um aumento estatístico significante no número de sujeitos que obtiveram a classificação Ótimo na avaliação final. Quando os dados foram agrupados em dois: Ruim/Regular e Ótimo/Bom também houve uma significância estatística entre os momentos inicial e final uma vez que o número de sujeitos do grupo Ruim/Regular reduziu-se enquanto que o Ótimo/Bom aumentou significantemente. CONCLUSÕES: o programa proposto foi efetivo uma vez que os escolares mostraram-se muito motivados e realizaram produções narrativas escritas melhor elaboradas em relação às Competências Comunicativas.PURPOSE: to analyze the effectiveness of a Written Narratives Promotion Program in a group of third grade students from public Elementary School. METHOD: twenty-one third grade students (14 girls and seven boys), with ages between eight years and seven months and ten years, had their free writing production based on a proposed theme evaluated before and after Written Narratives Promotion Program. The written productions were qualitatively and quantitatively analyzed using the Communicative Competence criteria (Generic, Encyclopedic and Linguistic), and the subjects' performances were classified as Bad, Regular, Good and Excellent, according to their scores. Data were classified and compared between the program's initial and final moments, and were statistically analyzed. RESULTS: a statistically significant increase was observed in the number of subjects that obtained an excellent classification, in the final evaluation. When data were paired: Bad/Regular and Excellent/Good, there was also a statistic significance between initial and final moments, since that the number of subjects within the group Bad/Regular decreased while the number of subjects classified as Excellent/Good increased significantly. CONCLUSIONS: the proposed program was effective, since that the students were highly motivated and produced better and elaborated written narratives regarding the Communicative Skills

Factors influencing short-term parasitoid establishment and efficacy for the biological control of Halyomorpha halys with the samurai wasp Trissolcus japonicus

Background: Classical biological control has been identified as the most promising approach to limit the impact of the invasive pest species Halyomorpha halys (Heteroptera: Pentatomidae). This study investigated the parasitism rate at sites where the biocontrol agent Trissolcus japonicus (Hymenoptera: Scelionidae) was released and where its unintentional introduction took place, in the Trentino-South Tyrol region. The effect of land-use composition was studied to understand which factors favor the establishment of hosts and parasitoids, including native and exotic species. Results: The released T. japonicus were detected a year after the start of the program, with a significant parasitoid impact and discovery, compared to control sites. Trissolcus japonicus was the most abundant H. halys parasitoid, and Trissolcus mitsukurii and Anastatus bifasciatus were recorded also. The efficacy of T. mitsukurii was lower in sites where T. japonicus was successfully established, suggesting a possible competitive interaction. Parasitism level by T. japonicus at the release sites was 12.5% in 2020 and 16.4% in 2021. The combined effect of predation and parasitization increased H. halys mortality up to 50% at the release sites. Landscape composition analysis showed that both H. halys and T. japonicus were more likely to be found at sites with lower altitude and with permanent crops, whereas other hosts and parasitoids preferred different conditions. Conclusion: Trissolcus japonicus showed a promising impact on H. halys, at release and adventive sites, with minor nontarget effects, mediated by landscape heterogeneity. The prevalence of T. japonicus in landscapes with permanent crops could support IPM in the future. © 2023 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry

Osimertinib-induced Cardiac Dysfunction in EGFR-Mutated Lung Cancer: A Case Series of Five Patients

Introduction: The gold standard treatment for Epidermal Growth Factor Receptor (EGFR) positive Non-Small Cell Lung Cancer (NSCLC)patients is represented byosimertinib, an irreversible third-generation EGFR inhibitor that has been providingimportant outcomes’ improvementscompared to chemotherapy and other target therapies; either upfront or as second line therapy, in case of  EGFR T790M detection after previous tyrosine kinase inhibitors (TKI).Osimertinib is generally well tolerated. Most common side effects are diarrhea, rash, paronychia, dry skin and alsochanges in QT interval.Presentation of case series: Here we report five cases of left ventricular dysfunction duringosimertinib treatment, observed between January 2017 and August 2018. The five patients, with a general low cardiovascular risk profile, required a dose modification/discontinuation of the TKI therapy and a specific cardio-protective treatment, normally with a recovery of the systolic function.Conclusion: Both American and European compound labels highlight warnings of cardiomyopathy and changes in cardiac contractility during osimertinib treatment, recommending cardiac monitoring and dose adjustment in patients with cardiac risk factors. In spite of this, a standardized echocardiographic follow-up in the entire population is still not available and recommendations about the use of tissue Doppler echocardiography with more sophisticated indices are missing. With the expanding use of osimertinib we need better strategies to prevent or mitigate cardiovascular damage from cancer therapy in a larger multidisciplinary approach in which every issue is carefully evaluated

Early Progression in Non-Small Cell Lung Cancer (NSCLC) with High PD-L1 Treated with Pembrolizumab in First-Line Setting: A Prognostic Scoring System Based on Clinical Features

Background: Pembrolizumab is approved in monotherapy for the first-line (1L) of advanced or metastatic NSCLC patients with high PD-L1 (≥50%). Despite a proportion of patients achieve long-term survival, about one-third of patients experience detrimental survival outcomes, including early death, hyperprogression, and fast progression. The impact of clinical factors on early progression (EP) development has not been widely explored. Methods: We designed a retrospective, multicenter study involving five Italian centers, in patients with metastatic NSCLC with PD-L1 ≥ 50%, treated with Pembrolizumab in a 1L setting. EP was defined as a progressive disease within three months from pembrolizumab initiation. Baseline clinical factors of patients with and without EP were collected and analyzed. Logistic regression was performed to identify clinical factors associated with EP and an EP prognostic score was developed based on the logistic model. Results: Overall, 321 out of 336 NSCLC patients treated with 1L pembrolizumab provided all the data for the analysis. EP occurred in 137 (42.7%) patients; the median PFS was 3.8 months (95% CI: 2.9–4.7), and median OS was not reached in the entire study population. Sex, Eastern Cooperative Oncology Group (ECOG) performance status (PS), steroids, metastatic sites ≥2, and the presence of liver/pleural metastasis were confirmed as independent factors for EP by multivariate analysis. By combining these factors, we developed an EP prognostic score ranging from 0–13, with three-risk group stratification: 0–2 (good prognosis), 3–6 (intermediate prognosis), and 7–13 (poor prognosis). The area under the curve (AUC) of the model was 0.76 (95% CI: 0.70–0.81). Conclusions: We identified six clinical factors independently associated with EP. We developed a prognostic score model for EP-risk to potentially improve clinical practice and patient selection for 1L pembrolizumab in NSCLC with high PD-L1, in the real-world clinical setting

Comparing T Cell Subsets in Broncho-Alveolar Lavage (BAL) and Peripheral Blood in Patients with Advanced Lung Cancer

Background: Lung cancer (LC) tissue for immunological characterization is often scarce. We explored and compared T cell characteristics between broncho-alveolar lavage from tumor affected (t-BAL) and contralateral lung (cl-BAL), with matched peripheral blood (PB). Methods: BAL and PB were collected during bronchoscopy for diagnostic and/or therapeutic purposes in patients with monolateral primary lesion. Results: Of 33 patients undergoing BAL and PB sampling, 21 had histologically-confirmed LC. Most cases were locally-advanced or metastatic non-small cell LC. T cell characteristics were not significantly different in t-BAL vs. cl-BAL. Compared to PB, CD8 T cells in BAL presented features of immune activation and exhaustion (high PD-1, low IFN-g production). Accordingly, regulatory CD4 T cells were also higher in BAL vs. PB. When dichotomizing T cell density in t-BAL in high and low, we found that PD-L1 expression in LC was associated with T cell density in t-BAL. T-BAL with high T cell density had higher %IFN-g+CD8 T cells and lower %T-regs. Conclusion: In BAL from advanced LC patients, T cells present features of exhaustion. T cells in t-BAL could be the best surrogate of tumor-infiltrating T cell, and future studies should evaluate T cell phenotype and density as potential biomarkers for cancer immunotherapy outcome