Effectiveness and safety of immunotherapy in NSCLC patients with ECOG PS score ≥2 - Systematic review and meta-analysis.

BackgroundImmune checkpoint inhibitors (ICIs) are standard of care in advanced non-small cell lung cancer (NSCLC), however their status in patients with poor performance status (PS) is poorly defined. We aimed to evaluate the efficacy and safety of ICIs in NSCLC patients with PS ≥ 2.MethodsWe conducted a systematic review and meta-analysis of interventional and observational studies, which reported efficacy and safety data on ICIs in PS ≥ 2 comparing to PS ≤ 1 NSCLC patients. Efficacy endpoints included: Objective Response Rate (ORR), Disease-Control Rate (DCR), Overall Survival (OS), Progression-Free Survival (PFS). Safety endpoint was the incidence of severe (grade≥3) Adverse Events (AE). Random-effects model was applied for meta-analysis. Heterogeneity was assessed using I2. The review is registered on PROSPERO (CRD42020162668).FindingsSixty-seven studies (n = 26,442 patients) were included. In PS ≥ 2 vs. PS ≤ 1 patients, the pooled odds ratios were: for ORR 0.46 (95 %CI: 0.39-0.54, I2:0 %); for DCR 0.39 (95 %CI: 0.33-0.48, I2:50 %) and for AEs 1.12 (95 %CI: 0.84-1.48, I2:39 %). The pooled hazard ratio for PFS was 2.17 (95 %CI: 1.96-2.39, I2:65 %) and for OS was 2.76 (95 %CI: 2.43-3.14, I2:76 %). The safety profile was comparable regardless of the PS status.InterpretationPatients with impaired PS status are, on average, twice less likely to achieve a response when exposed to ICIs when compared with representative PS ≤ 1 population. For lung cancer patients treated with ICIs, the impaired PS is not only prognostic, but also predictive for response, while the safety profile is not affected. Prospective randomized studies are indispensable to determine whether poor PS patients derive benefit from ICIs

26 Ocena wyników pooperacyjnej radioterapii skojarzonej z 5-fluorouracylem u chorych na raka odbytnicy

Celem pracy była ocena wyników leczenia uzupełniającego z udziałem chemio- i radioterapii chorych po radykalnym zabiegu operacyjnym z powodu raka odbytnicy, ze szczególnym uwzględnieniem tolerancji leczenia. Materiał obejmuje 64 chorych leczonych w Klinice Onkologii i Radioterapii w Iatach1991–1995. Głównymi powikłaniami w czasie leczenia były biegunki (58%), nudności i wymioty (15%), objawy dyżuryczne (6%), leukopenia (33%) i niedokrwistość (5%). Do ostrych powikłań doszło ogółem 43 chorych (66%) w tym u 15 (23%) miały one charakter ciężki (stopień III i IV). Troje chorych nie ukończyło leczenia z powodu znacznego nasilenia objawów niepożądanych leczenia i pogorszenia stanu ogólnego.Późne powikłania, przede wszystkim w obrębie jelit i dróg moczowych, wystąpiły ogółem u 22 chorych (34%) w tym u 6 (9%)- w stopniu ciężkim. Spośród ocenionych 64 chorych dotychczas zmarło 19 (30%). Mediana czasu przeżycia w całej grupie wynosiła 37 miesięcy (11–60 miesięcy). Do wznowy miejscowej doszło u 15 chorych (23%) natomiast przerzuty odległe wystąpiły u 18 chorych (28%). Przedstawione wyniki, wskazujące na wysoki odsetek nawrotów oraz dużą liczbę powikłań popromiennych, skłoniły nas do zmiany techniki napromieniania. Efekty tych modyfikacji będzie można ocenić dopiero za kilka lat

A tüdőrák molekuláris diagnosztikája

Development of the target therapies of lung cancer was a rapid process which fundamentally changed the pathological diagnosis as well. Furthermore, molecular pathology became essential part of the routine diagnostics of lung cancer. These changes generated several practical problems and in underdeveloped countries or in those with reimbursement problems have been combined with further challenges. The central and eastern region of Europe are characterized by similar problems in this respect which promoted the foundation of NSCLC Working Group to provide up to date protocols or guidelines. This present paper is a summary of the molecular pathology and target therapy guidelines written with the notion that it has to be upgraded continuously according to the development of the field

55. How often should we obtain complete blood counts (CBC's) from patients receiving radical radiation therapy?

Data on factors influencing decline in peripheral blood counts during radiation treatment are sparse and no guidelines exist on the appropriate frequency of obtaining CBC's from the patients.Patients and methodsA series of charts from 460 consecutive patients receiving radiotherapy in 1995 and 1996 was reviewed. In the final database, the data from patients receiving definitive radiotherapy with information on baseline CBC's and at least two results during treatment were included (183 patients, 810 results). Critical nadir values of haemoglobin (HGB), white blood cells (WBC) and platelets (PLT) requiring further tests and interventions were defined as follows: HG

60. Factors detremining local control in patients (Pts) with locally advanced breast cancer (Labc) managed with radiotherapy (RT) as the primary locoregional treatment

IntroductionRT plays an important role in the management of LABC, yet clinical outcomes still remain far from satisfactory. The aim of this study was to evaluate retrospectively factors determining local control in a large series of consecutive LABC pts managed with RT as the primary locoregional treatment.Material and methodsThe records of 261 primarily inoperable LABC pts treated between 1991 and 1997 at two institutions: Medical University of Gdansk, Poland and Velindre NHS Trust, Cardiff, UK were analysed. All pts received megavoltage RT to the breast with two tangential fields, and the adjacent lymph node areas were irradiated using customised fields. Due to a large scale of RT doses and fractionation schedules, normalised total dose (NTD) was calculated for all patients using a linear quadratic model. In 241 pts RT constituted the only local treatment and the remaining 20 pts were subsequently subjected to mastectomy. Most pts received chemotherapy and/or endocrine therapy prior or after RT.ResultsWithin the median follow-up of 37 months, locoregional recurrence occurred in 95 of 251 evaluable pts (38%). Three-year and five-year locoregional-free survival rates were 59% and 48%, respectively. At multivariate analysis of variables predicting the risk of locoregional relapse, inflammatory carcinoma (