Ensartinib (X-396) a novel drug for anaplastic lymphoma kinase-positive non-small cell lung cancer patients: we need smart trials to avoid wasting good bullets

Around 3–7% of patients with non-small cell lung cancer (NSCLC) have a translocation in the gene for anaplastic lymphoma kinase (ALK) (1). Since the first report of ALK detection in NSCLC in 2007, the prognosis and the treatment landscape has been revolutionized for this setting of patients (2)

New tools in percutaneous minimally invasive chronic subdural hematomas evacuation

Background: Incidence of chronic subdural hematomas (cSDH) is expected to progressive rise in the next decades. There is no univocal indication of the approach to be used. Furthermore, there is no data about the efficacy of twist drill craniostomy (TDC) in hematomas with membranes. Objective: To describe our modified technique for TDC in patients affected by cSDH with membranes and in treatment with antiplatelets. Methods: We analyzed a group of 37 patients, affected by cSDH with membrane (type D laminar membrane and type G trabecular membrane according to Nakaguchi classification), treated with mushroom TDC using a modified technique. Results: After surgery the average maximum thickness of the common postoperative liquoral subdural collection decreased from 18.8 to 6.21 mm. We documented one acute subdural hematoma (2.7%), asymptomatic and not treated, and one recurrence of cSDH (2.7%) after 2 months that needed re-intervention with single burr hole. Conclusions: We presented a modified twist drill technique, characterized by the introduction of an application of a new device that optimizes both surgical results, clinical outcome and surgical procedure time. The presence of membrane type D and G does not affect the efficacy of drainage, that is negatively related to the presence of clots or acute hematoma. This modified technique is safe, fast, effective and represents a valid first line treatment of an unstable and unpredictable pathology such as cSDH. We suggest performing such technique on a larger patients' cohort to further validate its effectiveness

Fears and perception of the impact of COVID-19 on patients with lung cancer. A mono-institutional survey

In February 2020, Italy became one of the first countries to be plagued by the SARS-CoV-2 pandemic, COVID-19. In March 2020, the Italian government decreed a lockdown for the whole country, which overturned communication systems, hospital organization, and access to patients and their relatives and carers. This issue had a particular regard for cancer patients. Our Thoracic Oncology Division therefore reorganized patient access in order to reduce the risk of contagion and, at the same time, encourage the continuation of treatment. Our staff contacted all patients to inform them of any changes in treatment planning, check that they were taking safety measures, and ascertain their feelings and whether they had any COVID-19 symptoms. To better understand patients’ fears and expectations of during the pandemic period, we created a nine-question interview, administered from April to May 2020 to 156 patients with lung cancer. Patients were classified by age, sex, comorbidity, disease stage, prior treatment, and treatment type. The survey showed that during the pandemic period some patients experienced fear of COVID-19, in particular: women (55% vs. 33%), patients with comorbidities (24% vs. 9%), and patients who had already received prior insult (radiotherapy or surgery) on the lung (30% vs. 11%). In addition, the patients who received oral treatment at home or for whom intravenous treatment was delayed, experienced a sense of relief (90% and 72% respectively). However, only 21% of the patients were more afraid of COVID-19 than of their cancer, in particular patients with long-term (> 12 months) vs. short-term cancer diagnosis (28% vs. 12.5%, respectively). Furthermore, the quarantine period or even just the lockdown period alone, worsened the quality of life of some patients (40%), especially those in oral treatment (47%). Our data demonstrate how lung cancer patients are more afraid of their disease than of a world pandemic. Also this interview indirectly highlights the clinician’s major guiding principle in correctly and appropriately managing not just the patient’s expectations of their illness and its treatment, but also and especially of the patient’s fears

Clinical and treatment features associated with improved 5-year survival rate in ALK-positive lung cancer treated with ALK-TKIs

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10Be i molekulska stanja

The 10Be excitation energy spectra have been obtained from the inclusive and coincident measurements of the reactions: 7Li +7Li at E0 = 8 and 30 MeV and 9Be +7Li at E0 = 52 MeV. Contributions of the 10Be states below 12 MeV in excitation have been observed. Decays of the states at 9.6, 10.2 and 11.8 into a +6He and, for the first time, into a +6He* have been found. The results are discussed in addition to the other experimental data and recent theoretical predictions. Proposals for future measurements to search for exotic structures in carbon nuclei are also made.Proučavamo ekscitacijske energijske spektre 10Be iz inkluzivnih i koincidentnih mjerenja reakcija 7Li +7Li na E0 = 8 i 30 MeV, te 9Be +7Li na E0 = 52 MeV. Opaženi su doprinosi stanja 10Be u energiji uzbude do 12 MeV. Nađeni su raspadi stanja na 9.6, 10.2 i 11.8 MeV na α +6He te, po prvi put, na α +6He∗. Ovi se rezultati razmatraju zajedno s ostalim eksperimentalnim podacima i novijim teorijskim predviđanjima. Predlažu se buduća mjerenja u kojima bi se tražila stanja lakih jezgara egzotične građe

Correlation among different KRAS alterations, genetic co-mutations and PD-L1 expression in patients treated with immunotherapy in metastatic NSCLC

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10Be i molekulska stanja

The 10Be excitation energy spectra have been obtained from the inclusive and coincident measurements of the reactions: 7Li +7Li at E0 = 8 and 30 MeV and 9Be +7Li at E0 = 52 MeV. Contributions of the 10Be states below 12 MeV in excitation have been observed. Decays of the states at 9.6, 10.2 and 11.8 into a +6He and, for the first time, into a +6He* have been found. The results are discussed in addition to the other experimental data and recent theoretical predictions. Proposals for future measurements to search for exotic structures in carbon nuclei are also made.Proučavamo ekscitacijske energijske spektre 10Be iz inkluzivnih i koincidentnih mjerenja reakcija 7Li +7Li na E0 = 8 i 30 MeV, te 9Be +7Li na E0 = 52 MeV. Opaženi su doprinosi stanja 10Be u energiji uzbude do 12 MeV. Nađeni su raspadi stanja na 9.6, 10.2 i 11.8 MeV na α +6He te, po prvi put, na α +6He∗. Ovi se rezultati razmatraju zajedno s ostalim eksperimentalnim podacima i novijim teorijskim predviđanjima. Predlažu se buduća mjerenja u kojima bi se tražila stanja lakih jezgara egzotične građe

Results of multilevel containment measures to better protect lung cancer patients from COVID-19. the IEO model

A novel coronavirus causing severe acute respiratory syndrome (SARS), named SARS-CoV-2, was identified at the end of 2019. The spread of coronavirus disease 2019 (COVID-19) has progressively expanded from China, involving several countries throughout the world, leading to the classification of the disease as a pandemic by the World Health Organization (WHO). According to published reports, COVID-19 severity and mortality are higher in elderly patients and those with active comorbidities. In particular, lung cancer patients were reported to be at high risk of pulmonary complications related to SARS-CoV2 infection. Therefore, the management of cancer care during the COVID-19 pandemic is a crucial issue, to which national and international oncology organizations have replied with recommendations concerning patients receiving anticancer treatments, delaying follow-up visits and limiting caregiver admission to the hospitals. In this historical moment, medical oncologists are required to consider the possibility to delay active treatment administration based on a case-by-case risk/benefit evaluation. Potential risks associated with COVID-19 infection should be considered, considering tumor histology and natural course, disease setting, clinical conditions, and disease burden, together with the expected benefit, toxicities (e.g., myelosuppression or interstitial lung disease), and response obtained from the planned or ongoing treatment. In this study, we report the results of proactive measures including social media, telemedicine, and telephone triage for screening patients with lung cancer during the COVID-19 outbreak in the European Institute of Oncology (Milan, Italy). Proactive management and containment measures, applied in a structured and daily way, has significantly aided the identification of advance patients with suspected symptoms related to COVID-19, limiting their admission to our cancer center; we have thus been more able to protect other patients from possible contamination and at the same time guarantee to the suspected patients the immediate treatment and evaluation in referral hospitals for COVID-19

Impact of trans-stent gradient on outcome after PCI: results from a HAWKEYE substudy

To test whether quantitative flow ratio (QFR)-based trans-stent gradient (TSG) is associated with adverse clinical events at follow-up. A post-hoc analysis of the multi-center HAWKEYE study was performed. Vessels post-PCI were divided into four groups (G) as follows: G1: QFR >= 0.90 TSG = 0 (n = 412, 54.8%); G2: QFR >= 0.90, TSG > 0 (n = 216, 28.7%); G3: QFR < 0.90, TSG = 0 (n = 37, 4.9%); G4: QFR < 0.90, TSG > 0 (n = 86, 11.4%). Cox proportional hazards regression model was used to analyze the effect of baseline and prognostic variables. The final reduced model was obtained by backward stepwise variable selection. Receiver operating characteristic (ROC) was plotted and area under the curve (AUC) was calculated and reported. Overall, 449 (59.8%) vessels had a TSG = 0 whereas (40.2%) had TSG > 0. Ten (2.2%) vessel-oriented composite endpoint (VOCE) occurred in vessels with TSG = 0, compared with 43 (14%) in vessels with TSG > 0 (p < 0.01). ROC analysis showed an AUC of 0.74 (95% CI: 0.67 to 0.80; p < 0.001). TSG > 0 was an independent predictor of the VOCE (HR 2.95 [95% CI 1.77-4.91]). The combination of higher TSG and lower final QFR (G4) showed the worst long-term outcome while low TSG and high QFR showed the best outcome (G1) while either high TSG or low QFR (G2, G3) showed intermediate and comparable outcomes. Higher trans-stent gradient was an independent predictor of adverse events and identified a subgroup of patients at higher risk for poor outcomes even when vessel QFR was optimal (> 0.90)