A Case of Non-Small Cell Lung Cancer with Possible “Disease Flare” on Nivolumab Treatment

Background. Recent clinical trials proven the clinically significant efficacy and tolerability of nivolumab, a programmed death 1 (PD-1) inhibitor, in previously treated patients with non-small cell lung cancer (NSCLC). Case Presentation. Here, we describe the case of a patient who experienced possible “disease flare” immediately after initiation of nivolumab treatment. A 54-year-old man was diagnosed with Stage IIB (T2N1M0) lung adenocarcinoma. After 7 years from recurrence, 10th line chemotherapy, nivolumab, was initiated. Six weeks later, after 3 cycles of nivolumab treatment, rapid lung cancer progression was observed with an increase in the size of the primary lesion, multiple novel nodules on both lungs, and multiple novel brain metastases. Conclusion. We believe that physicians should be made aware that, in a subset of NSCLC patients, disease flare might occur on nivolumab treatment

(-)-Epigallocatechin-3-gallate Inhibits Differentiation and Matrix Metalloproteinases Expression in Osteoclasts

The osteoclast is a multinucleated giant cell differentiated from monocyte macrophages that has an important role in bone resorption. Several studies have reported a relationship between tea consumption and decreased risk of bone fracture. Matrix metalloproteinases (MMPs) play an important role in the degeneration of bone and cartilage matrix. Regulation of osteoclast activity is essential in the treatment of bone disease. Moreover, MMPs are associated with osteoclast formation and differentiation. We have reported previously that (-) -epigallocatechin-3-gallate (EGCG) inhibits MMP-2 and MMP-9 expression and activity. However, the effects of EGCG on osteoclasts and other MMPs are not clear. Therefore, in the present study we examined whether EGCG affects MMP expression, as well as osteoclast formation, differentiation and activity, in vitro. We used bone marrow cells from the femur and tibial bones of male ddY mice. Bone marrow cells were cultured in the presence of 1-100µM EGCG for 6 or 8 days. EGCG decreased the number of mature osteoclasts, as determined by tartrate-resistant acid phosphatase staining. Concentrations as low as 1µM EGCG clearly inhibited the differentiation of osteoclasts from bone marrow cells. EGCG also inhibited the number of osteoclasts with an actin-ring, as determined by rhodamine phalloidin staining, as well as osteoclast activity, as determined by the pit formation assay. Furthermore, EGCG concentration-dependently decreased MMP-9 and membrane type 1-MMP mRNA expression in mouse osteoclasts. However, EGCG had no changing on mRNA levels of tissue inhibitor of metalloprotease (TIMP)-1 and TIMP-3. Together, the results suggest that EGCG may be a suitable agent or lead compound for the development of treatments for bone resorption diseases associated with MMPs

Clinical utility of blood neutrophil-lymphocyte ratio in Japanese COPD patients

Abstract Background Neutrophil-to-lymphocyte ratio (NLR) is a biomarker of inflammation in chronic obstructive pulmonary disease (COPD) patients. But, a meaningful threshold and the longitudinal changes are unknown. We aimed to investigate the association between NLR and the clinical characteristics of COPD patients and to determine a meaningful threshold and the longitudinal changes for NLR. Methods Keio University and its affiliate hospitals conducted an observational COPD cohort study over 3 years. We performed a blood examination and a pulmonary function test. Blood examination was completed at baseline and annually thereafter, at a time when the disease was stable. Two hundred seventy-four patients who had at least 3 blood examinations over 3 years were included. Results Baseline NLR was correlated with baseline C-reactive protein (CRP) (r = 0.18, p = 0.003) and SAA (r = 0.34, p <  0.001). We defined an NLR score of 2.7 as the arbitrary cut-off value based on upper quartile points. COPD patients with NLR ≥ 2.7 were older (p = 0.037), had a lower BMI (p = 0.005) and a lower %FEV1 (p = 0.0003) compared to patients with NLR < 2.7. Receiver-operating-characteristic (ROC) curves showed the optimal cutoff for the baseline NLR in the predicting moderate/severe exacerbation to be 2.7, which was same as the upper quartile points. Follow-up analysis over 3 years revealed that the differences in the trends of NLR among the three groups based on the categories of exacerbations (moderate or severe, mild, no exacerbation) were significant (p = 0.006). Conclusions NLR is associated with COPD severity and exacerbations. For predicting exacerbations, we estimated the threshold of NLR to be 2.7 at baseline. Trial registration Clinical trial registered with the University Hospital Medication Information Network (UMIN000003470, April 10, 2010)