Long-term survival with a combination of immunotherapy, anti-angiogenesis, and traditional radiotherapy in brain metastatic small cell lung cancer: a case report

PurposeBrain metastases (BMs) are common in Small Cell Lung Cancer (SCLC), but the prognosis is very poor. Currently, there is no standard of care on what constitutes optimal treatment, and there is no consensus regarding maintenance therapy in SCLC.Case descriptionWe report the case of a 55-year-old man with advanced SCLC. After the initial diagnosis, he received routine chemotherapy and chest radiotherapy but developed brain metastases with 2 lesions seven months later. We used an effective combination therapy consisting of the antiangiogenic inhibitor, Anlotinib and whole-brain radiotherapy. We then administered anti-PD-L1 immunotherapy Atezolizumab in combination with Anlotinib as long-term maintenance therapy. Twelve months later, there was a progression in one of the brain metastases. The patient underwent further stereotactic radiotherapy (SRT) for the lesion. However, after four months of treatment with SRT, the lesion began to gradually grow in size. The patient underwent surgical resection of the lesion, which confirmed radioactive brain necrosis. After a full 3-year course of anti-PD-L1 therapy, the patient discontinued immunotherapy and was administered only Anlotinib as maintenance. At the time of writing up this report, the patient was alive and the overall survival reached 41 months after the onset of BM.ConclusionThis indicated a potential synergistic effect of combined immunotherapy and antiangiogenic targeted therapy with local radiotherapy in patients with BM-SCLC and can provide directions for future clinical decisions

Tacrolimus-Based versus Cyclosporine-Based Immunosuppression in Hepatitis C Virus-Infected Patients after Liver Transplantation: A Meta-Analysis and Systematic Review

<div><p>Background</p><p>Most liver transplant recipients receive calcineurin inhibitors (CNIs), especially tacrolimus and cyclosporine, as immunosuppressant agents to prevent rejection. A controversy exists as to whether the outcomes of hepatitis C virus (HCV)-infected liver transplant patients differ based on the CNIs used. This meta-analysis compares the clinical outcomes of tacrolimus-based and cyclosporine-based immunosuppression, especially cases of HCV recurrence in liver transplant patients with end-stage liver disease caused by HCV infection.</p><p>Methods</p><p>Related articles were identified from the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, Medline, and Embase. Meta-analyses were performed for the results of homogeneous studies.</p><p>Results</p><p>Nine randomized or quasi-randomized controlled trials were included. The total effect size of mortality (RR = 0.98, 95% CI: 0.77–1.25, <i>P</i> = 0.87) and graft loss (RR = 1.05, 95% CI: 0.83–1.33, <i>P</i> = 0.67) showed no significant difference between the two groups irrespective of duration of immunosuppressant therapy after liver transplantation. In addition, the HCV recurrence-induced mortality (RR = 1.11, 95% CI: 0.66–1.89, <i>P</i> = 0.69), graft loss (RR = 1.62, 95% CI: 0.64–4.07, <i>P</i>  = 0.31) and retransplantation (RR = 1.40, 95% CI: 0.48–4.09, <i>P</i> = 0.54), as well as available biopsies, confirmed that histological HCV recurrences (RR =  0.92, 95% CI: 0.71–1.19, <i>P</i> = 0.51) were similar.</p><p>Conclusion</p><p>These results suggested no difference in posttransplant HCV recurrence-induced mortality, graft loss and retransplantation, as well as histological HCV recurrence in patients treated with tacrolimus-based and cyclosporine-based immunosuppresion.</p></div

Forest plot of histological HCV recurrence included trials comparing tacrolimus-based to cyclosporine-based group.

<p>Forest plot of histological HCV recurrence included trials comparing tacrolimus-based to cyclosporine-based group.</p

Forest plot of mortality comparing tacrolimus-based to cyclosporine-based immunosuppresant group.

<p>Forest plot of mortality comparing tacrolimus-based to cyclosporine-based immunosuppresant group.</p

Forest plot of graft loss comparing tacrolimus-based to cyclosporine-based group.

<p>Forest plot of graft loss comparing tacrolimus-based to cyclosporine-based group.</p

Characteristics of randomized and quasi-randomized trials included in the systematic review.

<p>NS = not stated.</p><p>MMF = mycophenolate mofetil; AZA = azathioprine.</p><p>Characteristics of randomized and quasi-randomized trials included in the systematic review.</p

Forest plot of graft loss due to HCV recurrence comparing tacrolimus-based to cyclosporine-based group.

<p>Forest plot of graft loss due to HCV recurrence comparing tacrolimus-based to cyclosporine-based group.</p