L'INTERVENTO DEL FARMACISTA NELL’EDUCAZIONE SANITARIA

Il fenomeno della diffusione delle sostanze di abuso tra i giovani ha assunto aspetti preoccupanti. Lo spaccio di droga avviene in tutte le strutture a cui accedono i giovani, nessuna esclusa e oggi anche nel web, una delle nuove frontiere del traffico illecito. All’interno di questo scenario la figura del farmacista ha dato contributi validi nella divulgazione, per tentare di salvaguardare la salute dei giovani anche attraverso la promozione diretta di campagne di educazione/sensibilizzazione che forniscano all’utente le informazioni necessarie a difendere la propria salute. Materiali e metodi: Abbiamo realizzato due conferenze inerenti l’informazione sulle sostanze di abuso e la nuova diffusione su Internet, presso le Scuole di Cefalù: Liceo Classico Mandralisca, e I.P.S.S.E.O.A Alberghiero. Nel questionario pre-conferenza sono state rivolte domande per indagare su quali fossero le reali conoscenze sulle sostanze di abuso da parte dei ragazzi e delle figure con cui normalmente si relazionano. Per il post-conferenza si puntava a capire,attraverso un altro questionario, se la visione nei confronti delle sostanze di abuso fosse cambiata dopo avere ascoltato i pericoli che si corrono. Risultati: Alla ricerca hanno partecipato 26 maschi di età compresa tra 16-24 anni con una prevalenza di età di 17 e 51 femmine di età compresa tra 16-20 anni con prevalenza di 17-18 anni. In pre-conferenza il 95% ha risposto negativamente alla domanda se ritenessero di avere una buona conoscenza sulle sostanze di abuso. Al quesito se avessero assunto sostanze di abuso, hanno risposto tutti no, tranne un ragazzo che però non ha specificato quale sostanza. Per quanto riguarda il post conferenza è stato chiesto se ritenessero positiva l’esperienza, hanno risposto tutti di si .Alla domanda se avessero adesso una maggiore conoscenza delle sostanze e dei loro pericoli, hanno risposto tutti di si, aggiungendo di essere più spaventati, dopo l’ascolto, all’idea di provarle. Conclusioni: Questo fa capire come i ragazzi agiscano da soli, cercando autonomamente informazioni su internet, proprio perché quasi sempre nessuno affronta con loro questi argomenti. Le differenze tra pre/post-conferenza, il 95% era all’oscuro sugli effetti delle droghe, sottolineano quanto sia importante la divulgazione della conoscenza in materia di sostanze d’abuso attraverso l’intervento del farmacista anello di congiunzione diretta con il cittadino verso una corretta educazione sanitaria. Questo sottolinea l’importanza della prevenzione sotto forma di informazione, specie se portata agli adolescenti, oggi sempre più vittime di falsi miti e della nuova frontiera dell’illegalità che si chiama Internet

Reliability of programmed death ligand 1 (PD-L1) tumor proportion score (TPS) on cytological smears in advanced non-small cell lung cancer: a prospective validation study

Introduction: Programmed death-ligand 1 (PD-L1) immunohistochemistry (IHC) assessment is mandatory for the single agent pembrolizumab treatment of patients with advanced non-small cell lung cancer (NSCLC). PD-L1 testing has been validated and is currently certified only on formalin-fixed paraffin-embedded materials but not on cytological smears. Unfortunately, a significant proportion of patients, having only cytological material available, cannot be tested for PD-L1 and treated with pembrolizumab. In this study, we aimed to validate PD-L1 IHC on cytological smears prospectively by comparing clone SP263 staining in 150 paired histological samples and cytological smears of NSCLC patients. Methods: We prospectively enrolled 150 consecutive advanced NSCLC patients. The clone SP263 was selected as, in a previous study of our group, it showed higher accuracy compared with clones 28-8 and 22-C3, with good cyto-histological agreement using a cut-off of 50%. For cyto-histological concordance, we calculated the kappa coefficient using two different cut-offs according to the percentage of PD-L1 positive neoplastic cells (<1%, 1–49% and ⩾50%; <50%, ⩾50%). Results: The overall agreement between histological samples and cytological smears was moderate (kappa = 0.537). However, when the cyto-histological concordance was calculated using the cut-off of 50%, the agreement was good (kappa = 0.740). With the same cut-off, and assuming as gold-standard the results on formalin-fixed paraffin-embedded materials, PD-L1 evaluation on smears showed specificity and negative predictive values of 98.1% and 93.9%, respectively. Conclusion: Cytological smears can be used in routine clinical practice for PD-L1 assessment with a cut-off of 50%, expanding the potential pool of NSCLC patients as candidates for first-line single agent pembrolizumab therapy

Phase 2 study of NAB-paclitaxel in SensiTivE and refractory relapsed small cell lung cancer (SCLC) (NABSTER TRIAL)

Background: Despite sensitivity to first-line chemotherapy, most small-cell lung cancer (SCLC) patients relapse. In this setting, topotecan demonstrated modest activity with significant toxicity. Paclitaxel was also active. This study was designed to evaluate activity and safety of nab-paclitaxel in relapsed SCLC. Methods: In this multicentre prospective Phase 2 trial, patients with refractory or sensitive SCLC progressed to first-line platinum-based chemotherapy received nab-paclitaxel 100 mg/smq on days 1, 8, 15 every 4 weeks up to six cycles, progressive disease or intolerable toxicity. Primary endpoint was investigator-assessed objective tumour response. Secondary endpoints were toxicity, progression-free survival (PFS) and overall survival (OS). Results: Of the 68 patients treated, partial response was 8% in the refractory cohort and 14% in the sensitive cohort. Most common toxicities of any grade were fatigue (54%), anaemia (38%), neutropenia (29%), leukopenia (26%) and diarrhoea (21%). Median PFS was similar in both refractory (1.8 months) and sensitive cohorts (1.9 months), while median OS was longer in sensitive one (6.6 versus 3.6 months). Conclusions: Although nab-paclitaxel has shown some modest anti-tumour activity in relapsed SCLC, associated with a favourable toxicity profile, the primary end-point of the study was not met. Clinical Trial registration: Clinical Trial registration number is ClinicalTrials.gov Identifier: NCT03219762

Minimally invasive mitral valve surgery: a systematic review.

In the recent years minimally invasive mitral valve surgery (MIMVS) has become a well-established and increasingly used option for managing patients with a mitral valve pathology. Nonetheless, whether the purported benefits of MIMVS translate into clinically important outcomes remains controversial. Therefore, in this paper we provide an overview of MIMVS and discuss results, morbidity, mortality, and quality of life following mitral minimally invasive procedures. MIMVS has been proven to be a feasible alternative to the conventional full sternotomy approach with low perioperative morbidity and short-term mortality. Reported benefits of MIMVS include also decreased postoperative pain, improved postoperative respiratory function, reduced surgical trauma, and greater patient satisfaction. Finally, compared to standard surgery, MIMVS demonstrated comparable efficacy across a range of long-term efficacy measures such as freedom from reoperation and long-term survival

KRAS and ERBB-family genetic alterations affect response to PD-1 inhibitors in metastatic nonsquamous NSCLC

Background: Programmed cell death 1 (PD-1) and PD-ligand 1 (PD-L1) inhibitors represent novel therapeutic options for advanced non-small cell lung cancer (NSCLC). However, approximately 50% of patients do not benefit from therapy and experience rapid disease progression. PD-L1 expression is the only approved biomarker of benefit to anti-PD-1/PD-L1 therapy. However, its weakness has been evidenced in many studies. More recently, tumor mutational burden (TMB) has proved to be a suitable biomarker, but its calculation is difficult to obtain for all patients. Methods: We tested specific NSCLC genetic alterations as potential immunotherapy biomarkers. Tumor DNA was obtained from advanced NSCLC patients treated with anti-PD-1 monoclonal antibody nivolumab (n = 44) or pembrolizumab (n = 3). The mutational status of 22 genes was assessed by targeted next-generation sequencing and the association with survival was tested in uni- and multivariate models. The association between gene mutations and clinical benefit was also investigated. Results: The most frequently mutated genes were TP53 (49%), KRAS (43%), ERBB2 (13%), SMAD4 (13%), DDR2 (13%), STK11 (9%), ERBB4 (6%), EGFR (6%), BRAF (6%), and MET (6%). We confirmed that KRASmut patients have a better response to PD-1 inhibitors, showing a longer progression-free survival (PFS) and overall survival (OS) than KRASwt patients. In addition, we observed that patients with ERBB-family mutations, including EGFR, ERBB2, and ERBB4 all failed to respond to PD-1 antibodies, independently of KRAS status. Conclusions: This study suggests that the analysis of KRAS and ERBB-family gene mutational status is valuable when assessing the clinical practice for the selection of NSCLC patients to treat with PD-1 inhibitors

p 53 abnormal expression might influence global outcome through egfr modulation in ras braf wild type metastatic colorectal cancer patients receiving later line irinotecan cetuximab

n/

PD-L1 SNPs as biomarkers to define benefit in patients with advanced NSCLC treated with immune checkpoint inhibitors

Objective: To investigate the role of CTLA-4, PD-1 (programmed death-1), and PD-L1 (programmed death-ligand 1) single nucleotide polymorphisms (SNPs) in predicting clinical outcome of patients with advanced non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs). Methods: A total of 166 consecutive patients were included. We correlated SNPs with clinical benefit, progression-free survival, time to treatment failure, and overall survival and evaluated the incidence of SNPs in nonresponder and long clinical benefit groups. Results: Considering the entire cohort, no correlation was found between SNPs and clinical outcome; however, PD-L1 rs4143815 SNP and the long clinical benefit group showed a statistically significant association (p = 0.02). The nonresponder cohort displayed distinctive PD-L1 haplotype (p = 0.05). Conclusion: PD-L1 SNPs seem to be marginally involved in predicting clinical outcome of NSCLC treated with ICI, but further investigations are required