Second line erlotinib therapy in a non-smoking patient with metastatic non-small-cel lung cancer harbouring EGFR mutation

Rak niedrobnokomórkowy płuca (NDRP) najczęściej jest rozpoznawany w stadium miejscowo zaawansowanym lub uogólnionym. Wyniki badań randomizowanych wykazały, że w wybranej grupie pacjentów z uogólnionym NDRP zastosowanie terapii celowanych molekularnie wydłuża czas wolny od progresji choroby w porównaniu z chemioterapią paliatywną, przy korzystniejszym profilu toksyczności oraz lepszej jakość życia chorych. Gefitynib i erlotynib — drobnocząsteczkowe inhibitory kinazy tyrozynowej (TKI) receptora dla naskórkowego czynnika wzrostu (EGFR) mogą być stosowane w praktyce klinicznej w leczeniu pierwszego rzutu u chorych na uogólnionego NDRP z mutacją aktywującą w genie EGFR oraz w kolejnych liniach leczenia po niepowodzeniu co najmniej jednego schematu chemioterapii. Celem pracy jest przedstawienie przypadku wielomiesięcznej terapii erlotynibem prowadzonej u niepalącej pacjentki z uogólnionym NDRP z obecnością mutacji aktywującej w genie EGFR, po niepowodzeniu chemioterapii paliatywnej pierwszej linii.The majority of non small cel lung cancer (NSCLC) patients are diagnosed with locally advanced or metastatic disease. Randomised trials have shown that in a selected group of patients with advanced NSCLC, molecularly targeted therapies prolong the progression-free survival time compared to chemotherapy, with favorable toxicity profile and patients’ better quality of life. Gefitinib and erlotinib — small molecule tyrosine kinase inhibitors (TKI) of epidermal growth factor receptor (EGFR) can be used in clinical practice in the first line treatment of patients with metastatic NSCLC with activating mutation in the EGFR gene, and after failure of at least one prior chemotherapy regimen. We present a case of erlotinib therapy in non-smoking patient diagnosed with metastatic NSCLC with EGFR activating mutation, after first-line palliative chemotherapy failure

Sekwencyjna terapia inhibitorami kinazy tyrozynowej EGFR u niepalącej pacjentki z uogólnionym rakiem niedrobnokomórkowym płuca z obecnością mutacji aktywującej w genie EGFR

Niedrobnokomórkowy rak płuca (NDRP) najczęściej jest rozpoznawany w stadium miejscowo zaawansowanym lub uogólnionym. U około 10–15 % chorych na NDRP rasy kaukaskiej oraz 30–40% rasy żółtej stwierdza się obecność mutacji aktywujących w genie EGFR. W tej grupie pacjentów zastosowanie inhibitorów kinazy tyrozynowej (TKI) związanych z receptorem naskórkowego czynnika wzrostu (EGFR) pierwszej i drugiej generacji wydłuża czas wolny od progresji choroby (PFS) w porównaniu z chemioterapią paliatywną, przy korzystniejszym profilu toksyczności oraz lepszej jakość życia chorych. Jednak średnio po 12 miesiącach terapii rozwija się nabyta oporność na terapie celowane molekularnie, najczęściej uwarunkowana pojawieniem się mutacji oporności T790M. Zastosowanie TKI EGFR trzeciej generacji (ozymertynibu) u pacjentów z obecnością mutacji T790M wydłuża czas wolny od progresji w porównaniu ze standardową chemioterapią dwulekową. W pracy przedstawiono przypadek sekwencyjnego zastosowania terapii TKI u niepalącej chorej na uogólnionego NDRP z obecnością mutacji aktywującej w genie EGFR

Molecular differences in the KRAS gene mutation between a primary tumor and related metastatic sites - case report and a literature review.

In recent years the the set of diagnostic tools in colorectal cancers has been extended by the assessment of the KRAS gene status. Currently it is a necessary step in order to qualify patients for the targeted therapy. The results of the analysis of several studies revealed a high rate of compliance of the KRAS gene mutational status in primary and metastatic tumors. In this paper we present a rare case of incompatibility of the KRAS mutations in the primary tumor located in the colon and metastatic changes in the liver

Molecular differences in the KRAS gene mutation between a primary tumor and related metastatic sites - case report and a literature review.

In recent years the the set of diagnostic tools in colorectal cancers has been extended by the assessment of the KRAS gene status. Currently it is a necessary step in order to qualify patients for the targeted therapy. The results of the analysis of several studies revealed a high rate of compliance of the KRAS gene mutational status in primary and metastatic tumors. In this paper we present a rare case of incompatibility of the KRAS mutations in the primary tumor located in the colon and metastatic changes in the liver

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research