Prognostic and Predictive Value of PD-L1 in Patients with Lung Cancer

Improved understanding of the molecular mechanisms has led to identification of checkpoint signalling and development of checkpoint inhibitors in the treatment of many cancers, including lung cancer. To be able to select the patients who benefit most from checkpoint inhibitors, predictive biomarkers are needed. Currently, the only predictive biomarker that has been approved in clinical use is PD-L1, the ligand of the inhibitory T-cell checkpoint PD-1. The use of PD-L1 as a predictive biomarker is confounded by multiple unresolved issues, from testing issues (e.g., cut-off values for positivity) to clinical use (e.g., the response to anti–PD-1 and anti–PD-L1 antibodies in patients without any expression of PD-L1). Even more open questions exist in the evaluation of PD-L1 as a prognostic biomarker. In the future, we expect that an improved understanding of immune system, tumor microenvironment, mechanism of action of immunotherapeutic drugs, and PD-L1 testing methods will elucidate the value of PD-L1 as a prognostic and predictive biomarker in detail

Obravnava težkega dihanja pri bolnikih v zadnjih dneh življenja

Dyspnoea is a distressing symptom frequently present in patients with incurable diseases. The goal of treatment for patients in the terminal stage is symptom control. Unfortunately, optimal treatment of dyspnoea has not been achieved in all patients yet. Frequent mistakes include unnecessary diagnostic procedures and suboptimal symptom control. In this review, the definition of dyspnoea is presented, followed by etiologic and epidemiologic data and pharmacological and non-pharmacological measures for relief. At the end, two more symptoms are presented; terminal rattle and massive pulmonary haemorrhagia.Občutek težkega dihanja (dispneja) je pogost simptom v zadnjih dneh življenja. Bolnik je zaradi dispneje zelo prizadet in velikokrat prestrašen. Ključno je, da ob takem bolniku ukrepamo hitro in pravilno. Pogoste napake so pretirana uporaba nepotrebnih diagnostičnih metod in neustrezno lajšanje simptomov. V prispevku prikazujemo obravnavo bolnika z dispnejo v terminalni fazi bolezni, ko vzročno zdravljenje ni več mogoče in je v ospredju lajšanje težav. Definiciji dispneje sledijo patofiziološka razlaga in praktični nasveti za uporabo farmakoloških in nefarmakoloških ukrepov. Na koncu so opisani ukrepi pri terminalnem hropenju in akutni obsežni krvavitvi iz dihal

Alleviating symptomatic heavy breathing in terminal patients

Občutek težkega dihanja (dispneja) je pogost simptom v zadnjih dneh življenja. Bolnik je zaradi dispneje zelo prizadet in velikokrat prestrašen. Ključno je, da ob takem bolniku ukrepamo hitro in pravilno. Pogoste napake so pretirana uporaba nepotrebnih diagnostičnih metod in neustrezno lajšanje simptomov. V prispevku prikazujemo obravnavo bolnika z dispnejo v terminalni fazi bolezni, ko vzročno zdravljenje ni več mogoče in je v ospredju lajšanje težav. Definiciji dispneje sledijo patofiziološka razlaga in praktični nasveti za uporabo farmakoloških in nefarmakoloških ukrepov. Na koncu so opisani ukrepi pri terminalnem hropenju in akutni obsežni krvavitvi iz dihal.Dyspnoea is a distressing symptom frequently present in patients with incurable diseases. The goal of treatment for patients in the terminal stage is symptom control. Unfortunately, optimal treatment of dyspnoea has not been achieved in all patients yet. Frequent mistakes include unnecessary diagnostic procedures and suboptimal symptom control. In this review, the definition of dyspnoea is presented, followed by etiologic and epidemiologic data and pharmacological and non-pharmacological measures for relief. At the end, two more symptoms are presentedterminal rattle and massive pulmonary haemorrhagia

Pljučni rak kot poklicna in socialna bolezen

Apart from clear association with tobacco, other factors of importance for prevention, early diagnosis and treatment of lung cancer have been offered little attention. We here present a case-control study focusing on social class and comparing lung cancer patients with those with large bowel cancer. A written questionnaire was completed by 248 consecutive patients with lung cancer and 244 patients with large bowel cancer. Both groups were comparable according to gender and age distribution. Data on place of birth, education, smoking history, diet and alcohol intake, body weight and height, profession, housing conditions and family income were analysed. As expected, there were significant differences between the two groups regarding smoking status. Patients with lung cancer had a significantly higher proportion of immigrants. The proportion of patients working as industrial workers or in other polluted working environment was also significantly higher among lung cancer patients, as compared to large bowel patients. This survey confirms that lung cancer is often a disease of low social class and points to polluted working environment as a co-factor in the etiology of the disease.Če izvzamemo jasno povezavo s kajenjem, so drugim dejavnikom, ki so pomembni za preventivo, diagnostiko in zdravljenje pljučnega raka, doslej namenjali malo pozornosti. Predstavljamo raziskavo, ki se je osredotočila na socialni položaj bolnikov. Anketo je izpolnilo 248 zaporednih bolnikov s pljučnim rakom, ki smo jih primerjali s kontrolno skupino 244 bolnikov z rakom debelega črevesa. Obe skupini sta bili primerljivi po spolu in starosti. Anketa je zajela podatke o rojstnem kraju, izobrazbi, kajenju, prehranjevalnih navadah, telesni teži in višini, poklicu, bivalnih razmerah in družinskih prihodkih. Kot smo lahko pričakovali, je bilo v skupini s pljučnim rakom značilno več sedanjih ali bivših kadilcev. Prav tako je bilo med bolniki s pljučnim rakom v primerjavi z rakom debelega črevesa statistično značilno več priseljencev iz drugih delov nekdanje Jugoslavije ter značilno večji odstotek delavcev v »umazanih«1 poklicih, še posebno pri obdelavi kovin. Študija potrjuje, da je pljučni rak pogostejši pri osebah iz nižjih socialnih slojev, in kaže, da je onesnaženo delovno okolje dejavnik, ki ob kajenju dodatno prispeva k nastanku bolezni