Pooled Analysis of Elderly Patients with Non-small Cell Lung Cancer Treated with Front Line Docetaxel/Gemcitabine Regimen: The Hellenic Oncology Research Group Experience

IntroductionThirty to 40% of patients with non-small cell lung cancer (NSCLC) are older than 70 years and rarely are enrolled in clinical trials. Moreover, in clinical practice, >75% of patients older than 65 years with metastatic NSCLC never receive any kind of chemotherapy.PurposeTo retrospectively evaluate the impact of age on efficacy and toxicity of chemotherapy regimens in patients with advanced NSCLC treated with the docetaxel-gemcitabine combination.Patients and MethodsPooled data from six clinical trials of the Hellenic Oncology Research Group were analyzed. According to their age, patients were divided into two groups: those with age <70 years and those with ≥70 years.ResultsA total of 858 patients were included in this analysis. Six hundred sixty-six (77.6%) patients were younger than 70 years, whereas 192 (22.4%) patients where ≥70-year-old. Overall response rate was 30.3% and 30.2% for patients <70 years and ≥70 years, respectively (p = 0.974). The median time to tumor progression was 4.1 and 4.5 months for patients <70 years and ≥70 years, respectively (p = 0.948). Median overall survival was 9.9 and 9.2 months for patients <70 and ≥70, respectively (p = 0.117). The multivariate analysis revealed performance status (PS) (p = 0.0001) and stage (p = 0.0001) as independent factors with significant impact on the hazard of death. Chemotherapy was well tolerated, but the incidence of grade III/IV mucositis was significantly higher in elderly patients (0.2% versus 1.5% for patients <70 versus ≥70 years, respectively; p = 0.011).ConclusionThe docetaxel/gemcitabine regimen has a comparable efficacy and tolerance in young (<70 years) and elderly (≥70 years) patients

Association between smoking cessation and alterations in forced expiratory volume in one second (FEV1). A Follow-Up Study from a Greek Tobacco Cessation Clinic

Background: Cigarette smoking is the most important preventable cause of several diseases such as malignancies, pulmonary and cardiovascular diseases. Smoking cessation is now supported by both behavioral counseling and medical pharmacotherapy and is the only effective approach for slowing down an accelerated decline in forced expiratory volume in one second (FEV1). Our study aims to examine changes in forced expiratory volume in one second (FEV1) after smoking cessation for smokers attending our smoking cessation clinic their correlation to smokers’ demographic characteristics.Methods: 114 smokers (48 males and 66 females), with a mean age of 48.36±10.49 years, were enrolled. They were classified in 4 groups, according to their age; 60 years (Group D) and underwent Spirometry on the 1st day of visit, one month (2nd visit) and, 3 months later (3rd visit).Findings: Statistically significant increase in FEV1 values at the 2nd and 3rd visit compared to the 1st visit was observed in smokers who quit smoking in Group Α, B and C (p<0.05). In addition, a statistically significant decrease in FEV1 values at the 2nd and 3rd visit compared to the 1st visit was noticed in smokers who continued smoking in Group B, C and D (p<0.05).Conclusion: Smoking cessation achieved through smoking cessation support led to the improvement of FEV1 values within 3 months. The greatest benefit was observed in smokers under the age of 60

Metastasis to the breast from an adenocarcinoma of the lung with extensive micropapillary component: a case report and review of the literature

Breast metastasis from extra-mammary malignancy is rare. Based on the literature an incidence of 0.4-1.3% is reported. The primary malignancies most commonly metastasizing to the breast are leukemia-lymphoma, and malignant melanoma. We present a case of metastasis to the breast from a pulmonary adenocarcinoma, with extensive micropapillary component, diagnosed concomitantly with the primary tumor. A 73-year-old female presented with dyspnea and dry cough of 4 weeks duration and a massive pleural effusion was found on a chest radiograph. Additionally, on physical examination a poorly defined mass was noted in the upper outer quadrant of the left breast. The patient underwent bronchoscopy, excisional breast biopsy and medical thoracoscopy. By cytology, histology and immunohistochemistry primary lung adenocarcinoma with metastasis to the breast and parietal pleura was diagnosed. Both the primary and metastatic anatomic sites demonstrated histologically extensive micropapillary component, which is recently recognized as an important prognostic factor. The patient received chemotherapy but passed away within 7 months. Accurate differentiation of metastatic from primary carcinoma is of crucial importance because the treatment and prognosis differ significantly

Simultaneous Pleural and Pericardial Effusion as First Clinical Manifestations of Giant Cell Arteritis: A Case Report

Giant cell arteritis (GCA) is a chronic granulomatous vasculitis of unknown aetiology occurring in the older patients and affecting mostly the cranial branches of the arteries originating from the aortic arch. GCA is associated with polymyalgia rheumatica (PMR). Clinical features of the disorder include headache, scalp tenderness, jaw claudication, temporal artery abnormalities on physical examination, vision changes, and symptoms associated to PMR. Systemic manifestations include fever, anorexia and weight loss while less rare manifestations are related to the nervous system, the respiratory system, the pericardium and extra-cranial large vessels. Here we report a rare case of simultaneous pleural and pericardial effusion as the first manifestations of GCA. The diagnosis was made with a temporal artery biopsy. Such a diagnosis should, therefore, be considered in older patients presenting with pleuropericardial manifestations, even in the absence of typical clinical features

Neutrophils to Lymphocyte Ratio as a Biomarker in Bronchiectasis Exacerbation: A Retrospective Study

Introduction Bronchiectasis is a disorder resulting mainly from bronchial inflammation caused by recurrent or chronic infections. It is characterized by permanently dilated airways due to bronchial wall destruction. Exacerbations have a key role in bronchiectasis as they are associated with a negative impact on patient prognosis. Exacerbations are generally infectious events caused mostly by bacterial microorganisms. Infective or inflammatory agents cause neutrophil recruitment into the airways, which leads to proteolytic enzymes such as neutrophil elastase and matrix metalloproteinases release, resulting in airway matrix destruction. Neutrophil to lymphocyte ratio (NLR) is used as a biomarker of inflammation. It is calculated by dividing the number of neutrophils by the number of lymphocytes. Our aim is to evaluate Neutrophils to Lymphocyte Ratio in patients with bronchiectasis exacerbation and its correlation to microbiological data. Methods The study involved patients with a diagnosis of bronchiectasis based on high-resolution computerised tomography (HRCT) of the chest who fulfilled the criteria of bronchiectasis exacerbation. Complete blood counts with differential counts, which included total white blood cells, neutrophils and lymphocytes, were obtained. NLR and C-reactive protein (CRP) levels were measured in patients with bronchiectasis exacerbation and in healthy controls. NLR was calculated as the ratio of the neutrophils to lymphocytes. The mean NLR values in patients with bronchiectasis exacerbation were compared to mean NLR values in healthy controls. The NLR values were compared to CRP levels in patients with bronchiectasis exacerbation. Sputum cultures were performed in all patients. The mean NLR values in patients with positive sputum cultures were compared with mean NLR values in patients with negative sputum cultures, and mean NLR values in patients with isolated Pseudomonas aeruginosa in sputum cultures were compared to mean NLR values in patients with other infectious agents isolated. Results The study population consisted of 80 patients with bronchiectasis exacerbation - 54 males and 26 females - with a mean age of 77.3 +/- 8.4 years, and 64 healthy controls - 36 males and 28 females - with a mean age of 62.9 +/- 15.3 years. The mean CRP levels in patients with bronchiectasis exacerbation were 75.03 +/- 73.87 mg/l. The mean NLR value in patients with bronchiectasis exacerbation was 9.2 +/- 7.8 and the mean NLR value of controls was 3.1 +/- 2.9 (p&lt;0.001). The NLR values in patients with bronchiectasis exacerbation had no linear correlation with CRP values in these patients (r=0.002, p=0.992). Fifty-two patients had positive sputum cultures and 28 patients had negative sputum cultures. The mean NLR value in patients with positive sputum cultures was 10.5 +/- 9.1, and in patients with negative sputum cultures, it was 6.7 +/- 3.6 (p&lt;0.012). The mean NLR value in patients with P.aeruginosa was 10.1 +/- 9.5, and in patients with other microorganisms isolated, it was 10.8 +/- 8.9 (p=0.784). Conclusions Neutrophil to lymphocyte ratio values are statistically greater in patients with bronchiectasis exacerbation compared to healthy controls. There is no linear correlation between NLR and CRP in these patients. NLR values are statistically greater in patients with positive sputum cultures compared to those with negative sputum cultures. Therefore, NLR can be used for predicting positive cultures in patients with bronchiectasis exacerbation

Solitary Fibrous Tumor of the Pleura as a Cause of Type II Respiratory Failure.

Solitary fibrous tumor of the pleura is a rare type of tumor originating from the mesenchyma of the pleura. It is traditionally a benign lesion. However, in some cases malignant features have been observed. The majority of solitary fibrous tumors of the pleura are noticed by accident on chest X-ray, while the main symptoms include cough, thoracic pain and dyspnea. When growing within the thoracic cavity, these tumors exert pressure on vital adjacent tissues and large vessels. In addition, these tumors can be accompanied with paraneoplastic syndromes that are completely resolved after tumor resection. Respiratory failure is a rare complication of this tumors, which is reported in a handful of cases. Herein, we report a rare case of a benign solitary fibrous tumors of the pleura in a 75-year-old woman complicated with type II respiratory failure

Firstcase of pneumonia-parapneumonic effusion due to Trichoderma longibrachiatum

Trichoderma longibrachiatum is a fungus belonging to the genus Trichoderma. Trichoderma long-ibrachiatum is not thought as a pathogenic for healthy individuals. However, it has the ability to produce toxic peptides and extracellular proteases and has been described to cause invasive infections in immunocompromised hosts. Trichoderma longibrachiatum has been reported as the causative microorganism of lung infections, skin infections, sinus infections, otitis, stomatitis endocarditis, pericarditis, gastrointestinal infections, mediastinitis and peritonitis. We report the first case of pneumonia with parapneumonic effusion in an old woman with diabetes mellitus due to Trichoderma longibrachiatum. (C) 2021 The Authors. Published by Elsevier Ltd

Pulmonary adverse events due to immune checkpoint inhibitors: A literature review.

Cancer immunotherapy aims to stimulate the immune system to fight against tumors, utilizing the presentation of molecules on the surface of the malignant cells that can be recognized by the antibodies of the immune system. Immune checkpoint inhibitors, a type of cancer immunotherapy, are broadly used in different types of cancer, improving patients&apos; survival and quality of life. However, treatment with these agents causes immune-related toxicities affecting many organs. The most frequent pulmonary adverse event is pneumonitis representing a non-infective inflammation localized to the interstitium and alveoli. Other lung toxicities include airway disease, pulmonary vasculitis, sarcoid-like reactions, infections, pleural effusions, pulmonary nodules, diaphragm myositis and allergic bronchopulmonary aspergillosis. This review aims to summarize these pulmonary adverse events, underlining the significance of an optimal expeditious diagnosis and management

Evaluation of Immature Platelet Fraction in Lower Respiratory Tract Infections: A Retrospective Study

Introduction Immature platelet fraction (IPF) is a parameter of an automated hematologic analyzer and is related to platelet size and cytoplasmic RNA content. It reflects thrombopoiesis and is often used as the marker of platelet activity. IPF has been evaluated mostly in hematologic disorders and has also been evaluated in patients with gestational hypertension, sepsis, autoimmune diseases and in hospitalised patients with neutrophilia. Platelets, asides from the maintenance of hemostasis, release inflammatory mediators that can modify leukocyte and endothelial responses to various inflammatory stimuli. Lower respiratory tract infections are the leading cause of death from infections worldwide. The role of platelets in lower respiratory tract infections has been reported in many studies. IPF, which is related to platelet activation, has not been evaluated in patients with lower respiratory tract infections. Methods The study involved patients who fulfilled the criteria of community-acquired pneumonia (CAP) and aspiration pneumonia (AP). In addition, age and sex-matched healthy controls were involved. Whole blood samples were collected from healthy controls and from the patients on admission. The mean IPF% and C-reactive protein (CRP) levels were measured in patients with CAP, in patients with AP and in healthy controls. The mean IPF% values in patients with infection were compared to mean IPF% values in healthy controls. The mean IPF% values were compared to mean CRP levels in patients with infection. Additionally, the mean IPF% values in patients that died in the first 14 days were compared to the mean IPF% values in patients that were alive. The statistical analysis of data was performed with the Statistical Package for the Social Sciences (SPSS) for Windows, Version 13.0 (SPSS Inc, Chicago, IL). Results The study population consisted of 45 patients (27 patients with CAP and 18 patients with AP), 27 males and 18 females, with a mean age of 72.11 +/- 16.4 years and 39 healthy controls, 22 males and 17 females with a mean age of 64.2 +/- 14.8 years. The mean CRP levels in patients with infection were 155.2 +/- 119.1 mg/dl. The mean IPF% value of patients with infection was 2.76 +/- 2.27 and the mean IPF% value of controls was 1.72 +/- 0.77 (p &lt; 0.006). The IPF% value in patients with CAP was 2.55 +/- 2.02 and in patients with AP 3.07 +/- 2.64 (p = 0.595). The mean IPF% value in patients with infection had no linear correlation with CRP value in these patients (r = 0.076, p = 0.62). The mean IPF% value in all patients that died in the first 14 days was 3.75 +/- 2.44 and the mean IPF% value in all patients alive was 2.35 +/- 2.11 (p = 0.06). The mean IPF% value in patients with CAP who died in the first 14 days of hospitalisation was 5.54 +/- 3.17 and in patients with CAP who were alive was 1.87 +/- 0.72 (p = 0.06). The mean IPF% value in patients with AP who died was 2.63 +/- 0.85 and in patients with AP who were alive was 3.41 +/- 3.51 (p = 0.554). Conclusions Mean IPF% value is greater in patients with lower respiratory tract infections, including CAP and AP, compared to healthy controls. There is no linear correlation between IPF values and CRP values in patients with lower respiratory tract infections. In addition, there is a difference in mean IPF% value between patients who died in the first 14 days of hospitalisation compared to those who were alive, but not statistically significant