European respiratory review : an official journal of the European Respiratory Society
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Review
Customising chemotherapy in advanced nonsmall cell lung cancer: daily practice and perspectives.
Treating patients with advanced nonsmall cell lung cancer (NSCLC) is a daunting task but during recent years new options have emerged. By tailoring treatment using either information on histological subtypes of NSCLC or biomarkers it is now possible to improve outcome and maintain stable quality of life. We conducted a literature search of tailored treatment already implemented in advanced NSCLC in order to highlight the information required to decide on the optimal oncological treatment for individual patients. 16 studies were identified by literature review. ⋯ Retrospective, unplanned analysis of excision repair cross complementation group 1 (ERCC1) and betatubulin III upregulation demonstrated poorer outcome in NSCLC patients treated with platinum-doublets and vinorelbine-based chemotherapy, respectively. In conclusion, tailoring treatment according to either histological subtype or EGFR mutation status in advanced NSCLC should today be part of daily practice based on current evidence. Future biomarkers need optimisation of methodology and prospective validation before clinical implementation.
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Review Comparative Study
Issues related to the management and therapy of paediatric pulmonary hypertension.
An increasing number of medical services dedicated to the diagnosis, treatment and follow-up of pulmonary hypertension (PH) in children are being established. This has, in turn, increased the need to adapt current guidelines for the treatment of PH to be more relevant to paediatric patients with PH. This article will summarise the data obtained so far from paediatric registries, national cohorts and clinical trials and discuss the best approach for developing a treatment algorithm designed for children with different types of PH. The many unanswered questions, challenges and issues relating to the PH in the paediatric population will also be discussed.
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Pulmonary arterial hypertension (PAH) is a life-threatening complication of systemic sclerosis (SSc). However, PAH-specific treatments are available and can significantly improve survival of patients, especially those diagnosed in World Health Organization (WHO) functional class (FC) II. Registry data have shown that without screening, more than two-thirds of PAH-SSc patients are in WHO FC III or IV when diagnosed. ⋯ Data from bosentan trials have shown that nearly one-quarter of patients in WHO FC III at baseline can attain WHO FC II status with monotherapy. Maintenance of PAH-SSc patients in WHO FC II with monotherapy is unrealistic, and sequential goal-directed combination therapy is now becoming an accepted treatment strategy. It is hoped that earlier diagnosis, coupled both with regular assessments to ensure treatment goals are being met and timely, appropriate treatment, will further improve the survival rates of those PAH-SSc patients.
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Since the introduction of the flexible fibreoptic bronchoscope in the late 1960s there have been relatively few technological advances for three decades, aside from the development of a white light video bronchoscope with a miniature charge-coupled device built in its tip replacing the fibreoptics. White light flexible videobronchoscopy with its ancillary devices (forceps biopsy, bronchial brushing, bronchoalveolar lavage, bronchial washings and transbronchial needle aspiration) has long been the only established diagnostic bronchoscopic technique. With the advances in microtechnology over the past two decades, recent technical developments such as autofluorescence bronchoscopy and endoscopic ultrasound allow better evaluation of endobronchial, mediastinal and parenchymal lesions.