Thorac Cancer
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Immune checkpoint inhibitors (ICIs) have revolutionized the clinical treatment of multiple cancers. Recent studies revealed the potential prognostic value of the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in patients receiving ICIs; however, the results were inconsistent. We conducted a meta-analysis to identify the prognostic significance of baseline NLR and PLR in cancer patients treated with ICIs. ⋯ These results indicate that high pretreatment NLR but not PLR level, as a routinely obtained hematological parameter, is a potential prognostic predictor for poor PFS and OS in cancer patients receiving ICIs.
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The combination of PD-1 inhibitors and cytotoxic drugs is reported to enhance anti-tumor activity in non-small cell lung cancer; however, the underlying synergistic mechanisms remain uncertain. This retrospective case series was designed to investigate objective response and survival rates of salvage chemotherapy following nivolumab and explore the immunohistochemical profiles of tumor-infiltrating immune cells. ⋯ Salvage chemotherapy following nivolumab improved anti-tumor activity regardless of tumor PD-L1 status, but nivolumab following chemotherapy did not. The presence of few PD-1+ tumor-infiltrating immune cells may serve as a potential predictor of response to salvage chemotherapy. Further studies involving a large cohort are needed to clarify how nivolumab re-sensitizes the tumor immune microenvironment to chemotherapy.
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Case Reports
Alectinib treatment response in lung adenocarcinoma patient with novel EML4-ALK variant.
Common gene fusion of the ALK gene is fusion of the ALK tyrosine kinase area and the 5'end of EML4. Seventeen EML4-ALK fusion variants have been reported. ⋯ This is the first case of EML4-ALK (E19: A20) fusion to be reported. Alectinib may show unsatisfactory therapeutic effects for this kind of ALK fusion.
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In early-stage lung adenocarcinomas, spread through air spaces (STAS) are reported to be a prognostic factor in patients who have undergone sublobar resection, but not lobectomy. In contrast, reports have also shown that STAS is significantly associated with poor survival outcomes after lobectomy, but not after limited resection. Thus, the prognostic impact of STAS differs according to published reports. ⋯ STAS was predictive of poor postoperative survival in patients with early-stage adenocarcinomas treated with limited resection and was associated with surgical margin recurrence.