Pembrolizumab as first-line treatment for advanced NSCLC in older adults: A phase II clinical trial evaluating geriatric and quality-of-life outcomes.

OBJECTIVES: Since specific data on immunotherapy in older adults with advanced non-small cell lung cancer (aNSCLC) are scarce, we designed this study to determine the overall survival (OS) at one year of first-line pembrolizumab in patients older than 70 years with aNSCLC expressing PD-L1. Secondary objectives included progression-free survival, disease-specific survival, response rate, tolerability, quality of life (QoL) changes, and geriatric assessments. MATERIALS AND METHODS: A single-arm, open-label, phase II clinical trial was carried out by the Spanish Lung Cancer Group between February 2018 and November 2019 at ten active sites in Spain. We included patients 70 years old and older with histological or cytological documented stage IIIB or IV aNSCLC and PD-L1 expression ≥ 1%. Each subject received 200 mg of intravenous pembrolizumab every three weeks for a maximum of two years. RESULTS: 83 patients were recruited for the study and 74 were finally analysed. Most were male (N = 64, 86.5%) and former smokers (N = 51, 68.9%). 24 patients (32.4%) completed at least one year of treatment, 62 (83.7%) discontinued treatment, and 30 (40.5%) experienced disease progression. The median follow-up of our cohort was 18.0 months [range: 0.1-47.7] and 46 patients (62.2%) died during the period of study. The estimated OS at one year was 61.7% (95% CI: 49.6-71.8%) and the median OS of our cohort was 19.2 months (95% CI: 11.3-25.5). QoL tended to improve throughout the study, although the differences were not statistically significant. The main geriatric scores remained stable, except for a worsening in nutritional status (P = 0.004) and an improvement in frailty (P = 0.028). CONCLUSION: Our results support treating older adults with aNSCLC expressing PD-L1 with pembrolizumab in monotherapy. The stability of most geriatric scores and the positive trend on the patients' QoL should be highlighted, although our results did not reach statistical significance.

Chronic hypercapnic respiratory failure and non-invasive ventilation in people with chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) should no longer be seen as a condition for which little can be done. Novel pharmacotherapeutic interventions, surgical and procedural advances, and respiratory assist devices have provided numerous ways to help patients with COPD and treatable traits. For nearly 30 years, non-invasive ventilation, the application of positive pressure through a mask interface placed outside of the airway, has been the cornerstone for treatment of acute hypercapnic respiratory failure due to COPD exacerbation. Clinical trials indicate that this intervention could benefit patients with COPD and chronic hypercapnic respiratory failure in a stable state. This narrative review aims to provide the necessary background for internists to consider this therapeutic option for their COPD patients. We discuss the mechanism of action and implementation, and provide a glimpse into the future of this promising intervention.

[What should be done and not done throughout the process of dementia? Dialogue and aid]. / ¿Qué hacer y qué no a lo largo del proceso demencial? Diálogo y ayuda.

Because dementia is a powerful predictor of dependence, people with this disease are those that live longest with disability. Dementia is the chronic disease provoking the greatest dependence at 12, 24, and 36 months after diagnosis, ahead of other diseases such as stroke, Parkinson's disease and cardiovascular disease. Many of us are aware of the devastating consequences of dementia, but few know how to recognize the symptoms in the initial phases. To rectify this situation, increased public information and training for health professionals is required. To improve the care of the distinct phases of dementia, progress must be made in three areas: dementia must be considered a public health priority, the erroneous belief that nothing can be done for patients with a diagnosis of dementia must be combatted and, finally, no less importantly, knowledge of how to recognize incipient dementia must be acquired. People with dementia less frequently receive palliative care than patients with cancer, despite clearly sharing the need for care in the advances stages of the disease and frequent requests by relatives and carers. In summary, action can be taken to improve the early diagnosis of dementia and the care of the distinct phases of the disease, thus delaying and/or minimizing dependency. Finally, comfort measures at the end stage can be improved.