EGFR mutation subtypes and response to immune checkpoint blockade treatment in non-small-cell lung cancer.

BACKGROUND: Although EGFR mutant tumors exhibit low response rates to immune checkpoint blockade overall, some EGFR mutant tumors do respond to these therapies; however, there is a lack of understanding of the characteristics of EGFR mutant lung tumors responsive to immune checkpoint blockade. PATIENTS AND METHODS: We retrospectively analyzed de-identified clinical and molecular data on 171 cases of EGFR mutant lung tumors treated with immune checkpoint inhibitors from the Yale Cancer Center, Memorial Sloan Kettering Cancer Center, University of California Los Angeles, and Dana Farber Cancer Institute. A separate cohort of 383 EGFR mutant lung cancer cases with sequencing data available from the Yale Cancer Center, Memorial Sloan Kettering Cancer Center, and The Cancer Genome Atlas was compiled to assess the relationship between tumor mutation burden and specific EGFR alterations. RESULTS: Compared with 212 EGFR wild-type lung cancers, outcomes with programmed cell death 1 or programmed death-ligand 1 (PD-(L)1) blockade were worse in patients with lung tumors harboring alterations in exon 19 of EGFR (EGFRΔ19) but similar for EGFRL858R lung tumors. EGFRT790M status and PD-L1 expression did not impact response or survival outcomes to immune checkpoint blockade. PD-L1 expression was similar across EGFR alleles. Lung tumors with EGFRΔ19 alterations harbored a lower tumor mutation burden compared with EGFRL858R lung tumors despite similar smoking history. CONCLUSIONS: EGFR mutant tumors have generally low response to immune checkpoint inhibitors, but outcomes vary by allele. Understanding the heterogeneity of EGFR mutant tumors may be informative for establishing the benefits and uses of PD-(L)1 therapies for patients with this disease.

Adult day care centres in British Columbia: client characteristics, reasons for referral and reasons for non-attendance.

This paper discusses a 1989 study of new admissions to 22 adult day care centres in British Columbia and compares it to similar studies in the U.S. The B.C. study investigated clients' characteristics, reasons for referral to the centres, and why some referrals did not attend. Of the new admissions, 63% were female and 30% lived alone. Compared to those in American studies, B.C. clients were older and more likely to live with a spouse. The primary medical conditions of B.C. clients were related to diseases of the circulatory system. As for daily activities, 58% could not bathe without supervision and 43% required assistance with dressing. Some 37% were unable to prepare their own meals; 31% needed help with housekeeping and 62% with shopping. The proportion of clients with mental diseases (38%) was similar to that in American adult day care centres. The three most common reasons for referring clients to adult day care centres were: to assist those who were socially isolated; to give family caregivers some respite; and to give clients emotional help. Perceptions varied as to why referred clients did not attend: for continuing care staff there were psychosocial factors; for adult day care staff it was related to characteristics of the service delivery system; and clients themselves cited functional, physical and operational factors (e.g., problems related to hearing and vision, transportation or physical barriers).

Adult Day Care centres in British Columbia: models, characteristics and services.

Adult Day Care (ADC) is increasingly being recognized as an important sub-system of the continuing care system. This paper reviews models developed in the United States and Britain and compares them, and the services they offer, with centres in British Columbia, Canada. Data on British Columbia are from a study in which all 49 centres in the province provided detailed information about their staffing, operating characteristics, activities and services. The study found B.C. compared favourably in providing services needed by ADC clients. Key differences between the B.C. centres and those in the U.S. and U.K. were: a larger proportion of B.C. centres were not affiliated with any other organization; B.C. centres admitted a range of clients and were less likely to cater exclusively to special needs groups; and, B.C. centres were more likely than centres in the U.S. to provide a number of services such as: dental care, transportation, bathing and physiotherapy.