Efficacy and safety of sorafenib plus hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma.

BACKGROUND: Sorafenib is the standard treatment for patients with advanced HCC with improvement in survival and radiologic progression of the disease. Recently, few studies have advocated the Sorafenib + HAIC combination therapy results in better overall survival and progression-free survival than Sorafenib monotherapy in patients with advanced HCC. Herein, we aim to identify the best possible treatment option among the above two lines of therapy for patients with advanced HCC. METHODS: The fixed effects and a random-effects model were used to perform a meta-analysis for overall response rate overall survival, and adverse events. Subgroup analysis of the data of univariate analysis in each included trial was performed to identify the specific patient population who could be benefitted from the combination therapy. RESULTS: Four RCTs containing 609 patients were included in the final analysis. The overall response rate (OR: 3.81; 95% CI 1.01 to 14.42; P = 0.05) and overall survival (HR: 0.70; 95% CI 0.40 to 1.24; P > 0.05) were comparable. Subgroup analysis of OS showed that patients with Child-Pugh score B (HR: 0.30; 95% CI 0.13 to 0.72; P < 0.05) and AFP <400 ng/ml (HR: 0.72; 95% CI 0.52 to 0.99; P < 0.05) were associated with significantly improved survival in the Sorafenib + HAIC group. Bone marrow suppression (OR: 3.76; 95% CI 2.58 to 5.48; P < 0.001) was significantly higher in the Sorafenib + HAIC group, but hepatic function impairment, constitutional symptoms, gastrointestinal events, and dermatological events were comparable (p > 0.05). CONCLUSIONS: Patients with Child-Pugh score B and AFP <400 ng/ml may be benefited most from Sorafenib + HAIC combination therapy.

Predictors of obesity hypoventilation syndrome among patients with sleep-disordered breathing in India.

INTRODUCTION: No study has been done in India to evaluate obesity hypoventilation syndrome (OHS) among patients with sleep-disordered breathing (SDB). The known predictors of OHS, i.e., body mass index (BMI) >35 kg/m2 and forced vital capacity (FVC) <3.5 L for men and <2.3 L for women from western countries, cannot be applied to Indian patients. OBJECTIVES: To find out the prevalence of OHS and to determine the predictors of OHS among Indian SDB patients. MATERIALS AND METHODS: It was a retrospective observational study conducted in a tertiary care institute from September 1, 2017, to August 31, 2018. All the patients who underwent polysomnography were analyzed for the presence of OHS. Of 85 patients referred for polysomnography, 76 had SDB. Thirteen patients were excluded because of hypoventilation due to other known causes or could not perform spirometry. RESULTS: The prevalence of OHS among SDB after excluding the other causes of hypoventilation was 15.87% (10/63). The predictors were determined using univariate analysis between daytime partial pressure of carbon dioxide (PaCO2) and other predictors. PaCO2 significantly correlated with minimum nocturnal oxygen saturation by pulse oximetry (SpO2), FVC %predicted, BMI, daytime SpO2, forced expiratory volume %predicted, and partial pressure of oxygen (PaO2). Following a stepwise multiple regression, minimum nocturnal SpO2, FVC %predicted, and BMI were found to be independent predictors of OHS. A minimum nocturnal SpO2 threshold of 60%, FVC %predicted <74.5%, BMI >30.95 kg/m2, and absolute FVC <2.33 L for men and <1.68 L for women were found to be predictors of OHS. CONCLUSION: The prevalence of OHS in Indian patients is similar to Caucasians. OHS is seen in Indian patients even at a lower BMI and lower spirometric parameters.

A "triple whammy" in adenocarcinoma lung.

Osimertinib (AZD9291), a third-generation epidermal growth factor receptor (EGFR)-tyrosine-kinase inhibitor (TKI), is useful in the treatment of non-small cell lung cancer who show resistance to first-generation EGFR-TKIs and harbor T790M mutation. Acquisition of resistance to osimertinib due to several mechanisms has been reported. We report the first case of an Indian patient with osimertinib resistance, due to C797S mutation. A 52-year-old nonsmoker man was detected to have metastatic lung adenocarcinoma (Stage IV) with EGFR exon 19 deletion and treated with erlotinib. After 12 months of response with erlotinib, he developed resistance because of the development of T790M mutation. He was started on osimertinib, with which he responded for 20 months. A follow-up positron emission tomography scan showed progressive disease. Subsequent liquid biopsy did not detect any mutation. However, rebiopsy of the lung lesion showed additional C797S mutation (in cis association with T790M). Hence, the patient was diagnosed to have "triple whammy," i.e., triple mutation of exon 19 deletion, T790M, and C797S mutations.

An interesting case of incidental solitary pulmonary nodule.

Doubling time, clinical prediction models of malignancy and positive bronchus sign are useful in stepwise evaluation of SPN to avoid thoracotomy. GeneXpert can be used as initial diagnostic test for tuberculosis and detection of rifampicin resistance. http://ow.ly/N37030mB8Fi.