RESUMEN
Checkpoint inhibitors (CIs) are now standard of care for late-stage non-small-cell lung cancer (NSCLC); however, only a minority of patients treated with a CI show clinical benefit compared to platinum-based chemotherapy alone, regardless of programmed cell death ligand 1 (PD-L1) expression levels. We describe a case of durable tumor response and disease stabilization in a patient with advanced pretreated squamous NSCLC given a maintenance treatment comprised of nivolumab, docetaxel, and ramucirumab combined with the allogeneic cellular cancer vaccine viagenpumatucel-L over a period of 28 months. Our case suggests that combination strategies that serve to sensitize tumors to checkpoint inhibition, even in patients refractory to available treatment, may lead to improved efficacy.
RESUMEN
Warfarin, an antagonist of vitamin K, which inhibits clotting factor synthesis, is prescribed for thrombosis prophylaxis and treatment and is known to have a narrow therapeutic range. Pitavastatin is a potent HMG-CoA reductase inhibitor. In this study, the influence of multiple-dose pitavastatin (4 mg once daily) on steady-state warfarin pharmacodynamic and pharmacokinetic profiles was investigated in 24 healthy male participants whose international normalized ratio (INR) was maintained by individualized doses of warfarin. The ratio of the least squares mean of prothrombin time and INR was 0.989 (90% confidence interval [CI], 0.955-1.023) and 0.993 (0.956-1.209), respectively (test: warfarin + pitavastatin; reference: warfarin only). The geometric mean ratios of C(max) and AUC were 1.034 (90% CI, 0.994-1.075) and 1.066 (1.035-1.099), respectively, for R-warfarin and 1.033 (0.995-1.073) and 1.058 (1.026-1.092), respectively, for S-warfarin. Warfarin pharmacodynamic profiles and pharmacokinetic profiles did not differ between the warfarin monotherapy and the coadministration of pitavastatin and warfarin. No drug-drug interaction between pitavastatin and warfarin was demonstrated.